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Item What counts as consent? : sexuality and ethical deliberation in residential aged care : final project report 19 November 2020(Massey University, 2020) Henrickson, Mark; Schouten, Vanessa; Cook, Catherine; McDonald, Sandra; Atefi, Narges (Nilo)This report is intended as a summary of the three-year Royal Society Marsden Fund-funded project “What counts as consent: Sexuality and ethical deliberation in residential aged care” (MAU-1723). The project was funded for the period March 2018 to February 2021. The aim of the project is to interrogate and inform conceptualisations of consent in the domain of sexuality and intimacy in residential aged care. The project completed and exceeded all recruitment and participation goals. While there is a general consensus that sexuality is an intrinsic part of human identity, intimacy and sexuality in aged care remain misunderstood and contested issues. This is particularly so in respect of older persons living with dementia. Gender and sexually diverse communities constitute a significant invisible and invisibilised minority in residential aged care (RAC), and that invisibility means their intimacy needs remain largely unknown and unacknowledged. There are cultural issues in aged care unique to New Zealand: for instance, while 85 percent of residential aged care facility (RACF) residents identify as European and an estimated 5.5 percent are Mäori, 44 percent of staff identify as other than European, including 10 percent who identify as Mäori, and 10 percent Pasifika. The dominant position in the theoretical literature on the ethics of sex and intimacy is that consent is of fundamental importance. Consent has dominated not just the theoretical discourse but also public and legal discourses about the ethics of sex and therefore carers and staff make decisions based on the management of institutional risk rather than the wellbeing of the resident. Vulnerabilisation of older persons in order to protect them, however well-intended, effectively robs them of possibilities to exercise self-governance, depersonalises them, and increases their social isolation. How sexual consent in particular is conceptualised has significant ethical implications for the growing number of elders in Aotearoa New Zealand who are living with degrees of cognitive decline. The specific contribution of this project is to interpret how aged care stakeholders (residents, families, and staff) make sense of consent, to contribute substantively to ethical theory around consent, sexuality, and intimacy, and to inform practice and policy in aged care environments. The project interrogates and intends to inform conceptualisations of consent in the domain of sexuality and intimacy in residential aged care. Our goals were: (1) to analyse how people are making decisions in practice about sex and intimacy in aged care; and (2) to use this information to inform the literature on ethical theory and discourses on consent and wellbeing.Item The sexual stories of adults who have lived in out-of-home care as young people : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University, Albany, New Zealand(Massey University, 2019) Vague, Tiffany MelindaYoung people who are in out-of-home care occupy a space in which what is public and what is intimate intersect. Families, sexuality and reproduction are interconnected and subjected to implicit and explicit government regulation. In contemporary liberal societies, the emphasis on parents caring for their children leads to discourses that call into question the worth of children who are not looked after by their parents. In 17th century Europe, these beliefs were associated with moralism; in contemporary New Zealand, these beliefs are associated with neoliberalism. Sexual stories are “simply the narratives of the intimate life, focussed especially around the erotic, the gendered and the relational” Plummer (1995, p. 6). Utilising a narrative methodology, this research involved a series of interviews with ten adults who had spent time in out-of-home care as young people to explore the sexual stories of those who have been in out-of-home care to consider three research questions: firstly, how the public and the intimate converge at the intersection between sexuality and the provision of out-of-home care, secondly, the intersection between experiences of out-of-home care, sexual and romantic relationships, and lastly the meaning that adults who have been in out-of-home care have made of their lives. The responses to these questions were underpinned by the theory of meaning making, which describes “a sophisticated understanding of the relationship between the psychological and the social, between the past and the present, and between emotion and thought” (Kegan, 1982, p. 15). Participants were aware of being positioned as existing outside of dominant social discourses and being perceived as less worthy because they had been in out-of-home care. The stigma associated with being in out-of-home care intersected with sexual stigma that they experienced. Participants actively sought power, agency and inclusion and imagined that if they were to have socially acceptable relationships with socially acceptable partners, they would experience a sense of social inclusion that they had not experienced before. Relationships were made more challenging by the fact that participants had to discover how to have a healthy relationship when they had seen few examples of these in their own lives. Making meaning was more challenging for adult participants who have been in out-of-home care as young people, as not only did they have very complex lives and relationships of which to make meaning, they often lacked relationships with key family members to help them make this meaning. Participants who had made meaning of their experiences in out-of-home care before entering a relationship expressed more satisfaction within their relationships than those who had not made meaning. This research calls into question the neoliberal foundations on which the New Zealand child protection system is predicated but acknowledges that in the immediate future young people will come into out-of-home care. Thus, based on the findings of this research this thesis makes several recommendations to improve that system. The first is a system that promotes better connection between young people in out-of-home care and their caregivers and social workers. The second recommendation is the prioritisation of life-story work with young people in out-of-home care. Both deeper connections and more opportunities for young people in out-of-home care to make meaning of the lives will provide a foundation in which social workers and caregivers are able to engage in meaningful sex and relationship education with the young people that they care for. These changes, as with any development of policy and practice should be informed by the voices of those who are in, or who have been in, out-of-home care.Item Relationships matter : caregiver experience of contact/access planning practice and outcomes for permanency : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work at Massey University, New Zealand(Massey University, 2019) Nielson-Vold, KristinWhen children are removed from parental care and placed out of home it is generally expected that birth family contact will occur. This commitment to birth family contact is based on beliefs about its psychological and emotional importance for children and is protected and enshrined in national and international policy. Literature clearly outlines, however, that birth family contact is one of the most complex and contested areas of practice for social workers and is often difficult for caregivers. This research set out to examine how caregivers in New Zealand experienced social worker practice in relation to contact planning. The aims of this research were to: critically explore caregivers’ experience of social work practice in regards to contact planning for children progressing to their permanent care; and identify processes and practices that were helpful for caregivers, pre-permanency, which supported quality outcomes post-permanency. To achieve these aims, a qualitative approach was utilised involving six semi-structured interviews of seven kin and non-kin caregivers. Research questions included: · How did caregivers’ experience social work practice in regards to contact planning? · What processes and practices were helpful for caregivers to support post-permanency outcomes? · What recommendations do caregivers have to improve quality contact outcomes post- permanency? A rather disheartening picture of social work contact practice emerged with caregiver experiences generally ranging from dissatisfying through to distressing. Several key findings were identified by caregivers in this research including, exclusion from decision-making processes, lack of information, limited support, lack of assessment, and limited relational practice by social workers. The findings of this research echo similar research both in New Zealand and internationally in relation to social work contact practices and the experiences of caregivers. Given this consistency of experience for caregivers, additional factors were examined to help provide explanations for the ongoing issues for caregivers, including organisational practice and culture. Recommendations were made which focused on contact experiences, assessment processes, training, policy, and the importance of relationship, to strengthen practice in this challenging area of work and improve caregiver experiences.Item Piloting a dialectical behavioural therapy-based skills with New Zealand youth in care using three case studies : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Albany, New Zealand(Massey University, 2019) Morton, Lara AnneChildren in care are a complicated and vulnerable population. Youth who live in the care of the State often present with behaviours that are challenging to manage and which leave those around them struggling, whether they are caregivers or peers. Behaviour such as shown by these youth, is commonly thought to be an expression of emotional dysregulation or an attempt to regulate emotions. Dialectical Behavioural Therapy (DBT) is a therapy designed to support clients with extreme emotional dysregulation whose behaviour can be similar to what is observed in youth in care. DBT skills groups as a standalone intervention have been shown to support youth with emotional dysregulation and the resulting behavioural difficulties. The aim of the current research is to understand the experiences of New Zealand youth in care participating in a DBT based skills group. The research uses three case studies to explore each participant’s engagement with the activities and skills individually throughout the eight sessions. This will be done using in-group observations, what they thought and felt about the group and whether staff working with the young people identified any behavioural changes. Preliminary results demonstrated positive engagement with the skills, noted positive change from those working with the young people, as well as positive reports of behavioural change and increased understanding from the participants themselves.Item Nutrition risk in age-related residential care : prevalence and associated factors in adults of advanced age : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2017) Senior, Stacey MarieBackground: The New Zealand population is rapidly ageing. Adults of advanced age (≥85 years) are one of the fastest growing population groups with numbers expected to double by 2036. Increasing longevity is associated with reduced mobility, health loss, cognitive decline, and nutritional vulnerability. This often results in increased care requirements and movement into age-related residential care (ARRC). Overseas research indicates an increased prevalence of malnutrition in ARRC residents. Malnutrition in older adults is associated with increased morbidity and mortality, and consequently increased cost of health care. This study aims to establish the prevalence of nutrition risk and associated factors among adults of advanced age recently admitted to ARRC within the Waitemata District Health Board (WDHB) region of Auckland, New Zealand. Methods: A total of 97 participants aged ≥85 years were recruited within five days of admission to WDHB ARRC facilities. Sociodemographic and health characteristics of participants were determined during a single 60-minute interview. Standardised measures were used to measure body composition, grip strength and gait speed. Nutrition risk was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), dysphagia risk using the 10-Item Eating Assessment Tool (EAT-10) and cognitive status using the Montreal Cognitive Assessment (MoCA). Results: Of the 97 participants (mean age 90.9 ± 3.8 years), half (50.5%) were malnourished, 40.2% at nutrition risk and a third (37.1%) were at dysphagia risk. Malnourished participants were more likely to be ≥90 years (p = 0.019), admitted to ARRC on a permanent basis (p = 0.016), at dysphagia risk (p = 0.015), have a BMI <23 (p = 0.022), lower fat mass (p = 0.005), and fewer comorbidities (p = 0.030). The MNA-SF score was inversely correlated with age (r = -0.225, p = 0.027) and positively correlated with BMI (r = 0.499, p = <0.001) and fat mass (r = 0.765, p = <0.001). Conclusion: A high prevalence of malnutrition and dysphagia risk was discovered within this study population. Residents aged ≥90 years with low BMI are at greatest nutrition risk and are an easily identifiable group. Early screening and intervention is recommended upon admission to ARRC. Key words: Aged, anthropometric measures, deglutition disorders, malnutrition, mini nutritional assessment, rest homeItem A study of families' experiences of assisting a member into residential care : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Nursing at Massey University(Massey University, 1997) Stewart, AnnetteTraditionally the responsibility of caring for an aging relative has fallen upon the family of that person, usually the spouse or the daughter(s). An increase in the state recognised age of retirement, more women returning to or remaining in the workforce, and the tendency of families to be more mobile than in the past, means that the option of being cared for in the community by family members has diminished for some elderly people. Residential care - an umbrella term for retirement homes, hospitals and secure units - provides an alternative for families unable to care for their aged relative(s). Some research has been done on the phenomenon of relocation into residential care from the client's perspective, yet there is a paucity of information about the experience from the point of view of the families involved in this process. This piece of research sets out to address this issue and to hopefully influence the nursing practice of those who work in this area.Item Indigence to independence : the development of social policy in New Zealand for people with learning disabilities : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work at Massey University(Massey University, 1995) Thomson, Janet BeattieThis study traces the development of social policy in New Zealand for people with learning disabilities. The study examines the social influences and the outcomes of past social policies which have shaped the development of an increasingly explicit social policy for disabled people. Integral to this analysis is a consideration of the impact of these policies upon the family. This study suggests that social policy, in establishing services which have moved people with learning disabilities progressively towards independence, has required a concomitant role of the family that has increasingly involved them in the lives of their dependants. Social policy for people whose learning capacity is impaired reflects society's movement towards an understanding of the condition as a "learning disability"1. 1 The terms that recognise an impairment in intellectual functioning are subject to ongoing debate amongst the disabled community. Since this thesis was commenced, the term "intellectual disability" has returned to use alongside "learning disability". The term "intellectual disability" reflects disabled people's intent to have their disability recognised as a valid part of self. The term "learning disability" arises out of the notion of difference, which includes such 'otherness' as impaired intellectual functioning, within its continuum. The term "learning difficulty" extends this continuum further. The forms which recognise an impairment in Intellectual functioning have moved to increasingly positive modes, removing the stigma associated with other labels such as "mentally retarded". The study examines the changes in societal perceptions of learning disabled people which been fundamental in the construction of social policy, partnering changes in philosophies of care that in turn have shaped the nature of service delivery. Notions of deviancy. sickness, difference and partnership underpinned the development of social policy, as it related to people with learning disabilities, from the 1840s. Services to people with learning disabilities have been delivered by both the State and the voluntary sector. The study contrasts the role of the State as a major service provider through the health, education and welfare sectors with the role established by voluntary agencies. A discussion of the development of service provision to people with learning disabilities provides an understanding of the changing relationship between the State and voluntary sectors. Ideologies of 'welfare' underpinned the provision of services through the period of this study and were themselves influenced by the wider political and economic environment. Laissez-faire ideologies in the settlement period of the nineteenth century, fabian socialism in the 1930s and libertarian ideologies in the 1980s are discussed as they relate to the formation of social policy for people with learning disabilities. The State's changing role in providing for the welfare needs of its citizens, including those with learning disabilities, is discussed against this background. The outcomes of past policies have been a major influence in the development of current social policy. Current policies are likely in their own turn to influence the nature of future social policy and services to those with learning disabilities. Some consideration is given to the implications they might hold for families who have dependants with learning disabilities, and for people with learning disabilities themselves.Item Sink or swim : leaving care in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Social Policy at Massey University, Albany, New Zealand(Massey University, 2000) Yates, DeborahThe main purpose of this qualitative study is to highlight the issues for young people who are in out-of-family care at the age of sixteen. It has involved interviews with eight young New Zealanders about their experiences in care, their circumstances when leaving care and, for the seven who had already left care, their ongoing transition to adulthood. In many countries and states overseas the difficulties of young people leaving care have received considerable attention, resulting in legislative change and programme development to ensure ongoing services and support. In contrast, the topic has been overlooked in New Zealand in recent years and most young people leave care on, before or shortly after their seventeenth birthdays, with no follow up services or monitoring. For all but two participants in this study, the point of leaving care coincided with other important steps towards independence, such as independent living circumstances and independent financial management. This placed enormous demands on their coping abilities and limited life skills. Since leaving care only two had been in continuous fulltime work and only three progressed with their studies. Most had moved frequently after leaving care, one was homeless, one was a single mother in supported accommodation and one was awaiting a possible jail sentence. Relationships with family were mostly very poor. Four of the participants had significant psychosocial disorders and very little secondary schooling and their level of risk was acutely heightened on leaving care, two struggling with long-term substance problems and at least three with depression. There were, however, two examples of well managed and empowering discharge processes, one to permanence and one to independence. Most participants readily expressed appreciation of positive aspects of the care experience and were quick to defend the commitment and efforts of caregivers and social workers working under difficult conditions. The findings raise issues about adherence to the care and protection principles of the Children, Young Persons and their Families Act 1989 and compliance with the United Nations Convention on the Rights of the Child. The Act's guardianship provisions to the age of twenty provide scope for policy and practice development in this area.Item Involving family members of people with dementia in the music therapy process at a residential care facility : an exegesis presented in partial fulfilment of the requirements for the degree of Master of Music Therapy at Massey University, Wellington Campus, New Zealand(Massey University, 2012) Dennis, PatriceThe therapeutic use of music with older adults with dementia is widely documented, and family involvement is encouraged in both music therapy practice and dementia care services. This qualitative study explores and describes the experience of a student music therapist involving the family members of people with dementia in the music therapy process in a residential care facility. Grounded theory methodology informed analysis of the data sources. Secondary data was analysed and a theoretical perspective regarding family involvement in the music therapy process in this setting was developed. The findings are presented in main categories consisting of: building relationships, sharing information, unplanned family involvement in music therapy sessions, flexibility, spontaneity, joy and humour, and negotiation of the music therapist role in the community of the facility. The emergent theoretical perspective suggests that involving family members in the music therapy process in residential care facility is valuable in fostering and strengthening a sense of community between residents, family members and care staff.