Abuse, neglect, and mistreatment in the nursing facility are difficult topics, particularly because there is an expectation that dedicated care is being given to vulnerable frail older adults and those with disabilities. Elder abuse is a deliberate act or failure to act that initiates or creates a risk of harm to an older adult. Abuse can be divided into physical abuse, sexual abuse, domestic abuse, psychological abuse, financial abuse, and neglect. The abuse often occurs at the hands of a caregiver or a person whom the elder trusts. All social workers, along with all other members of the nursing facility team, are generally considered mandated reporters. In all states, licensed social workers are required to report suspected or actual abuse, neglect, or mistreatment. Reporting abuse does not mean that the social worker is liable for its occurrence nor true verification of its occurrence. It is valuable for the social worker to be familiar with the definitions of abuse and to carefully review their facility’s policy defining abuse, neglect, and mistreatment and their particular policy of the mandatory reporting law. Policies can vary from facility to facility, and the social worker should not assume that every facility, even in the same state or region, handles these issues in the same manner.

Families have existed in every culture and are a primary cornerstone of every human society. This chapter examines families as a matrix of relationships that exist across multiple generations and over many decades. It highlights how unprecedented reductions in mortality, morbidity, and fertility in the last century–the same changes that have created aging societies–have transformed family structures and what that means for the presence, duration, and nature of family relationships. It also highlights the centrality of the roles of child, parent, spouse, and grandparent in later-life families. The chapter discusses how social norms regulate those relationships, especially norms related to independence and dependence, and obligation and voluntarism, which are also reinforced in laws. It points to tensions between solidarity, conflict, and ambivalence in intergenerational families, and to the critical role of family caregivers in ensuring the well-being of its oldest members.

This chapter considers aging in place both within larger community and societal contexts as well as through description of the unique experiences of older Latinos or Hispanics, African Americans, Asian Americans, Native Americans, and Pacific Islanders. In addition to racial and ethnic status, aging in place may also be influenced by changes in longevity, family demographics, caregiving, and household structures. Most considerations of aging in place emphasize the importance of the fit between the physical environment and the individual to successfully age. The recent addition to the model of the individual life course and historical change now offers a means to recognize three particularly influential components of aging in place relevant for African Americans, Latinos, Asian Americans, Native Americans, and Native Hawaiian/Pacific Islanders: social capital, the impact of the social environment, and acculturation. The characteristics of assisted-living residences or assisted-living facilities vary across the United States.

Arguably, nurses may subconsciously view their role as a private relationship between patients and their families and themselves, the individual nurse. In the same vein, nurses studied nursing in college, not political science or law, alternative pathways that might have indicated an intention to become active in politics. This chapter describes U.S. governmental structures and the policy process. It details points of influence in policy formation. The chapter explores the unique contribution of nurses in policy formation. The chapter develops a learning agenda for enhancing personal political influence. In such cases, identification of additional stakeholders and subsequent coalition building is a valuable way to foster a nursing presence. Finally, nursing involvement in health policy may be focused on health care, but activities directed toward the broader social determinants of health are a worthy contribution as well.

Patients and/or family members often do not understand why patients are discharged from the hospital more quickly than they expect. By understanding patients’ and family members’ concerns about discharges, providers can assess, in advance, the content and interpersonal communication that will be needed to effectively share information and enhance decision making. Health literacy is an important component of effective health communication. Providers must recognize the education level of the patient and/or family member and use language choices that are appropriate for the other communicator’s understanding. In particular, providers should avoid technical jargon, like medical vocabulary or terminology in communication with patients and family members. The provider suggests that perhaps the patient had not taken her hypertensive medication as prescribed. Health care providers, by definition, are part of a unique culture and as such have learned a new language medical terminology.

Risman posits a tension between an individual’s interest in relationship equality and a social system still imbued with gender expectations and assumptions. Given the growing evidence that equality enhances relationship satisfaction and stability, the author’s are interested in what processes or situations help couples move in the direction of greater equality. Couples vary widely in the extent to which gender is central to their family organization, but three fairly distinct patterns emerge: postgender, gender legacy, and traditional. The institutional tensions between gender hierarchy and the ideal of marital equality described in the scholarly literature on family are articulated frequently by couples. Three factors stimulate a move toward equality in couples are awareness of gender issues, dual commitments to family and work, and situational pressures. Traditional couples need help in defining the meaning of relational equality for themselves within external definitions of male and female roles.

Older people are part of interdependent family systems, giving and receiving support of all kinds and performing important functions for their families. In both developing and developed countries, some older adults provide economic support for younger family members. This chapter provides an overview of informal and formal systems of care, with a special emphasis on family caregiving. Understanding who provides what kinds of care, and why, in different cultures is a complicated task because ideas about who should provide a specific type of care are deeply embedded in each culture. How deeply those values are held and how powerfully they can be challenged by shifting economic and demographic change is a question that is considered implicitly throughout this chapter. The chapter begins, however, by considering why caregiving is such a crucial issue for both families and societies—the stress and burden it places on the caregiver.