THE STRUCTURE
5.2 The Structure
5.2.3 Admission criteria
now is a national commitment to measure, improve, and maintain quality care for all its citizens (SA DOH, 2000).
they had the baby, I think it will be better I stay elsewhere since I knew it would be stressful for them to look after me and the baby at the same time.
Perceived care giving stress has also been reported by some studies. For example, Buhr, Kuchibhatla and Clipp (2006) conducted one study in which they identified reasons for residential placement and examined the relationship between caregivers and their reasons for placement in RCFs. In that study, the reasons given for admission by the carers were significantly related to characteristics of caregivers and patients, which include care- giving burden and resident's physical and mental disabilities.
Factors that determine the use of residential care have been widely researched. For example, it is well documented that females, whites, and the frail elderly in the United States are more likely to be institutionalized than males, blacks and those elderly who are not frail (Gu, Dupre & Liu, 2007; Ness, Ahmed, & Aronow, 2004). Other studies also show that married persons, and those with a greater number of living children, are less likely to enter residential care than individuals with fewer family care-giving resources (Aykan, 2003; Vida, Monks and Rosier, 2002). In terms of health, functional dependency, cognitive impairment, and other physical ailments are often the leading risk factors for institutionalization (Gaugler, Duval, Anderson & Kane, 2007; Bharucha, Pandav, Shen, Dodge, & Ganguli, 2004; Miller & Weissert, 2000). A review of nearly 80 studies by Miller and Weissert (2000) revealed that age, race, disability, and cognitive functioning were the most robust predictors of institutionalization found in the literature.
The above research findings are consistent with the findings of this study in that the reasons for admission reported were varied among study participants.
In East Asian countries, many old people are not admitted to residential care. The major reason is that filial piety is a commonly practice in those places, whereby frail parents receive care from their children (especially from daughters or daughters-in-law). Filial piety is a regulation that is enshrined in the constitution of East Asian countries that enforces the relationships between parents and children. "Parents are responsible to rear and educate their minor children, and when those children become adults, they are also responsible to support and assist their parents" (Article 49 of the 1982 Constitution of the People's Republic of China in (Chow, 2006). Research in these countries generally show that advanced age, females, the absence of a spouse, being childless andlor having small number of living children, are all strongly associated with the use of residential care (Kim
& Kim, 2004). This trend is consistent with findings of this study in that some residents were residents due to age, separation from their family of origin, childlessness and absence of spouse.
Other reasons reported by the elderly in Case One were severe depression due to the death of a child, exceeding age limit in RCFs and lack of family care giving support. In Case Two, the reasons for admission included death of a primary family support, homelessness and chronic health-related conditions. Other reasons for admission were children living overseas, lack of future caregivers and the desire to live independently away from adult children. The reasons for admission in Case Three were: apprehension about availability of caregivers when old and frail; lack of family support in case of illness; fear of future eventualities related to ageing and availability of nutritional food.
The researcher also observed that the food at that RCF was nutritional; it included a
variety of fruits and vegetables. Dietary variety is one of the most important ways to ensure a balance of nutrients for people of all ages, particularly the elderly (American Dietetic Association (ADA) Reports, 2003). Other studies have shown that the intake of nutrient is positively related to the number of different food consumed (Evans & Crogan, 2006; Bernstein, Clements, Evans, Tucker, Ryan, Nelson, Sing, Fiatarone and O'Neill, 2002). These authors found dietary variety to be associated with biochemical measures of nutritional status, including fewer cases of macro-vascular disease, decreased cardio vascular risk factors and obesity, due to increased consumption of fruits and vegetables.
The above authors further found that consuming inadequate amounts of food may lead to lower pre albumin, poor nutrition status, which was linked to higher death rates in certain residential care.
In Case Four, among the reasons for admission reported were cultural belief and fear of strangers. According to one female participant, the Zulu culture forbids mothers to live in the same house with their married daughters: "You know, we the black people, we do not stay with our children when they are married".
Cultural beliefs and practices play significant role in health perception and health maintenance. Although a general understanding of cultural factors is important, the best source of accurate information about a person's belief and practices is that individual (Wold, 2004). Beliefs influence how health and illness are perceived. Thus, in order to effectively communicate with patients and their families, the nurse must take cultural variations into account.
Other reasons reported for admission to residential care was abuse by domestic workers as reported by one female participant from Case Four.
They had to get servants who were foreign people to take care of me. I cannot stand and I cannot get out, but they will say to me come and stand with me. They used to also go to town during the day when my children were gone to work. They will only return when my daughters are about to come from work. They used to leave me alone, so I decided to come to the nursing home.
Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. It was first described in British scientific journals under the term "granny battering" in 1975 (Baker, 1975; Burston, 1975). But it was the United States Congress that first identified it as a social and political issue followed by discussions in the literature in Eastern and Western countries (Choi & Mayer, 2000; Jamuna, 2003). Later, it was described by the World Health Organization (WHO) (2001 in Krug, 2002) as any violation of human rights and a significant cause of injury, illness, lost productivity, isolation and despair to the elderly.
In South Africa, elder abuse tends to also be a hidden and under-reported issue just like in many societies. There is no available and reliable data on the prevalence of elder abuse, nor any empirical studies on the health consequences and mistreatment of the elderly (Joubert & Bradshaw, 2003/2004). Similarly, relatively scanty knowledge exists on the situation of older persons in sub-Sahara Africa (Ferreira, 2005b; Velkoff & Kowal, 2003). Even though there are unreliable data on elder abuse in South Africa, Halt Elder Abuse Line (HEAL), a toll-free national help-line provides some evidence that elder abuse is widespread throughout this country (Joubert & Lindgren, 2003). Regardless of
its form, abuse is usually a hidden problem since both those abused and the perpetrators frequently feel ashamed and thus hide the incidents from investigators. The findings of this study concur with the literature in that in each of the RCFs, abuse was reported by only one resident.
5.2.4 Human and material resources