A Qualitative Exploratory Study on the Service Delivery System for the New Long-Term Care Insurance System in Korea

ABSTRACT

To cope with the rapid growth in its aging population, the Korean government introduced a new social long-term care insurance (LTCI) system for elderly people beginning in July 2008. This study aims to understand how National Health Insurance Corporation (NHIC) staff and home-visiting service providers experienced and evaluated the new service delivery system. A total of 26 semistructured in-depth interviews were conducted with NHIC staff primarily responsible for the functional assessment of the elderly and the home-visiting service providers responsible for providing direct services to elderly clients. In summary, interviewees had negative experiences with the new service delivery system such as difficulties in carrying out their roles. The findings suggest that Korea's new LTCI service delivery system faces challenges and that a more active role for the Korean government, especially regarding the introduction of a proper care management system, is needed to address the issues. Future research with larger sample sizes is needed to examine and understand the issues in detail.     

From walls to homes: Child care reform and deinstitutionalisation in Ghana

In 2006, the Ghanaian government, in partnership with the United Nations Children's Fund (UNICEF), began to reform the child welfare system. The main aim of this reform was to provide a sustainable and culturally appropriate system of care for children without parental care by shifting from an institutional‐based model to a family and community‐based one. Drawing on existing peer‐reviewed and grey literature, this article provides an overview of the major components of the reform, including reintegration with the extended family, foster care and adoption. In addition, the article discusses the prospects and challenges involved in achieving the reform's intended component. Key Practitioner Message: ● Use community development techniques to raise the resources needed to provide family support services for vulnerable families; ● Social work practitioners partner with non‐governmental organisations to train community members as para‐social workers; ● Social workers, especially in developing countries, understand the challenges they face when embarking on deinstitutionalisation.     

A viable care migration programme for Australia's ageing population: Recruiting migrant personal care workers for Australian aged care

Scholars and stakeholders alike have proposed the recruiting of migrant personal care workers as part of a strategy to respond to a prospective aged care deficit in Australia's ageing population. In recent years, there has been an increase in care migration to fulfil shortages among Australia's culturally and linguistically diverse and more remotely based populations. However, it is a difficult and resource‐intensive process to recruit migrant personal care workers under the labour agreement stream of the Temporary Skills Shortage visa. This article addresses the lacuna in existing literature dealing with the question of how Australia's migration framework ought to be structured to recruit migrant personal care workers as part of a strategy to prevent, or respond to, an aged care crisis. The article argues that the formation of an aged care industry labour agreement based on geographical and niche subsector labour market need is necessary to ensure the accessibility of the programme to aged care organisations. However, it is also argued that the introduction of a new low‐skill visa would better facilitate the recruitment of migrant personal care workers.     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

A lesson learned from community-based integrated long-term care in Thailand

Abstract

Thailand is the second most rapidly ageing of the Association of Southeast Asian Nations (ASEAN) countries. With this rapid pace of population ageing, the demand for long-term care has increased. Due to lower fertility and migration of adult children, the availability of children as a main source of long-term care has been reduced. In order to retain the traditional lifestyle of ageing-in-place, community-based integrated long-term care has been implemented as an alternative approach in Thailand. The development of such community-based care and its challenges can be used as a lesson for other ASEAN countries in confronting ageing societies.     

The Development of Korea's New Long-Term Care Service Infrastructure and Its Results: Focusing on the Market-Friendly Policy Used for Expansion of the Numbers of Service Providers and Personal Care Workers

One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.     

Getting behind the closed door of care leavers: understanding the role of emotional support for young people leaving care

There have been significant changes in the legislative frameworks and guidance that surround social work practice with young people leaving the care system over the recent years. However, care leavers continue to face a range of challenges, achieve poor outcomes and research has consistently highlighted the insufficient attention paid to sources of emotional support. This paper provides empirical data from a small number of care leavers reflecting on their experiences of transitioning to independence. The findings provide further evidence of the lack of attention paid to emotional support by professionals and highlight the impact that this had on the young people's experiences. The young people identify their changing perceptions and needs as their experiences post‐care change, the complex reasons for why they may have rejected offers of support and make key recommendations for practice. This paper provides valuable insight into the process of leaving the care system from the perspective of care leavers themselves and raises key questions that challenge the structure of the current support systems, the nature of the professional relationship with young people in care and the priorities of current policy initiatives.     

The “Socialization of Elderly Hospitalization” in China: Development,Problems, and Solutions

ABSTRACT

Objectives to analyze the development of the elderly patients with chronic diseases and to make some suggestions for the elderly social hospitalization. Methods By using yearbook data and theoretical analyses, the paper respectively presents the problems and furthermore solutions of China's elderly services. Results The elderly patients with chronic illnesses have formed a new group, and the phenomenon of “socialization of elderly hospitalization” has become a major social risk. Discussions China needs to promote the idea of “long-term care” in elderly social security, establishing long-term care insurance and fostering a private, professional elderly service system.     

Therapeutic residential care in Spain. Population treated and therapeutic coverage

Therapeutic residential care (TRC) is the name given to specialized children's homes for treating cases with severe emotional and behavioural problems that have been placed in residential care. A recent international review has revealed great diversity in the referral criteria of cases and in the models of intervention carried out. The goal of this study is to describe the population treated in these types of facilities in Spain and the therapeutic coverage given. The sample is made up of 215 young people in children's homes, of whom 93 are in TRC. The cases referred to TRC have been in residential care for less time but have gone through a greater number of placements. These young people also exhibit more problems of drug use, and there is a larger percentage of clinical‐range cases in the Child Behaviour Checklist scales of attention problems and aggressive behaviour. Nevertheless, the results of logistic regression indicate that the only variables that significantly increase the probability of being referred to TRC are drug use and changes of care placements. With regard to therapeutic care, there is a higher percentage in the TRC group receiving psychiatric care, and the sessions are also more frequent.     

Little cash to large households: Cash transfers and children's care in disadvantaged families in Ghana

Social protection is widely considered to have a positive effect on children, including supporting improvements in nutritional, educational and health outcomes. Much less is known, however, about the impact of interventions on children's care. This article considers the impact of a social cash transfer targeted at poor households – Ghana's Livelihood Empowerment Against Poverty (LEAP) programme – on child well‐being, quality of care and preventing children's separation from their parents as perceived by programme and non‐programme beneficiaries in a context of vulnerability, large households and widespread informal kinship care. Findings suggest that cash transfers can improve both material and non‐material aspects of well‐being and contribute to the quality of care and have the potential to prevent children's separation from their parents. At the same time, not all children appear to benefit equally, with non‐biological children being disadvantaged. The combination of large household sizes with programme design and implementation challenges, including low transfer amounts, a cap on the maximum number of eligible household members and poor sensitization and follow‐up, undermine the positive role that cash transfers can play.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.     

A tangled web: parental contact with children in kinship care

Contact between parents and children in care is a contested area. Parental contact is recognized to be important, yet may present protective issues; in the kinship care environment, it brings the particular challenges of complex family relationships. Seeking the parents' perspective in a child protection context is difficult and therefore under‐researched. This paper describes a nested study within an Australian research project on family contact in kinship care in which the perspectives of 18 mothers and 2 fathers were sought via in‐depth interviews. Mothers and fathers described strong feelings of disempowerment in the context both of their family and the child protection system. The relationship between parent and caregiver emerged as a significant issue. All of the parents wished to remain in contact with their children in a meaningful way, whether or not they were likely to resume their children's care; however, contact arrangements presented many difficulties for them. Mothers articulated the need for services that are more empowering and respectful, rather than oriented towards them as failed parents. In order to build appropriate models of support and intervention, we argue for a more inclusive conceptual frame for family life that gives greater recognition to the role of non‐custodial parents in the lives of their children.     

Dialogic literary gatherings and out‐of‐home child care: Creation of new meanings through classic literature

Research on out‐of‐home child care has revealed that foster care programmes focused on educational attainment and reading have the potential to improve the academic outcomes of children in care. However, no studies have examined which elements of these programmes positively benefit children's emotional well‐being. This article presents evidence of the positive effects of implementing a successful educational action, dialogic literary gatherings, in a children's residential care institution. A qualitative study using a communicative‐oriented methodology was conducted and involved five participant observations and eight daily life stories with children in out‐of‐home care in Catalonia (Spain). The children's reflections demonstrated that reading classic books, such as Dickens' Oliver Twist, deeply influenced their feelings and self‐conceptions and created new and exciting meaning in their lives.     

The Effects of Marketization of Long-term Care Services for Older Adults in Korea

To cope with the rapid increase in aging population, the South Korean government introduced new long-term care insurance in 2008 by using the market forces and mechanisms of competition and choice. The study explored the effect of the marketization of long-term care (LTC) services on the provision of services under the Korean long-term care insurance (LTCI) system. By adopting qualitative semi-structured in-depth interview methods, the experiences of 17 home visiting service provider managers were examined. The study results suggest that the marketization of LTC services faces several challenges. Some of the stakeholders in the field, such as home visiting service providers, care workers, and older clients, appear to employ unlawful activities or unprincipled behaviors to maximize their individual interests. The results also suggest that the unprincipled behavior, unlawful activities, and financial problems that service providers face contribute to low quality care services. Future studies should explore these issues using larger samples of service users and providers.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Children's journeys through organizations: how inspectors evaluate coordination of care

Inspectorates have been criticized for assessing compliance with the rules rather than outcomes for children. In the Netherlands, inspectorates have developed a ‘journey tool’ to reconstruct children's travels through all the organizations providing care. Using document analysis and semi‐structured interviews, we evaluated how inspectors use this tool in practice. We applied an ontological theoretical framework to the coordination of care to analyse 24 journeys through care organizations, including a selection of six journeys in further detail. Our analysis shows that up until now, inspectors used only one form of coordination, the creation of a hierarchy, resulting in one problem definition. However, in complex care practices, children have multiple and often incompatible problems so that one coherent problem definition cannot be made. We show that ‘patchwork’, a form of coordination that allows discrepancies enables inspectors to reflect on complex care practices and evaluate options to improve outcomes for children.     

Nonresidential fathers with children in foster care: A descriptive study in the United States

This study used the data from 64 nonresidential fathers who had their children placed in foster care to describe their characteristics. The survey included questions about demographic background and personal challenges, the father's involvement with his child in foster care, the father's relationship with the mother, barriers to the father's involvement, and the relationship with child welfare agencies and workers. The average age of the participants was about 39 years, and the majority of them were African American. About 70% of the fathers reported low levels of education. Almost 69% of fathers reported frequent face‐to‐face contact with their children. On average, the participants were arrested 2.6 times, and it ranged from 0 to 34. More research is necessary to learn more about these fathers, develop programs to help them become a viable source for permanency option, and become more involved in their children's lives.     

Life after institutional care: Implications for research and practice

This study sought to investigate the lived experiences of care leavers from institutional care facility in Botswana. The study objectives were to explore the challenges faced by children after leaving the institutional care and to identify services that can be offered to them in preparation for life in a society in general. The study adopted a cross‐sectional qualitative research approach, and data were collected through in‐depth interviews that were qualitatively analysed. Thirty participants was sampled, and there were divided into 2 sections comprising care leavers and key informants who were part of the institutional care staff. They were selected using purposive and snowball sampling methods. The findings confirm that institutional care has both positive and negative effects on care leavers in the sense that it provides children with educational opportunities, family, and strong interrelation skills. Furthermore, the study findings show that during children's stay in the institutional care, they are sometimes neglected by housemothers that affect their transition into mainstream society. Moreover, the study findings reveal that care leavers encounter many challenges ranging from finance management to unemployment, discrimination from the society, and poverty. Lastly, future research, policy direction, and implications are discussed.     

‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.