Volunteerism and social capital in policy implementation: evidence from the Long-Term Care Ombudsman Program

We assess the link between a program's volunteer support and state social capital in the case of the joint implementation of the federal Long-Term Care (LTC) Ombudsman Program by state and federal authorities. This program, which is designed to prevent elder abuse and ensure quality care in long-term facilities, is implemented at the state and local levels and relies heavily on volunteer staff. First, we find that volunteerism is vital to the efficacy of the program's monitoring and investigative functions. Second, we find that volunteerism in this program is tied to broader level conditions of a state's social capital. Last, we discuss the implications of our findings for volunteer-based programs devolved to the states.     

An exploration of older Hong Kong residents’ willingness to make copayments toward vouchers for community care

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people’s willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people’s receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents’ amount of co-payment. Results show that respondents’ WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people’s acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.     

Measuring the Efficiency of Health Services in Lower‐income Countries: The Case of Papua New Guinea

Papua New Guinea (PNG) faces enormous health challenges and information concerning how to allocate limited health resources efficiently is lacking. This article finds that geographical location is important in achieving higher efficiency scores. In addition, it compares efficiency scores against a range of quality indicators. The results demonstrate that different conclusions are reached when efficiency scores are assessed in the context of broader health system objectives. Analyses of this kind can provide valuable information to policy‐makers in lower‐income countries.     

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

     

Long-Term Care Policy: Singapore’s Experience

Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government’s philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers.     

Challenging the techno-politics of anonymity: the case of cryptomarket users

Anonymity is treated as a problem of governance that can be subject to technical resolution. We use the example of the darknet to critically examine this approach. We explore the background assumptions that have been made about anonymity as a quality of social life. We conceive of anonymity as a way of engaging and maintaining social relationships in an anonymous mode. We draw on a study of darknet ‘cryptomarket’ users who mainly use the darknet to buy and sell illicit drugs, discuss drug quality and share information on safe and effective use. We identify the personal satisfaction that comes from interacting anonymously online, the challenges this represents for maintaining trusted interactions and how they are overcome, and the combination of technology and action involved in maintaining anonymity. We argue that attempts to promote de-anonymising norms and technology are based on an erroneous understanding of what anonymity is.     

Voluntary long-term care insurance: best practices for increasing employee participation

This is the second of two Issue Briefs (April and May 2000) on long-term care (LTC) insurance. The previous Issue Brief addressed the problem of increasing sponsorship, while this report addresses the issue of increasing employee participation. Participation rates in group LTC insurance plans tend to be low. A potential watershed event for the development of the employment-based group LTC market is the proposed LTC program for federal employees and retirees (a program that would have to be enacted by Congress). The perception of a successful offering to federal employees could provide an enormous boost to the group LTC insurance market. Employee communication and education are seen as critical to the success of LTC enrollments. The importance of support shown by an employer for a new LTC plan offering cannot be overstated. Unlike 401(k) plan participation trends, LTC participation rates are highest among large companies. Insurers tend to view the 40-60 age range as the primary target for group LTC insurance, and employee salary as the best predictor of LTC insurance enrollment. Higher educational levels also are associated with higher levels of LTC participation. Perceived need for LTC insurance is perhaps the biggest barrier to the purchase of LTC insurance by employees due to competing financial priorities and the fact that LTC issues are generally off the "radar screens" of younger employees. Plans with skilled nursing home and home care benefits experience higher participation rates than plans lacking these benefits. The availability of lower-cost and long duration benefit options can be an important factor in determining participation. Most sponsors have chosen to offer noncontributory (i.e., fully employee-paid) LTC plans. Employer reluctance to make contributions may be caused by HIPAA's prohibition on the inclusion of LTC insurance in cafeteria plans. One of the major advantages of group LTC plans is the availability of guaranteed issue (i.e., issuing coverage without requiring evidence of insurability) for employees, which is not available in the individual LTC market. It is easy for enrollment to be derailed by the presence of any of a number of harmful conditions, such as employer-sponsors who distance themselves from the offer, ineffective communications, or difficult enrollment processes. Achieving consistently strong levels of participation in LTC plans will require employer-sponsors and their insurance carriers to form strong partnerships, with worker participation as their primary stated goal.     

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions

There is a critical need for high‐quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention‐level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.     

The future of financing for long-term care: the Own Your Future campaign

The purpose of this study was to examine the outreach effort and impact of a joint federal-state campaign, Own Your Future, promoting awareness and planning for long-term care (LTC) in the state of Washington. The study applied survey methodology to evaluate the extent of campaign dissemination, evidence of its impact on LTC planning behaviors, and barriers to purchasing private LTC insurance. A total of 3,198 survey responses from a randomly selected community sample and a Washington State employee sample (ages 51 to 71) were analyzed. Results indicated that the impact of the campaign was limited, both with respect to awareness of the campaign itself and to initiation of LTC planning behaviors. Quantitative data revealed a high prevalence of health-related problems (e.g., obesity, diabetes), inadequate knowledge of basic LTC-related information (e.g., cost, payers), and negative attitudes toward purchasing LTC insurance among respondents. Qualitative analyses suggested that respondents perceived significant problems related to affordability and accountability within the current LTC insurance industry. These possible barriers to the purchase of LTC insurance suggest targets to be addressed by policy makers seeking to find ways to offset the public costs of LTC.     

The Future of Financing for Long-Term Care: The Own Your Future Campaign

The purpose of this study was to examine the outreach effort and impact of a joint federal-state campaign, Own Your Future, promoting awareness and planning for long-term care (LTC) in the state of Washington. The study applied survey methodology to evaluate the extent of campaign dissemination, evidence of its impact on LTC planning behaviors, and barriers to purchasing private LTC insurance. A total of 3,198 survey responses from a randomly selected community sample and a Washington State employee sample (ages 51 to 71) were analyzed. Results indicated that the impact of the campaign was limited, both with respect to awareness of the campaign itself and to initiation of LTC planning behaviors. Quantitative data revealed a high prevalence of health-related problems (e.g., obesity, diabetes), inadequate knowledge of basic LTC-related information (e.g., cost, payers), and negative attitudes toward purchasing LTC insurance among respondents. Qualitative analyses suggested that respondents perceived significant problems related to affordability and accountability within the current LTC insurance industry. These possible barriers to the purchase of LTC insurance suggest targets to be addressed by policy makers seeking to find ways to offset the public costs of LTC.     

Comparing Long-Term Care Recipients in Urban and Rural Municipalities in Japan and Sweden

Japan and Sweden both have national systems of long-term care (LTC) and face similar challenges. This study compared various indicators of disability in LTC recipients in nine large urban, midsize urban, and rural municipalities in both countries. The aim was to establish whether urban-rural differences exist and whether they follow similar patterns in Japan and Sweden. It was found that LTC recipients in large urban municipalities in both countries were on average significantly less disabled than those from the other types of municipalities, regardless of the indicator for disability. Fewer persons in large urban municipalities live in extended families, which may increase the propensity to apply for LTC. The number of older people living alone in Japan is increasing, which means that the formal LTC system will come under increased pressure.     

Measuring Social Return on Investment

Strategic decision making and evaluation in philanthropic giving and social investment requires good‐quality information about the social impacts of that investment. One way to meet this need is by calculating a social return on investment (SROI) measure, akin to the return on investment (ROI) approach used in business analysis. Despite much buzz in the field, SROI measurements are rarely used, in part because of the complexity of the calculations but also because of a number of thorny and often expensive organizational challenges associated with implementing an SROI process. This article explores these implementation challenges by comparing four social venture organizations in the health care field—two in the Netherlands and two in the United States—that have utilized some sort of SROI measurement. We summarize the SROI process and identify the specific organizational challenges in each case. Lessons learned from this analysis include the value of process versus product and the importance of fitting the type of measurement to the organizational context. We conclude with a summary of best practices for organizations and social investors who might try to make effective use of SROI measures.     

Valuing and Integrating Informal Care as a Core Component of Long-Term Care for Older People: A Comparison of Recent Developments in Italy and Spain

The international long-term care (LTC) debate has recently been focusing on how to strengthen home care provision. In this regard, a major role has been played by informal care and how to best integrate it in a holistic care approach. Italy and Spain, usually labeled as “familialist” or “family-based” care models, have been promoting national reforms or actions to support the integration of “informal” actors into the overall LTC system. Through a comparative review of recent trends observed in the two care regimes, this article aims at contributing to improve our cross-national understanding of how LTC is changing across Europe, identifying the basic approaches adopted in Italy and Spain and highlighting both their strengths and drawbacks.     

A Generic Model of Long Term Care for Social Work Education

Abstract

With the “graying” of America and the increasing life expectancy for the developmentally disabled, there is an increasing demand for long-term care (LTC). As in the past, provision of this care will depend heavily on families. Professional social work can expect an increased role in facilitating the balance of LTC resources. As this role evolves, social work educators may develop anticipatory responses by incorporating a generic but comprehensive framework of LTC in social work curricula. Such a framework is presented in this paper. It is neither age- nor etiology-specific; it is appropriate for use with the developmentally disabled, the frail elderly, or any other population in need of LTC.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Contextual and Audience Moderators of Channel Selection and Message Reception of Public Health Information in Routine and Crisis Situations

A richer understanding of audience channel selection and message reception during routine and crisis situations through receiver-oriented research offers great promise to extend situational theory's predictive utility. Key variables of situational theory, including involvement, constraint, and problem recognition in information seeking and processing may be moderated by broader demographic and contextual factors in consumption of health information. Thus, situational theory frames this analysis of channels most important for public use in routine and crisis contexts in health information seeking, differences in preferences between contexts, and the criteria publics apply when evaluating the quality of health information. Results of a national random telephone survey (n = 400) indicate a need for more receiver-based studies in public relations, as involvement and demographics played key moderating roles in channel preferences. Use of several channels including radio, magazine, and television differed between crisis and routine contexts for health information consumers. In both crisis and routine contexts, those with high health involvement were more likely to use active media channels such as newspapers and magazines. Perceived accuracy is also revealed as a key criterion in evaluating the quality of health information consumers receive.     

Using Relationship Education Programs with Same-Sex Couples: A Preliminary Evaluation of Program Utility and Needed Modifications

Same-sex couples represent a group likely to benefit from relationship education, given the many unique challenges they face. However, it is unclear whether existing programs, predominantly designed for married heterosexual couples, are appropriate for use with same-sex couples. In this article we highlight the need for quality relationship education programs for same-sex couples and review the literature to identify unique needs of same-sex couples that may not be met by existing programs. We then describe a small survey of couple therapists and researchers conducted to provide preliminary information about whether same-sex couples are perceived to benefit from existing relationship education programs and whether modifications to program content are needed. Twenty respondents indicated that a core set of relationship education components were useful when working with same-sex couples, although the presentation of these components generally required modifications to remove heterosexist bias and to improve applicability to same-sex couples. In addition, several novel program foci were suggested (e.g., stigma management). Implications for the design and delivery of relationship education to same-sex couples are discussed.     

Introduction: Environmental (im)mobilities: Improving the evidence base for effective policy making

Despite the converging agreement on the linkages between climate and broader environmental change and human (im)mobilities, evidence gaps persist that often relate to data challenges. It remains necessary to improve knowledge and data to better map, understand, project, and address environmental migration, displacement, planned relocation, and immobilities. Analyses of continuing data gaps and strategies for innovative data use are key to rise to the challenge. This Special Section of International Migration highlights these gaps and presents innovative strategies to address them.     

American Military Government after Two Wars

Researchers have argued for increased collaboration between teachers and museum educators to improve the outcomes of museum education on students; however, significant gaps in understanding between the two remain impediments to effective collaboration. We surveyed fifty-one museum educators, conducted in-depth interviews with ten of these respondents, and analyzed the data with use of an inductive lens. In this article we use a composite dialogue between a museum educator and a teacher to present a series of questions teachers should ask of, and information they should provide to, museum educators. Such questions and information can be used to initiate more effective collaborative relationships that may ultimately improve the quality of museum education for our students. We argue that gaps in museum educators’ understanding about teachers’ needs, objectives, and concerns about museum visits could be bridged if teachers knew what questions to ask and what information to volunteer to museum educators before arranging a museum visit.