Policymaking for Diversity Among the Aged in India

Abstract

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.     

Rural HIV/AIDS Social Services for Gays and Lesbians

Abstract

The HIV pandemic persists into its second decade, with an untoward toll on rural gays which continues to generate suffering and loss. Rural HIV infections are increasing, and the unique problems of health and social services represent new challenges. Professional social services that would overcome barriers to care for rural gays and lesbians have been historically inadequate or non-existent. The HIV pandemic shows that services for HIV diseases must become part of efforts to strengthen the care delivery services for all in rural America, especially by fostering the power and resiliency of gays and lesbians. The empowerment of rural gays, bisexuals, lesbians and transgendered persons assumes that basic differences occur between those in rural and urban areas, and health and social services must build upon the unique strengths of these diverse groups.     

Mobility Intentions of Rural Elderly and Non-Elderly

Although mobility investigations in urban areas indicate an overwhelming desire of older persons to age in place, such studies in rural areas are scarce. This study of 198 rural residents assesses the differences between elderly and younger respondents for socio-demographic and housing characteristics, as well as housing attitudes. Findings indicate rural elderly prefer to remain in their present home and are significantly different from their younger counterparts in socio-demographic characteristics. Recommendations are made for planned housing and for services to assist aging in place.     

Chapter 3. Housing Older Canadians

ABSTRACT

Reflecting a world-wide trend toward avoidance of institutionahzation and the fostering of aging in place in the community, a range of housing alternatives has been developed for older persons in Canada. This paper examines: (1) current patterns of housing and living arrangements of older Canadians; (2) philosophies that have dominated policy and production of housing for seniors for the last 30 years; and (3) seniors' preferences and utilization rates of various options. Data sources include the 1991 census and two cross-Canada studies, one urban and one rural, in which seniors were asked about their housing and related support service needs, usage patterns and preferences. The paper concludes with a discussion of emerging trends blending shelter and services and of policy gaps that need to be addressed in meeting the future housing needs of older Canadians.     

Organization and Delivery of Long-Term Care in Singapore

Summary

This paper focuses on the Singaporean model of long-term care for older people. With only about 2% of the older population living in institutions, the mainstay of long-term care is community care. The reader is provided an overview of the Singaporean services, including case management, followed by a discussion of the current issues and future challenges. In keeping with the prospect of a rapidly aging population profile, the Singapore government plays a leading role in framing policy and planning for future needs of this sector of the population.     

Local Housing and Service Decisions

Abstract

The purpose of this research was to identify factors associated with local housing and service decisions that support aging adults in rural communities. These decisions represent de factostrategies that affect the quality of life of older residents and their ability to age in place. Data were collected from 951 informants in 134 Midwest rural communities. Analyses were undertaken to identify the role of community characteristics in predicting the availability of a group of housing options and support services. Findings support the notion that the community context is important to the delivery of key housing and service needs. Population size, proportion of community residents 65 years and older, and housing planning processes promoted gains in housing and services.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Health Status and Health Care Services Among Older Persons in India

Summary

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

Future Planning and Financial Education Needs for Asset Building Among Persons with Multiple Sclerosis in Rural Areas

Abstract

This paper presents findings from a study of individuals with multiple sclerosis examining their planning and preparation activities for their future independent living and long-term care needs. Data collected from a representative sample of National Multiple Sclerosis Society members in the greater metropolitan St. Louis and eastern Illinois area indicate significant differences in income, assets, education, health and functional limitation status between individuals living in rural versus urban areas. Additionally, findings show respondents with greater levels of education and assets, and those living in urban areas, are more likely to have saved for retirement, made legal preparations, or engaged in planning activities for future needs. Recommendations for asset building programs include incorporating education and training on planning for independent living and long-term care into financial planning curriculum, particularly for people with multiple sclerosis living in rural areas.     

Contestability and social justice: The limits of competitive tendering of welfare services

Abstract

This paper critically analyses competitive tendering as a model for the provision of welfare services. Competitive tendering, driven by National Competition Policy and other imperatives for greater efficiency and a smaller public sector, is now used extensively by governments to fund welfare services. However, the suitability of this funding model to welfare services generally, and specifically welfare services in non-metropolitan areas, can be criticised on both theoretical and empirical grounds. Competitive tendering is grounded in economic rationalist, urbo-centric assumptions that are largely inappropriate for welfare provision, and have limited validity in rural areas. There is little rigorous empirical evidence of improved efficiency and effectiveness of service delivery under this model. Conversely, there is mounting evidence about the negative impacts. In rural areas this includes the erosion of community service obligations, less collaboration and greater secrecy between agencies, the reduction of choice, limited opportunities for local planning, cost shifting, and threats to continuity of care. This paper concludes with a call for greater application of the ‘public benefit’ test under the provisions of the National Competition Policy, and the development of more sophisticated frameworks for assessing the contestability of welfare services. Social workers have a leading role to play in challenging the dominant ideology of competition-orientated welfare reforms.     

Health maintenance antecedents among older citizens in rural and urban communities

The evidence is clear that rural older people in most nations are less physically healthy than their urban counterparts. Research suggests that such differences may be due more to lifestyle characteristics, biological factors and environmental conditions than to access to, or utilization of, medical services. Utilizing a statewide sample of Idaho residents this study compares the characteristics of those people associated with a disease prevention/health maintenance model and those associated with the medical or disease oriented model. Results show some clear differences in characteristics between people utilizing the two models of health care.     

Health and Well-Being for Late Middle-Aged and Old Lesbians in a Rural Area

Abstract

Previous research on lesbian health care has drawn primarily from samples of young lesbians living in metropolitan areas. Through face-to-face interviews with twenty-one lesbians aged 54 or older and living in rural communities, this exploratory, naturalistic inquiry begins to fill a gap in the literature by examining the health care experiences of older, rural lesbians. Five themes emerged from the narrative data: issues of access; good health/good care; open to her own diversity; family and community; and visions-ideals and fears. We present these themes through informant quotes and discuss implications for policy and practice.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Residential Differences in Filial Responsibility Expectations Among Older Persons1

Abstract This study examines variation in filial responsibility expectations-the extent to which adult children are expected to assist and care for their aging parents-among a sample of 440 older persons. The analysis focuses on the relationship of filial responsibility expectations to residential location and tests the hypothesis that older rural residents have higher expectations for assistance from their children than do older urbanites. Current residential location is found to have little impact on expectations, but older persons who were raised in rural areas, particularly on farms, have significantly higher expectations for filial assistance than do older persons from urban backgrounds. Possible consequences of these patterns for the transmission of expectations from parents to children are discussed.     

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.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Intergenerational Exchange Between Parents and Migrant and Nonmigrant Sons in Rural China

This investigation examined whether intergenerational exchanges of time and money resources between older parents and their adult sons in rural China were conditioned on sons' migration status. Data derived from 2001 and 2003 waves of a longitudinal study of 1,126 parents, aged 60 and older, living in rural areas of Anhui Province, China, and their 2,724 adult sons. Random‐effects regression analysis showed that marginal financial returns to parents of providing grandchild care services and financial assistance were greater from migrant sons than from nonmigrant sons. We explain these results in terms of strategic investments in the earning potential of migrant sons and the bargaining power wielded by grandparents who care for dependent children of migrants.     

Policymaking for diversity among the aged in India

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.     

Young Children in Rural Areas: Implementing the Children Act

SUMMARY. This article is based on the results of the first stage of a study of the Children Act (day care and preschool education), and looks at how the Children Act 1989 has been put into practice with respect to services for children under eight, in rural local authorities in England and Wales. It considers the duties given by the Act to local authorities from a rural perspective, including providing a range of services for children in need, reviewing the services that are available for all young children, and setting standards for day care services provided by the voluntary and private sectors. It concludes that although the Act has helped to focus attention on the needs of children in rural areas, there is a danger that nothing will be done to meet them because of the principle of targeting resources on children who are most in need. Rural isolation was rarely specified as an indicator of need, and other criteria often had an urban bias which may work against the development of services in rural areas. The article also argues that there is a particular need to develop new models of service delivery and ways of providing training and support to early years workers which are appropriate for rural areas.