New Developments in Home Care Services for the Elderly: Innovations in Policy, Program, and Practice

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And she couldn't take him to work with her. In desperation, Luz persuaded her cousin to continue babysitting for a few more days, and decided to talk to her boss, the housekeeping supervisor. When she explained the situation, he looked serious. Luz was in tears now. She went to the Board last month, and they've decided to start a day care center at the hospital for employees' children - it's already in the works.

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They were going to announce it next week. That will mean a big increase in salary, and should be enough so that you can get child care until the hospital day care center opens. In Luz's fictional case, the problem was solved, and she was able to continue working. For a lot of real people, however, situations like this are not easily resolved. The chances are that, at many hospitals or other places of business, Luz would have either had to quit, and perhaps end up on welfare, or to somehow find enough money to pay for child care. The fact that her employer had decided to institute a family-friendly solution to a problem common to many employees made all the difference.

Family-friendly workplaces and a family-friendly society are goals for a healthy community. In this section, we'll discuss what family-friendly can mean, look at why it's a benefit for everyone involved, and explore how it can be promoted as policy in business and government. There are really two definitions to the term "family-friendly" in this section.

One has to do with the operation of the workplace, the other with government policies that affect that operation:. A family-friendly workplace or employer is one whose policies make it possible for employees to more easily balance family and work, and to fulfill both their family and work obligations. While this definition often applies to government, a major employer, as well, government has another function in promoting family-friendly policies. Many of the family-friendly policies of government are those laws, regulations, and social policies that recognize the importance of families to society, and act to meet, directly or indirectly, the needs of children, parents, disabled family members, and the oldest generation.

Family-friendly workplace policies can take many forms. The on-site day care that we talked about in the introductory example is perhaps the one that many people think of first, because it's so clearly family-friendly. What could be more directly aimed at the needs of working parents and their children than day care that is convenient and secure, allows parents to be there instantly if something is wrong, and provides a high quality experience for the child?

If, as is often the case, in-house day care is free to the employee, that's frosting on the cake.

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In-house day care, especially free in-house day care, is hardly the most common of family-friendly policies, however. It's almost entirely restricted to large companies or institutions or places where day care teachers are trained , because it's expensive, and requires permits and licensed facilities and staff. There are, however, a large number of other policies, many of which can be adopted even by small, mom-and-pop businesses, that help employees to balance work and family. Some are directly aimed toward family-friendly outcomes, while others may be only incidentally family-friendly.

In either case, they make a workplace a better place to work. Some possible family-friendly workplace policies:. Telecommuting is generally possible only where the employee's work can be done independently, and where the work computer programming, for instance, or writing can be translated to computer or print. The exception to this is the type of job often advertised in the classifieds - "Work at home!

Simple assembly. The employee also has to be trusted to work efficiently and independently. The U. The guarantee is that, if you take such a leave, your job - and your seniority - will be waiting for you when you return. There are really two ways that government can be family-friendly.

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The first is to institute family-friendly policies, like those described above for other workplaces, for its own employees. The other way that government at any level can be family-friendly is to encourage - by laws or other methods - family-friendly policies in business and public life in general. Some of the ways it might accomplish this purpose include:.

The government of the United Kingdom, for instance, funds studies supporting family-friendly workplace policies, helps businesses and organizations construct such policies, and engages in other activities supportive of family-friendliness. Although it doesn't mandate family-friendly policies and practices, it makes its position clear, employs family-friendly policies in its own branches, and encourages employers to do the same.

Family-friendly policies are, in general, part of a win-win situation: everyone involved benefits from them. They're good for children, parents, and elders; they are in the best interest of employers; and, in the long run, they benefit communities and the society in general. Some of the specific reasons why family-friendly policies are worth striving for:. Having more time with their children helps parents bond with babies, strengthens family bonds in general, and aids children's learning.

It leads to better parenting, because it allows parents to interact with their children without the burden of guilt over not spending enough time with them or the stress of time pressure I really should be working on that report; I have to leave for a meeting. An argument can be made that, by reducing stress around the issue of parenting, family-friendly policies make it possible for parents to see their children as a pleasure as well as a responsibility, This reduces the potential for child abuse and increases the potential for close relationships among spouses as well as among parents and children and positive results for children as they grow.

There are other child-friendly results to some specific family-friendly policies. On-site day care, for instance, takes the guesswork out of child care placements, because the parent can see what she's getting. If the situation is a good one, then quality day care is assured. Flexible parental leave time allows parents to participate in their children's lives.

They can be at the soccer games and theater performances that are so important, particularly to younger children. All of this contributes to peace of mind for everyone, and means when parents are at work, they can concentrate on work without being distracted by the demands of family. Studies show that a certain amount of controlled stress can be productive, but too much can be a killer. Whether an employee's family responsibilities involve children, an ill spouse, a frail elder, or his own health, policies that make it easier to balance work and family will make his life more manageable.

Keeping stress at a reasonable level helps maintain health and contributes to healing, and increases the amount of energy the employee can give to both work and family obligations. Several studies have shown that it's control, even more than stress, that influences employees' health and their feelings about their jobs. A high-stress job is not necessarily a problem as long as the employee also has a good deal of control over what she does.

Those with high stress and very little control in their jobs, however, are most at risk for stress-related illnesses, and for leaving their jobs. Studies in both the U.

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A article in Business Week magazine cites a number of companies where a switch to a family-friendly workplace resulted in increased productivity and profits. Knowing that family obligations are taken care of, and knowing that their work time is more limited, make it possible for employees to concentrate more fully on their work.

The more families are able to flourish economically, the better it is for society, as well as for the families themselves. The Business Week article cited above, as well as a number of studies demonstrate a relationship between family-friendly policies and employee retention. By keeping people for long periods, employers reduce training costs and avoid losing the knowledge and experience that walk out the door with any veteran employee.

Those who have taken advantage of a leave policy to tend to a dying parent or a chronically ill spouse, for instance, often feel they owe their employers something for being responsive to their situations. In many cases, existing family-friendly policies still aren't fair enough. Often, such options as flex time and job sharing are offered only to managerial-level or white-collar workers, leaving those in lower-paying and less satisfying jobs with fewer resources, when they are often the ones who most need them.

As family-friendly policies become more common, more attention has to be paid to this issue. Who is in the best position to champion family-friendly policies with employers, government, and the public? The answers are probably somewhat different for each audience, but there are groups or individuals who may be more effective than others. Business people. Members of the business community have a number of advantages in promoting family-friendly policies. Politicians and other policy makers.

These folks also have some built-in advantages, in some ways similar to those of business people. People affected by family-friendly policies, or those affiliated with them. These may include:. Key individuals in the community. Every community has a few people - or sometimes more than a few - who have a lot of influence with others. They may be some of the other people referred to here, or may be leaders in other ways - clergy, citizen activists, respected former officials or longtime pillars of the community, or simply ordinary community members whose integrity and intelligence and fairness have made them opinion leaders.

More often than not, if you can get a few of these folks on your side, things will happen. The media. It's always important to have the media on your side, but it's even better if they decide to take up the cause. If you can convince a newspaper or TV station to sponsor the idea of family-friendly policies, you can at least be certain that people will hear about it and its advantages.

A broad-based coalition. As with all policy change, a coalition that includes as many of the above groups and individuals as possible is probably the ideal promoter. If everyone's represented, there's high credibility, and the ideas are likely to penetrate all segments of the community. There's also a much better chance that what the group proposes will be accepted as their own by a majority of the community.

The simple answer to this question is "When they're needed," which is whenever they're not readily available to all workers and citizens. There are some times, however, when your efforts might be particularly fruitful. In many cases, for either employers or government, the adoption of family-friendly policies is more than a simple decision to do things one way as opposed to another. It involves a change in perception about the nature of a workplace or community, and about what's important for businesses, other employers, and society.

For that reason, promoting family-friendly policies may take time and careful thought. The following series of steps takes that into account. Your success may depend on the issue you choose to address first, and the setting and scale in which you address it a single workplace? You're not going to change a workplace or a community overnight, and you're not going to persuade either one to change everything at once.

What's a good first step toward a totally family-friendly environment? You might find different preferences for different folks: white collar workers might value flex-time, while blue collar workers might want child care. You should aim for fairness in what you propose: what's the greatest benefit for everyone? Based on your research, you should try to come up with a clear, well-defined goal.

What do you want to have happen where, and by when? The ideal is to start with something that will have a real impact, but that isn't so ambitious that it's impossible - or impossibly expensive - to achieve. If child care seems to be the major need, for instance, you may want to start with a small employer subsidy for child care costs, or an arrangement whereby people could bring their kids to work when circumstances dictate. Starting out by demanding free child care for all may doom your effort at the start. This isn't to say that you can't raise the idea, and give examples of other employers or communities that have provided child care see below.

In general, though, the way to profound and lasting social change - and that's what we're talking about here - is one reachable goal at a time. Trying to cross the bridge in one leap can actually slow you down over the long term. Especially if there is to be a public debate about the issue of family-friendly policies, you need to have not only ideas, but facts at the tip of your tongue. Some of the areas you should research:. Your research might include searching libraries and the Internet, talking to people who've had direct experience with the issue - local officials, human resource directors, union activists, employees, etc.

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Gathering examples of family-friendly policies that have worked elsewhere can help you in several ways. As examples, they'll establish that such policies exist; they'll answer arguments that such policies cost too much or don't work; and they'll give you ideas for creating your own family-friendly policies or programs.

Your effort is far more likely to be successful if you know what you're talking about, and have answers to the objections of opponents or skeptics. Assessed the local cost savings resulting from community water fluoridation, given current exposure levels to other fluoride sources. Geographic variation in Medicaid claims for dental procedures in NYS: role of fluoridation under contemporary conditions.

Pub Health Rep. Study examined whether the number of claims reimbursed for caries-related procedures for children in the NYS Medicaid program varied by county fluoridation coverage. Discovered that Medicaid enrollees in less-fluoridated counties needed 33 percent more fillings, root canals, and extractions than those in counties where fluoridated water was more prevalent.

Water Fluoridation in NYS Manual Materials, resources, fact sheets, articles, and official policy statements on the topic of water fluoridation. Return to top of page Goal 2 Action Plan Dashboard : Reduce potential public health risks associated with drinking water and recreational water. Utilize tools to conduct sanitary surveys and monitor water quality at regulated beaches. Beach Sanitary Survey Guidance EPA developed a beach sanitary survey tool — one each for marine and Great Lakes beach — to help beach managers evaluate all contributing beach and watershed information, including data on water quality, pollution source and land use.

The tool consists of three types of beach sanitary surveys in paper and electronic form. Distribute outreach materials for proper maintenance and operation of waste disposal systems for protection of recreational water from contamination. Septic System Operations and Maintenance Overview of how septic systems operate and how they should be maintained. Enforce standards for proper design, location and operation of sewage disposal systems. Identify resources to support beach assessments and a water quality monitoring program by State district offices and local health departments.

Federal Clearinghouse for Grants Includes grants available to support beach assessments and water quality monitoring. Provide NYSDOH with sanitary survey and water quality monitoring data for regulated beaches to inform decision-making. US EPA. Best Management Practices for Private Water Systems Brochure summarizes the proper maintenance of private water wells. Drinking Water from Household Wells General information about drinking water from home wells also considered private drinking water sources.

Describes types of activities that can create threats to a water supply, as well as problems to look for and offers maintenance suggestions. Sources for more information and help are listed. Provide education to elected officials on the importance and need for asset management at community water systems to ensure the long-term sustainability of the systems infrastructure.

Asset Management Best Practice Guide Intended for owners, managers and operators of water systems, local officials, technical assistance providers, and State personnel about how to best manage local water systems. Bridging the Gap: An Educational Primer on Sustainable Water Infrastructure Asset Management Web site synthesizes initiatives to develop an educational primer for water and wastewater utility infrastructure asset management. Asset Management for Local Officials Fact sheet provides information for local officials on the basics of asset management and the vital role local officials have in successfully implementing an asset management program.

Develop or enhance scientific curricula for primary and secondary school science classes on long-term impacts of, and adaptation to, climate change. Global Climate Change Resources Subscription required Listings of the best available student and educators resources related to global climate change, including NASA products. Stanford University Climate Change Education Curriculum Integrates concepts from the earth, life, and physical sciences as well as the most current data on climate systems to help students understand the phenomena of climate change, the justification for these phenomena, and why they are scientifically and socially important.

Support infrastructure upgrades through funding mechanisms, such as the Drinking Water State Revolving Fund, and identify additional mechanisms to create fiscal incentives for local governments to update aging infrastructure. How to Upgrade and Maintain Our Nation's Wastewater and Drinking-Water Infrastructure Report details water infrastructure problems, explains the authority structure for these systems, and argues why projected funding levels are insufficient.

Commonsense reforms to help address the systems' failures are promoted. Website contains implementation guidance and a tool to compare financing alternatives. Promote better land use practices across all sectors.

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Smart Growth State Department of Environmental Conservation web site that describes tools to promote the principles of Smart Growth and initiatives underway in the state. Watershed Management for Potable Water Supply: Assessing the New York City Strategy Free electronic download with site registration Lays out how and why New York City's watershed agreement can be a good template for proactive watershed management that, if properly implemented, will maintain high water quality. Return to top of page Focus Area 3: Built Environment Goal 1 Action Plan Dashboard : Improve the design and maintenance of the built environment to promote healthy lifestyles, sustainability and adaption to climate change.

Smart Growth Public Infrastructure Policy Act Smart Growth is sensible, planned growth that integrates economic development and job creation with community quality-of-life by preserving the built and natural environments. Information on NYS Complete Streets Law Law presents an opportunity to expand programs and collaborate with bicyclists, pedestrians, people with disabilities and others to identify best practices and designs for transportation facilities.

Website includes resources for planning, funding, and design. US EPA Smart Growth program - EPA provides resources and case studies to help communities grow in ways that expand economic opportunities and protect the health and environment. Smart Growth Self-Assessment for Rural Communities: Madison County, New York Developed in collaboration with EPA, this tool helps local governments evaluate how well their policies and regulations support the type of development they want and identify strategies for improvement.

NYS Department of State's Office of Planning and Development advances progressive land use solutions, community-based development and building standards to increase resilience and sustainable growth. Through partnerships, grants and other tools, OPD provides assistance for Brownfield redevelopment, waterfront and downtown revitalization efforts, and Regional Economic Development Councils.

Program facilitates community redevelopment planning and their resilience. Promote progressive codes and incentives for 'green buildings.

New Developments in Home Care Services for the Elderly Innovations in Policy, Program, and Practice

The plans focus on three components of a disaster: preparedness, initial response and recovery. These plans can be used to prepare for emergencies in other areas of the state. Provide accessible, neighborhood cooling centers. New York City Cooling Centers A cooling center is a facility, such as a senior center or community center, where people may go for air-conditioned comfort during a heat emergency.

New York State Cooling Centers Cooling centers are facilities where you can go to cool off during extreme heat. The New York State Department of Health collected information about seasonal cooling centers from local health departments and emergency management offices. Conduct school, workplace and community-based physical education programs. Communities Putting Prevention to Work Locally driven initiative supporting 50 communities to tackle obesity and tobacco use — two leading preventable causes of death and disability in the United States.

School Health Guidelines to Promote Healthy Eating and Physical Activity CDC-synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in nine guidelines. Each one is accompanied by implementation strategies to help schools implement each guideline.

CDC cross-cutting programs to prevent and control chronic diseases and improve community health Develop targeted education and outreach materials to key audiences, such as clinicians, teachers, employers, property owners, local planning and zoning boards on the impact of the built environment on health. Materials should include intensive strategies for vulnerable populations e. CDC's Division of Community Health programs fund community-based activities to prevent and control chronic diseases.

CDC's Healthy Places website provides informational resources and tools for promoting health though healthy community design. Broadly support efforts to mitigate and adapt to climate change by reducing carbon-based energy use. NYS Rideshare NY Rideshare is New York's home for ride-matching, commuter and traveler services for individuals who are seeking enhanced mobility options.

It works with commuters, travelers and employers to make ridesharing an easy, affordable and appealing alternative to driving alone. Climate Smart Community Program NYSDEC program is an state-local partnership to reduce greenhouse gas emissions, save taxpayer dollars and advance community goals for health and safety, economic vitality, energy independence and quality of life.

Make space available for and support the development of community gardens, especially in low income urban communities. Starting a Community Garden Fact sheet designed to give groups basic information to get a gardening project off the ground. Cornell's Integrated Pest Management develops sustainable ways to manage pests in ways to minimize environmental and health effects.

Construct and maintain safe sidewalks, bike lanes, recreational facilities, parks and other amenities, especially in low-income communities. The Built Environment and Health: 11 Profiles of Neighborhood Transformation Highlights neighborhood-level changes to the built environment that can have a positive influence on the health of community residents, especially in low-income communities. These profiles demonstrate how health practitioners, community members and many others can work together to improve community well-being by making changes to the built environment.

Designing and Building Healthy Places Web site lays out several ways public health personnel and community design decision makers can collaborate to improve the health of a community. Surgeon General's Call to Action to promote walkable communities. New York's State Environmental Quality Review Act Requires all state and local government agencies to consider environmental impacts equally with social and economic factors during discretionary decision-making.

Site also provides links to technical information and support. Provide incentives for Brownfield Opportunity Areas. Brownfield Redevelopment Toolbox: A Guide to Assist Communities in Redeveloping NYS's Brownfields Toolbox designed to explain the cleanup and redevelopment of brownfields in straightforward terms and provide a systematic, start-to-finish guide to cleanup and redevelopment. Return to top of page Goal 2 Action Plan Dashboard : Improve the design and maintenance of home environments to promote health and reduce related illness.

Disseminate or develop, if needed targeted educational programs and materials about exposures, health risks and effective control strategies for hazards in homes, schools and other indoor environments.

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Seven Tips for a Healthy Home Tips for ensuring a safe and healthy home. NYS Environmental Health Information Numerous topics related to health and safety in the home, workplace and outdoors. CDC Environmental Health Information on healthy homes, air quality, asthma, lead, fire prevention and more. National Center for Healthy Housing Report describes housing interventions and their impact on health status. Managing Asthma in the School Environment Materials for schools on creating and maintaining an asthma-friendly environment.

Support educational efforts aimed at primary care providers to assess risks, screen patients, take environmental histories and provide follow-up treatment, using relevant guidelines e. ATSDR: Taking Exposure Histories Educational case study is one in a series of self-instructional publications designed to increase primary care providers' knowledge about hazardous substances in the environment and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients.

Diagnosing CO Poisoning Issue of Emergency Medicine Practice covers the epidemiology, pathophysiology, diagnosis and management of carbon monoxide poisoning in the general population and special groups. Enhance mechanisms, and increase resources for, referrals to support services. NYS Healthy Neighborhoods Program Program seeks to reduce the burden of housing-related illness and injury through a holistic approach.

Provides in-home assessments and interventions for asthma, tobacco cessation, indoor air quality, lead, fire safety and other environmental health hazards in selected communities throughout NYS.


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Breathe Easy at Home Boston-based model program developed to ensure that initial and follow-up inspections are performed quickly to resolve substandard conditions. Incorporate 'Healthy Homes' education and inspections into other non-health 'opportunity points. CDC Healthy Housing Inspection Protocol Model reference tool for local jurisdictions or others to use that can improve the effectiveness and efficiency of the public health and housing management workforces that identify, prevent and control health problems associated with housing.

Implement the Medicaid Redesign Team recommendations to provide home assessments e. Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan In-home environmental public health program where program staff assessed homes for asthma triggers and subsequently provided products and services to reduce exposures to cockroaches, dust mites, mold, tobacco smoke and other triggers.

Investing in Best Practices for Asthma: A Business Case Identifies best practices and policies in asthma funding and reimbursement which foster excellence in environmental and clinical asthma management. Boston Children's Hospital Community Asthma Initiative Initiative developed to help improve the health and quality of life of children with asthma and their families and can serve as a model.

EPA Asthma Program EPA provides resources and information for physicians and healthcare plan administrators to establish home visit programs. The programs are proven to be effective in improving overall quality of life and productivity by improving asthma symptoms and reducing the number of school days missed due to asthma. It offers step-by-step instructions on how to implement an asthma home visit program with a particular emphasis on environmental risk factor management. NYS Healthy Neighborhoods Program Seeks to reduce the burden of housing-related illness and injury through a holistic approach.

Program provides in-home assessments and interventions for asthma, tobacco cessation, indoor air quality, lead, fire safety and other environmental health hazards in selected communities throughout NYS. Encourage safe home and building renovations and modifications such as weatherization, carbon monoxide alarms, smoke detectors, fire alarms, and other safety mechanisms.

NYS Weatherization Assistance Program helps reduce heating and cooling costs for income-eligible families. USDA grant to improve rural housing conditions The Very Low-Income Housing Repair Program provides loans and grants to very low-income homeowners to repair, improve or modernize their dwellings, or to remove health and safety hazards.

North Carolina program for home rehabilitation Example of a program that helps low-income homeowners who need urgent repairs, accessibility modifications, comprehensive rehabilitation or energy-related home improvements by providing funds to local governments and nonprofit organizations which provide these services. Guide details the NYS regulations that schools must follow during renovation and construction to protect children and adults from hazards. Parents or others who care about the health and safety of children must be informed about the law and vigilant about its implementation.

Provides guidance to homeowners and occupants so that each may learn to properly address lead-based paint hazards associated with renovation, repair and painting activities. Maryland renovation guidelines Information can help project managers and site inspectors identify construction hazards and facilitate inter-departmental communications. Providence, R. Fact sheets or individual points on the fact sheets may be used with attribution.


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Conduct activities and programs that provide clean energy sources in homes, schools and other buildings e. NYSERDA provides resources for improving energy efficiency, clean energy and financing options for homes, businesses, and schools. NYS Solar Power Initiative NY-Sun This initiative brings together and expands existing programs administered by the NY-Sun facilitates installation of solar systems to support clean energy in our communities and create a robust solar industry in New York.

NYS Collaborative for High Performance Schools Provides a framework that helps school districts and their design teams build sustainable school buildings that enhance the educational environment and facilitate learning.



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