Volunteers of America conducted a national survey of directors of 500 organizations providing services to older people with an intellectual disability in order to establish a baseline for assessing current status of end of life care. The questionnaire contained 56 questions. The return rate was 32% (N = 160). Data analysis provided an overview of organizational needs, resource allocations, end of life care services currently provided, obstacles to care, methods for monitoring such care, and existing and recommended strategies for improving this care. Results underscored the needs for practical guidelines and resources, increased staffing and training, and policy-level reduction of obstacles to promote improved end of life care.

More than three-fourths of older adults with developmental disabilities and mental illness live in the community with aging parents, the majority of whom do not complete plans for the residential, financial, and legal future of their offspring. The authors used a true experimental design to evaluate the effectiveness of a six-week psychoeducational group intervention with 27 older mothers. Data collected in pre- and posttest telephone interviews were analyzed with repeated measures MANCOVA to test five hypotheses. Significant multivariate effects were found for mothers' knowledge and awareness about permanency planning, confidence and competence to plan, planning activities, and stage of planning. Findings support use of group interventions with older parents and underscore the need for professional education about planning for adults with special needs.

Ethical dilemmas are an integral part of the practitioner's reality and impact upon the quality of care provided to the resident. The establishment of ethical principles aims to guide the worker through difficult scenarios involving morals, values and beliefs. Often, these precepts contradict one another and are strongly bound to the practitioner's and the resident's standpoints. The ethical principles of beneficence and respect for autonomy pose a conflict in judgment regarding an elderly woman's care in an 816-bed long term care facility. The contributing parties to the conflict are the medical staff, social worker and the resident. The ethical dilemma will be analyzed according to the utilitarian and deontological theories. Resolution to the conflict is offered at the conclusion.

It is estimated that more than 650,000 individuals with intellectual disabilities live with caregivers who are 60 or more years old. As they age, they face end- of- life issues in relation to their caregivers, as well as their own health care needs. This article examines some of the major issues concerning end- of- life care for people with an intellectual disability, presents findings of a recent national survey on end- of- life care vis-á-vis the policy implications, and describes some of the emerging strategies and innovations designed to promote improved end- of- life care.

The article reviews research on the rate of return to work of heart transplant recipients, examines findings associated with return to work and explores the implications of those findings for social work research, practice and policy in heart transplantation programs. Findings of studies reviewed in the article support the conclusion that there are significant sources of variation in recipients' return to work other than surgical outcome. Predictors of return to work include pre-transplant factors as well as social structural factors.