Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

A Research Program on Homelessness in France

Data on the homeless in France were obtained from two surveys conducted in Paris and a recent national survey. What emerges from these surveys of homeless people is their social proximity to other people who are living in conditions of poverty. The findings draw attention to the diversity of the individuals involved. Both contextual factors (e.g., industrial restructuring) and individual handicaps (e.g., poor education and living conditions during childhood) must be taken into account in order to explain why some people are at greater risk than others of losing their home. The findings suggest that preventive policy must not just focus on keeping people in their homes, but also contribute to the more general struggle against all aspects of poverty .     

Structural pressures, social policy and poverty

The purpose of this article is twofold. The first aim is to examine 15 OECD countries from the point of view of the so-called third-generation studies, analysing if the development of poverty and income transfers has been uniform in countries classified under the same welfare state models. This has been done to test how appropriate it is to use welfare state models as an analytical tool in comparative welfare state research. The second aim is to examine the effect of different structural factors on poverty and income transfers. Obtained results indicate that two demographic variables studied behave somewhat differently. The share of older people in the population is – not very surprisingly – connected to an increase in income transfers. In the case of younger population groups, the results are the opposite. The results show that the greater the proportion of older people in the population, the lower the poverty rates. Social policy has in many countries consisted primarily of pension policy, and investments in the elderly population are now beginning to bear fruit. Good pension schemes diminish the immediate poverty risk of older people. As a consequence of their increased well-being, the overall poverty rate will fall. In addition to demographic factors, the results indicate that the unemployment rate is connected, on the one hand, to growth in income transfers and, on the other hand, also to increases in poverty. However, unemployment's effect on poverty is not straightforward. The direct effect is indeed an increase in poverty but, if income transfers are taken into account, the indirect effect is a decrease in poverty, since unemployment increases income transfers (unemployment benefits), which on their side alleviate poverty.     

Driving outcomes: learning to drive,resilience and young people living in residential care

There are continuing concerns about the experiences offered to older adolescents being looked after (‘in care’) in the UK and, especially, to care leavers. Questions are asked about the limitations of State care compared with normal family life. This paper reports on an initiative to provide driving lessons to a group of six young men living in residential homes in one city. It links with resilience theory – how individuals can have relatively good outcomes despite early adversity. A qualitative study was undertaken to explore the effects of the initiative, including individual interviews with young men, heads of homes in which they lived and children's services managers. The overall results indicated that the initiative was very worthwhile. The lessons were a significant part of young people's lives. Possible effects on young people were divided into personal, instrumental and social. Benefits were reported from all parties concerning young people's self‐esteem and self‐confidence, as well as in forging close relationships with supportive adults. Driving would not be seen as a panacea for complex personal histories and structural problems, yet this small experiment suggests that driving lessons could be of disproportionate benefit and there is a moral obligation to provide them in any case.     

Utilization of Community-Based Social and Health Services Among Foreign Born Hispanic American Elderly

ABSTRACT

This study examined factors associated with the utilization of community-based social and health services among foreign born elderly Hispanic Americans. The data came from a nationwide probability sample of Hispanic Americans age 65 and older including 296 Mexico-born Mexican Americans, 571 Cuba-born Cuban Americans, and 247 respondents from other Hispanic countries. Being a Cuba-born Cuban American, living alone, having poorer self-rated health and living below poverty level were positively related with the utilization of community-based social services. Cuban Americans with more limitations in activities of daily living (ADL) used more community-based health services. Among Mexico-born Mexican Americans, those who lived alone used more social as well as health services while those who were married used more social services. Those with greater limitations in ADL used more health services. Among other foreign born Hispanic Americans, going to church, living alone and living below poverty status, were positively correlated with the utilization of social services. Respondents with better English language ability were less likely to use community based health services. Elderly men and people who rated their health as poorer or had more ADL limitations were more likely to use these services. Implications of these findings for health and social services are discussed.     

Poverty and Hardship among the Aged in Urban China

China's record in reducing poverty over the last three decades has been impressive, yet few studies have examined the incidence of poverty among older people despite the rapid ageing of the population. This article uses a unique national data set to examine patterns of poverty, deprivation and exclusion among the urban aged population (60 years and over) in 2000. The results point to the importance of poverty as an issue for older people, particularly for women and those who live alone. A number of indicators of hardship are developed in four areas – economic insecurity, housing, health, and social isolation – and the incidence of these is examined, separately and in combination, by living arrangement and gender. Women are shown to experience greater levels of hardship and isolation than men, and to be more likely to experience multiple deprivation across two or more areas. Finally, the overlap between poverty and hardship is examined as a way of validating the poverty estimates and giving them greater credibility. The results indicate that there are strong overlaps, although these differ across the different dimensions of hardship. Access to pension income and concern over the cost of necessary visits to see a doctor emerge as strong predictors of poverty and point to areas where policy change is needed.     

Ageing-in-place in studio apartments in Singapore: maintaining independence in community living

Abstract

Living alone in later life is increasingly a common style of living in Singapore. We investigated the extent of maintaining independent living in a studio apartment using a survey of older residents (n = 925), focusing on three aspects of coping strategies: self-care management, social support, and use of social services. As compared to older adults who lived with others, those who lived alone had better self-care management, tended to rely more on friends and neighbours, and indicated higher use of social services. Those living alone also showed higher awareness in managing their health. This study provides valuable insights to understand the issues on coping strategies involved with living alone in later life.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Settling In and Moving On: Transience and Older People in Care Homes

This paper reports on a study which examined the experiences of 46 older people who moved into nursing and residential care homes, interviewing them at four points, from before the move to up to six months afterwards. A key finding was that older people were actively involved in the process of settling into homes and forming new friendships. Participant data also indicated that these older people had often experienced many moves in recent years, as their need for care had changed, and following them through after their inclusion in the study indicated that, for some, there were more moves to come. These data place the debates about assessment, and the identified problem of "misplacement" in a different light. The problem is not simply one of improving assessment techniques so that needs and provision can be matched more accurately, but it may mean accepting that the needs of older people are likely to change over time. The question then is whether we can develop services and forms of provision which ensure that care moves to older people, rather than older people having to move to care.     

Immigration,living arrangement and the poverty risk of older adults in Hong Kong

Using 2011 census data, this study investigated how living arrangement affects disparities in poverty between older adults (aged 65 and older) who migrated to Hong Kong from Mainland China and those who were born in Hong Kong. Our sample consisted of 29,987 immigrants and 9,398 natives, all of whom were ethnic Chinese and living in Hong Kong at the time of the census. We found higher poverty rates among older immigrants than among natives, a disparity that persisted even after adjusting for living arrangement, human capital characteristics, assimilation‐related variables, household composition and demographic characteristics. We also found that living arrangement moderated the impact of immigrant status on the poverty risk among older adults, and that the impact was due mainly to the number of earners in the household. The implications of our results with respect to poverty among older adults and anti‐poverty measures are discussed.     

Determining Semi-Normative Poverty Lines Using Social Survey Data

Debates about how to set minimum income standards for health and general well-being are very current in Britain. Family budget standards remain popular but the results can be criticized for being little more than abstractions. They are to an extent 'artificial' and this raises questions about their 'real adequacy'. Another way to operationalize adequacy of income, in a lived sense, is to consider the household income levels at which a specified, desirable, healthy standard of living is in fact achieved, indicated here by diet and nutrition. Data are taken from the United Kingdom's Expenditure and Food Survey; the sample has been restricted to an older population, and three years of data (2002–5) provided a combined sample of 4,300 households. The study findings and semi-normative poverty lines are critically discussed in relation to the national UK policy context as well as the international research literature on poverty measurement.     

Depression,Hopelessness, and Suicidal Ideation Among the Elderly

Abstract

This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.     

The impact of tax-financed pensions on poverty reduction in Latin America: Evidence from Argentina, Brazil, Chile, Costa Rica and Uruguay

In many Latin American countries, tax-financed pensions (TFPs) have expanded, mainly resulting from growing informalization of employment and stagnating or declining pension insurance coverage. In the five countries examined in this article, TFPs have generally been effective in reducing poverty and indigence. In Brazil rural social assistance pensions cut the incidence of destitution among poor older people by 95 per cent. In Chile TFPs considerably improved their poverty reduction effectiveness between 1990 and 2000. Tax-financed pensions have therefore been seen as an instrument to supplement contributory pension coverage and boost overall social security coverage. A key challenge is to increase pension insurance coverage through existing statutory pension insurance or special contributory schemes targeted on workers in the informal economy. Otherwise, TFPs could become financially and socially unsustainable in the future. There are also various ways to improve the financing, administration and eligibility criteria of TFPs, particularly because it is necessary to define consistent structure and benefit policies between these and contributory schemes.     

Charity or Entitlement? Generational Habitus and the Welfare State among Older People in North‐east England

Current UK policies aimed at reducing pensioner poverty involve targeting those in greatest need by supplementing their incomes with means-tested welfare benefits. It is believed that such policies provide more resources for those in greatest need. However, non-uptake of state welfare benefits by many older UK citizens exacerbates the widening income gap between the richest and poorest pensioners. We examine the underlying beliefs and discourses among those currently in retirement who lived through a time when welfare programmes had more of a putative abstract universalism than is now the case. Based on the narratives of people aged over 60 in North-east England, we show how the collective forces of structure and individual practice in relation to welfare accumulate over a lifetime and influence the ways in which people interact with the welfare system in later life. We find that the reasons for the apparent lack of agency among older people in relation to claiming benefit entitlements are linked to the particular social, economic and political circumstances which have prevailed at various points prior to and since the inception of the UK welfare state. We argue that the failure of some older citizens to operate as citizen consumers can be conceptualized in terms of a generational welfare 'habitus', the consequences of which are likely to exacerbate inequalities in later life.     

Distribution of home help services in an elderly urban population: data from the Kungsholmen Project

Data from the total urban population 75 years and older in Kungsholmen, Stockholm were used to calculate the distribution of home help services. A structured questionnaire was used to collect information about education, occupation, living conditions, Katz Activities of Daily Living Scale, contact with the family, medical treatment and also questions about help needed and functional ability. Home help was considered to be provided when the subjects reported receiving home help service from the municipality. The number of hours of home help and the services received were registered. The results show that 86% of the elderly population in the Municipality of Kungsholmen live in their own homes, even when they are very old. Twenty-seven percent of those over 74 years and 33% of those over 80 years received home help services. The people receiving help were mostly women, single living, older and with disability detected by the Katz Activities of Daily Living Scale. The predicting factors of hours of home help are older age, condition of single living, disability detected by the Katz Activities of Daily Living Scale and less years of education. Our results also show that, among those who receive home help service, those with disability in the activities of daily living get more hours of help. However, a considerable group of elderly people are disabled but do not receive any home help. Our data stress the need for more attention by health care planners of domiciliary and intensive care and residential facilities for the high risk population (very old, living alone and with disability).     

Poverty Among Korean Immigrant Older Adults: Examining the Effects of Social Exclusion

ABSTRACT

Previous studies have shown that elderly Asian immigrants face greater risks for living in poverty compared with their native contemporaries. Particularly, Korean immigrant older adults are reported to be most likely to experience poverty among many Asian immigrant groups. The purpose of this study is to examine the extent to which demographic, human capital, and social exclusion factors contribute to such economic vulnerability among Korean immigrant older adults. Adding to previous research, this study broadly conceptualizes social exclusion and tests for its additive effects on poverty using nationally representative public data of Korean immigrant older adults. From the 2008–2010 Public Use Microdata Sample of the American Community Survey, this study extracts a sample that consists of individuals aged 65 years and older whose national origin is Korean, who were not born in the United States, and thereafter immigrated to the United States (N = 3,820). The findings indicate that 3 dimensions of social exclusion—exclusion from social and civic life, exclusion from asset building, and exclusion from the labor market—contribute significantly to Korean immigrant older adults’ odds of living in poverty. The study concludes with practice implications for socially inclusive workforce development as a way to ameliorate economic afflictions among Korean immigrant older adults.     

农村老年人生活状况的调查与思考——以胶南市Z村为个案

随着我国人口老龄化的加速,数量庞大的农村老年人的生活状况日益引起世人关注。通过对胶南市Z村老年人的经济收支、健康及医疗、住房及养老、精神文化生活等基本状况的调查,发现他们基本实现“老有所养”,但“老有所乐”的目标尚未达到。适度转变农村养老模式、建立健全农村养老保障制度、加强精神文明建设等,成为当前提高农村老年人生活质量的较为可行的对策。     

A comparison of youth resilience across seven South African sites

The resilience of children and youth is an increasingly important area of research. Young people growing up in distressed communities, characterized by poverty, crime and family troubles, are particularly vulnerable. Resilience can assist these young people in navigating through these challenges towards independent living, particularly as they transition out of adolescence and into young adulthood. Children in South Africa are almost universally vulnerable, but children growing up in residential care facilities and children from poverty‐stricken communities are particularly in need of resilience. This quantitative study of 575 South African children compared their resilience in terms of individual, family and community protective factors across seven sites, including child and youth care centres, schools in poor communities and schools in middle‐class suburban communities. Contrary to expectations, the study found that children in one of the children's homes and one of the poor communities had the highest levels of resilience. Moreover, all but one of the sites scored very high on at least one of the resilience variables, suggesting unique profiles of resilience across the sites. Practice implications for child and family social work are discussed.     

Income security for older people: An Asian perspective

In Asia and the Pacific, as in other developing regions, the continuing growth of the aged population has a great impact on social security programmes generally and, in particular, on the income security of older persons. In societies where traditional support systems are breaking up, their need for social security protection is increasingly important. A system of social security for the elderly population exists in most countries of the region. Many are provident fund schemes, which are basically saving schemes, and their coverage is low. Where social insurance pension schemes exist, the levels of benefits provided are also low. The focus for future development, therefore, lies in converting the savings schemes into multitiered pension schemes, extending their coverage and raising the level of benefits. In this context the critical question concerns the role of the State and the type of schemes used. The need for public pension schemes is great in Asia and the Pacific, where the level of poverty is comparatively high. Building pension schemes, whether public or private, involves a set of issues that need to be addressed. This article considers the systems currently in place and the challenges and limitations faced when considering the future development of social security in this area.     

Trajectories of Community-Based Service Use: The Importance of Poverty and Living Arrangements

ABSTRACT

This study examined how older adults’ living arrangements and poverty status affected their use of in-home health, functional, and out-of-home services over time. Using eight waves of data from the Korea Welfare Panel Study, we employed a logistic mixed-effect model to analyze how poverty and living arrangements affect community-based service use. Living-alone older adults and elder-only couples were more likely than co-residing households to use services. Elder-only couples, when poor, were more likely to use in-home and out-of-home services over time. Understanding predictors of community-based service use over time enables researchers and policymakers to better understand the process of aging-in-place.