Rediscovering the Asylum

Spending a night at a typical big city shelter for the homeless has reminded the author of the massive and regimented environment in institutions that she had mistakenly believed no longer existed after the much acclaimed deinstitutionalization of America. St. Mary\u27s is run by a religious order attempting to provide charitable care in a nondemanding environment. Many demands are made, however. The lack of privacy and respect for individuality inherent in institutional life tends to erode the inmate\u27s very conception of self. It controls their activities, time, and choices, and thus creates barriers to exit. Providing shelter for the homeless just repeats the cycle of ephemeral reforms replete in America\u27s previous approaches to controlling the poor. As a nation we should acknowledge that we are institutionalizing the poor again, as inefficiently and inhumanely as we ever have

Payments to Informal versus Formal Home Care Providers: Policy Divergence Affecting the Elderly and Their Families in Michigan and Illinois

State policies vary widely on paying friends and family rather than home care agencies to care for the elderly. We explore two state programs that exemplify different payment options: Michigan, which pays clients' informal caregivers, and Illinois, which generally pays agencies to provide services. We ask how different payment policies affect clients, specifically exploring program structure (division of labor and bases for need determination) and financing incentives created by Medicaid (centralization, means testing, and quality assurance). These factors shape provider and client preferences, well-being, and assessment of care quality. Comparatively, Illinois's approach favors professionalism, high cost/quality, documentation, and an orientation toward medical and physical needs. It has experienced high worker turnover and less regard for caregiver-client relationships. Michigan's approach favors informality, casual accountability, long-term stability of helping relationships, and respect for client preferences and autonomy. Both approaches offer important client benefits, but state precedents and incentives to administering agencies have shaped their overall directions. The recent rapid growth of the home care industry in Illinois could proscribe a fuller range of provider options. We recommend greater flexibility in considering states' payment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66882/2/10.1177_073346488800700403.pd

A Preliminary Study of Elderly Emergency Service Clients in Chicago and Their Housing-Related Problems

Emergencies to which city agencies respond reveal a connection between homelessness and other housing hardships of the elderly. This study examines a random sample of 125 case records of elderly clients assisted by the Chicago Department of Human Services Emergency Services program between 1984 and 1987. The crises that lead to emergency services, the extent of clients' housing-related problems, and the needs that cluster around shelter placement and other housing related problems are analyzed An extraordinarily broad range of problems and service needs are identified The findings reveal the prevalence of housing problems for the elderly and the relationship between basic needs, patterns of services offered, and certain emergencies, includ ing homelessness. They have implications for improving client services and underscore the importance of ongoing rather than emergency assistance with the elderly. Very old persons without kin who experience crises are at great risk and pose growing dilemmas for urban public agencies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68265/2/10.1177_073346489201100102.pd

State Medicaid Budgeting in Hard Times: Implications for Long-Term Care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74578/1/1540-5850.00782.pd