The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aide, physical therapy, occupational therapy, or social work services. The review indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment of the care recipient is severe or caregiver burden is high. Implications for social work practice and research are discussed.

This article reviews the literature on the relationships between gay men with AIDS and their families of origin to determine why the family is not a principal source of social support. Several reasons explain the absence of the family from the support network, including the family's lack of acceptance of homosexuality and the relationship with a male partner; the stigma associated with AIDS; the inability of family members to communicate openly about homosexuality and AIDS; the lack of competence among family members in dealing with HIV issues; and overprotective, infantilizing behavior by parents. A sibling, most often a sister, is the family member to whom the gay man with AIDS feels closest and from whom he is most likely to seek support. Implications for practice and research are discussed.

Eighty social workers working with elderly patients in 36 acute care hospitals provided information about their overall job satisfaction as discharge planners and identified sources of satisfaction and dissatisfaction in their jobs. Twenty-eight percent were very satisfied and 50 percent somewhat satisfied with their jobs. Sources of satisfaction were the ability to help patients and families, concrete resource provision, job challenge, and autonomy. Dissatisfaction resulted from organizational constraints and lack of support from other health care professionals. Educational and theoretical implications are discussed.

Although home care is one of the fastest growing segments of the health care delivery system, there is little empirical data on the professional functions or ethical concerns of social workers employed in home care. To provide this information 118 social workers in proprietary and nonprofit agencies in one midwestern and one southern state were surveyed. The results indicated that social workers performed a wider array of professional functions with a more diverse population of patients than had been documented previously. Workers experienced ethical concerns related to self-determination, barriers to access of services, implementing advance directives, and assessment of mental competence most often. Workers in proprietary agencies rated the ethical concern of barriers to access of services as occurring significantly more often than workers in nonprofit agencies.

The survey in this article examined several factors related to the frequency and difficulty of resolving four ethical conflicts in a national sample of 364 home health care social workers. Ethical conflicts regarding the assessment of mental competence, self-determination, and access to services were moderately frequent and difficult to resolve, whereas conflicts over implementing advance directives were infrequent and not difficult to resolve. Each ethical conflict involved multiple stakeholders. Multiple regression analyses revealed significant predictors of the frequency and difficulty of resolving the ethical conflicts. Implications for practice and administration in home health care and social work education are discussed.

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Social work educators are confronting new challenges in preparing students for health care practice. Given the changing environment in which health care social workers practice and the changing nature of practice itself, it is surprising that there have been no surveys of health care curricula since the 1980s. This study, which is based on an analysis of the outlines for graduate-level health care practice courses from 53 accredited schools, attempts to determine what students are taught to prepare them for this altered practice environment. Content reflective of current practice issues was infrequently included in course outlines. Implications for social work education and practice are discussed.