Implementing public policies and services in rural Japan: issues and problems

While the sharply increased services for the elderly in the revised Gold Plan--announced in 1994--are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Implementing Public Policies and Services in Rural Japan

While the sharply increased services for the elderly in the revised Gold Plan-announced in 1994-are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Rural Area Agencies on aging: An overview of activities and policy issues

This article presents an overview of the nature and service activities of rural Area Agencies (AAAs) with data from a recently completed national survey. Compared to their urban counterparts rural AAAs serve much larger, more sparsely populated areas with poorer and older elderly populations; have much smaller budgets and staffs; and support fewer services. This leads to a clear rural disadvantage in resources and services for the elderly. Policy makers need to examine and address factors identified as associated with this rural-urban inequity including SUA intrastate funding formulas, “rural” service models and training needs, and regulations regarding direct service provision. Important research and policy questions in need of further study are also identified.     

Older rural women as recipients and providers of social support

The literature on serving the rural elderly has focused on rural elders primarily as passive recipients of care. This article views rural older women as active manipulators of the social support system within which they meet their perceived needs and the needs of others in their social network. It is based on the findings of a multi-phase qualitative study of 30 older women in central Minnesota. Data were collected through life history interviews, in-depth structured interviews, observation and network analysis profiles. The informants relationships with family, friends, neighbors and formal service providers are discussed. Implications for formal service delivery to rural elders are explored.     

Mr. Franks refuses surgery Cognition and values in competency determination in complex cases

The evaluation of medical decision-making competency is challenging and subject to low reliability for many reasons including petentially different life perspectives and cognitive processes between evaluators and patients, but especially because of the difficulties in defining and determining “competency” in complex cases. In this article, the case of an elderly man who is refusing surgery is presented to illustrate such difficulties. In these situations, the evaluator can assess both specific decisional tasks and personal values relevant to health care. Instruments designed to assess such specific decision-making abilities and values have benefits and limitations.     

Community Based Rural Health Care in India

SUMMARY

India is a large country, geographically as well as popula-tionwise. The majority of its population lives in rural areas, i.e., villages. Again, most of the villages are in remote areas. The State has been making sincere efforts to make the basic social services accessible to all in the rural area. Health being one of the vital services, it has been a challenging task before the State to extend it to the remote rural areas, many of which are not yet connected by motorable roads. As a result of various experiments carried out over the last five decades, the State has developed a fairly well-designed primary health care service, and it is in operation in rural areas. However, there appears to be a striking gap between the delivery of health services in rural areas and utilization of the services by the people. Attempts have been made in this article to apprise the readers of the health service system in India, and it discusses the issue of health service delivery at the village level. The discussion is based on a small study carried out in a rural area in the State of West Bengal (India) where students of social work of the University to which the author belongs are placed for field work. Following the inputs received through supervision of the students' work, the study was initiated and conducted.

This article based on the study seeks to focus on peoples' perception of the health services as provided by the State in rural areas, which in turn gets reflected in the extent to which they utilize the services. Social workers being an integral part of the health set up, their role bears special significance. Discussion, therefore, centres on scope for social work intervention at the community level as well as in institutional level of the health service delivery system to make the services meaningful and effective in rural areas. In fact, it has to take the leadership role in reforming the service delivery system when required.     

Telemedicine,rural elderly,and policy issues

Historically, rural America has had a difficult time providing health care to its residents, particularly its frail elderly population. Rural health care is often faced with a shortage of health care specialists, facilities with inferior equipment, and insufficient resources compared to health care in more urban areas. It is anticipated that the use of telemedicine will help address many of the problems facing the delivery of health care services to rural elderly. This paper reviews some innovative projects delivering services to the elderly. Also, the paper discusses several issues that need to be addressed before telemedicine can reach its full potential in improving access to health care, including reimbursement policies, patient and provider liability and confidentiality, and the infrastructure supporting telemedicine. Although telecommunications has tremendous potential to address the care needs of frail isolated elderly, without comprehensive reimbursement policies, guidelines for ethical conduct of a teleconsultation, acceptable security measures of patient records, and adequate as well as compatible infrastructure, that potential cannot be completely realized.     

Intersecting Contexts: Understanding Rural Utah Veterans’ Experiences with Accessing VA Health Care

Since the passage of the Rural Veterans Care Act of 2006 research has focused on health care provider issues with less attention given to individual and contextual factors that contribute to the remaining service gap. Adopting the health care user's viewpoint, we focus on two questions: How do health care users perceive access to health care, and which contextual factors are relevant to explaining the failure of recent efforts to increase access by rural veterans? We collected detailed data through focus groups and individual interviews involving veterans and knowledgeable community members in four rural areas of Utah. Framing the analysis of interview data using the sociospatial approach reveals key dimensions of several contexts that affect rural veterans’ access to health care: the historical period of military service that influences attitudes toward use of Veterans Administration health care and access to specialists, regulations of regionally and locally organized insurance coverage that affects access to and coordination of health care, and local social aspects of rural communities that inform use of specific health care sources. These dimensions provide new insights into the conditions that contribute to variations in the vulnerability of rural Utah veterans.     

Narratives and self-identity in later life: Two rural American older women

Older adults often draw on memories to construct stories about themselves that help them to retain and validate their self-identities, doing this within the cultural contexts that have shaped their lives. In this paper, we examine the life history narratives of two working class, rural American older women and the ways in which those narratives are similar despite one major difference: one has dementia. In both cases, major themes that are consistent with gender-based, working class, rural American cultural values are dominant, including closeness of family, hard work, ties to the land, and religious faith. In the first case, she reconstructs memories of her life in accordance with dominant cultural and personal values, downplaying the ways in which her experiences were “out of step” with these values. In the second case, her sense of identity remains and is expressed through her co-constructed memories although she is experiencing cognitive loss.     

Nursing in tele-mental health

This article discusses a cooperative project involving an academic health sciences center, a state university, a women's shelter, and a community mental health center in East Texas, a medically underserved, rural region of Texas. The U.S. Department of Commerce provided grant funding to develop a telehealth network to provide an evaluation, referral, and treatment program for victims of domestic violence. Nurses were involved in all phases of the project, from initial conception through development, implementation, and evaluation. The authors concluded that all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery.     

The economic importance of air travel in high-amenity rural areas

The western United States offers a case study on the importance of access to large population centers and their markets, via road and air travel, for economic development. The vast distances between towns and cities in the American West can be a detriment to business, yet they also serve to attract technology and knowledge-based workers seeking to live in a picturesque setting. In spite of the increasing importance of amenities to migration and business location, also needed is access to markets, particularly via commercial air service. We test a new county classification system for the western United States to reflect differing degrees of access to population centers and account for the increasing importance of airports. Past classifications are based on population size and cross-county commuting. We examine the validity of this new classification and test for differences in economic performance among the three county types. Our findings show that there are three distinct Wests that can be classified using economic performance measures and socioeconomic characteristics. The results show that “metro” and “isolated” counties are clearly distinct, but “connected” counties, those that are rural in nature but have ready access to metropolitan areas via air travel, can be difficult to distinguish from “metro” and “isolated” counties. Much of the variation is explained by travel distance to airports. The findings illustrate the importance of airports in rural development, and the limitations facing those communities that are isolated from markets and population centers. The results apply to other parts of the world with similar characteristics that include large expanses of open space, natural amenities that attract migrants and stimulate new business, and different degrees of access to large population centers via road or air travel, and therefore different rates of economic growth.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

Age Concerns

Summary

Age Concerns is a proprietary care management firm serving the elderly. Established in 1982, the firm has prospered by employing an integrated model of care whereby the caregivers are employees of Age Concerns. In addition, the firm's ability to keep the elderly at home, out of institutional care, has resonated with consumers. Various features of Age Concernsorganizational format, characteristics of consumers, and economic considerationsare described. In 2001, Age Concerns was acquired by the Senior Care Action Network, a social health maintenance organization. In an increasingly commercial environment in which the elderly are a burgeoning market, Age Concerns may be a prototype of future elder-care service delivery.     

Age concerns: innovation through care management

Age Concerns is a proprietary care management firm serving the elderly. Established in 1982, the firm has prospered by employing an integrated model of care whereby the caregivers are employees of Age Concerns. In addition, the firm's ability to keep the elderly at home, out of institutional care, has resonated with consumers. Various features of Age Concerns--organizational format, characteristics of consumers, and economic considerations-are described. In 2001, Age Concerns was acquired by the Senior Care Action Network, a social health maintenance organization. In an increasingly commercial environment in which the elderly are a burgeoning market, Age Concerns may be a prototype of future elder-care service delivery.     

The risk climate and the delivery of child welfare services

The community is conceptualized as a “risk climate” in which the traditional child welfare services such as own-home services, foster placement, adoption and institutionalization are delivered. The community generates incidence of child welfare cases through the pressure of conditions, and affects prevalence by the extent of its response. Any method of allocating scarce resources should take variations in the risk climate into account in order to put resources where the problem is. This report presents an effort to achieve such a procedure through (1) a literature review to isolate variables related to child welfare service delivery; (2) a report of zero order relationships between these variables and outcome measures; and (3) the use of a multiple regression analysis to develop predictive procedures. The process developed is put forward as an equitable way of distributing scarce resources.     

The Evolution of the System of Care for the Aged in Denmark

In Denmark, formal services are viewed as a right to be used by any member of hat society who is in need of assistance, premised upon a societal model of mutual self-help. The focus here is on the dual themes of philosophical consistency and of transition in the formal system of services and delivery of care in Denmark. Denmark's system centers on meeting the basic needs of the elderly while enabling individuals to retain control over decisions regarding their own lives. It was effective during the economically expansive period of the 1960s and 1970s, but became less effective during the 1980s. Because of the economic necessity of cutting back on budgels, the national government has in fact attempted to define and redirect available choices in service delivery. The dual themes of consistency and dynamism are demonstrated through the case of a rural municipality northwest Jutland during the prosperous period into the more economically limited period of the last decade and the present. Implications for informal social support and relationships between the aged and their families, friends, and neighbors in Denmark are explored.     

Factors Affecting Subjective Weil-Being for Rural Elderly Individuals

Abstract

A cross-sectional survey design was used to examine the relationships between spirituality, religiousness, social support, and the subjective well-being in a sample of 215 elderly individuals in the rural counties of West Virginia and North Carolina. The Brief Multidimensional Measures of Religiousness/Spirituality (BMMRS) was used to measure various domains of religiousness/spirituality, including daily spiritual experiences, values/beliefs, forgiveness, private religious practice, religious/spiritual coping, and religious support. Multivariate analyses found social support was positively related to life satisfaction and spirituality/religiousness was inversely related to depression. These findings provide health/mental health care providers and social workers with information that can increase their awareness of and sensitivity to services or programs that are congruent with religious/spiritual values and beliefs in order to enhance quality of life among rural elderly individuals.     

The evolution of the system of care for the aged in Denmark

In Denmark, formal services are viewed as a right to be used by any member of that society who is in need of assistance, premised upon a societal model of mutual self-help. The focus here is on the dual themes of philosophical consistency and of transition in the formal system of services and delivery of care in Denmark. Denmark's system centers on meeting the basic needs of the elderly while enabling individuals to retain control over decisions regarding their own lives. It was effective during the economically expansive period of the 1960s and 1970s, but became less effective during the 1980s. Because of the economic necessity of cutting back on budgets, the national government has in fact attempted to define and redirect available choices in service delivery. The dual themes of consistency and dynamism are demonstrated through the case of a rural municipality in northwest Jutland during the prosperous period into the more economically limited period of the last decade and the present. Implications for informal social support and relationships between the aged and their families, friends, and neighbors in Denmark are explored.     

生态养老:养老服务中场所性的健康促进策略

老年人口占总人口比例以及提供健康服务成本的财政需求增加,正日益威胁着全球的稳定性。同时,这样的人口发展趋势也给传统的老年人健康服务供给带来挑战。本文以澳大利亚的案例为背景,论证在养老服务中运用场所性的健康促进能够给老年人创造更大的福利,缩短通常与年龄增长有关的慢性病患病率时间。提倡生态养老意味着无需像以前那样对老年人实行隔离管理,而是将他们视为整个社会生活、工作和娱乐不可缺少的一部分。文章比对了健康促进学校与养老产业等场所性的健康促进的特征,认为涵盖各种养老服务的场所是建立一个新的健康促进场所的最佳选择。场所性的健康促进策略的核心就在于为老年人的生活创造有利的环境。更广义地说,生态养老指导我们将环境与健康联系在一起,减少这一日益庞大的人口群体对环境的影响。因此,在老龄事业中应用场所性的健康促进策略有助于降低待赡养的老年人口对全球稳定性的威胁。     

Entrepreneurs in the rural environment

Change in rural activities is frequently seen as: (1) reaction to changes in other areas and sectors, and (2) negative. This downplays the role and importance of entrepreneurs, both farm and non-farm, in sustaining the vitality of rural areas. The notion of entrepreneur can be extended to entrepreneurial activity by other people, e.g. local government activity, which is an integral part of rural community economic development. Both the entrepreneur and the quasi-entrepreneur in local government are critical leaders in urban fringes and other rural areas alike. Their activity in an area is partly dependent upon the broader political, social and economic environment which influences: (1) the need to change and (2) whether any “benefit” can be derived from entrepreneurial activity. A framework is presented in this paper to place entrepreneurs and entrepreneurial activity into the context first, of decision-taking generally in the rural environment, and second, of the broader “enabling” environment. It is argued that constraints originating in this broader environment are often necessary, but they may have unforeseen side-effects in discouraging innovation. Changes in such constraints or in the manner in which they are implemented may be a necessary ingredient to maintain rural vitality through encouraging entrepreneurial activity.