Intergenerational Care Providers of Non-Institutionalized Frail Elderly

This study reports on the care provided to (41) non-institutionalized frail older persons by their children and/or grandchildren. The study is based on a population of frail elderly persons referred for in-home assessment services to the Iowa Model Gerontology Project in Scott County, Iowa. These referrals were based on the referral sources belief that the older person was at risk for institutional care. The study explores three aspects of intergenerational family caregiving: the characteristics of the off-spring caregivers, their perceptions of both the positive and negative impacts of providing care, and their perceptions of supplementary assistance needed and desired from outside agencies in carrying out the caregiving tasks.     

The application of the Olmstead decision on housing and eldercare

This article reviews the Supreme Court's interpretation of Title II of the Americans with Disabilities Act (ADA) and discusses its application for the frail older person. The parallels and differences between the societal ideas about, and the development of, community-based housing programs for younger populations of people with disabilities and for aging populations will be examined. This article explains how frail older people may be included in the ADA's definition of persons with disabilities. It then explains the Supreme Court's interpretation of discrimination in Olmstead v. L.C. ex rel Zimring (1999). Lastly, it examines the implications of the Olmstead decision for long-term care as it relates to housing for older people.     

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis

ABSTRACT

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although public-private partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources.

Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on state-provided care, use of expensive private care, and waiting lists to secure services.     

Hospital-Based Long-Term Care Services for the Frail Elderly

This paper examines acute care hospital diversification into long-term care services for the frail elderly. The discussion focuses on five multifaceted roles played by health care social workers as hospitals develop long-term care initiatives. The need for an advocacy stance in both macro and micro aspects of care is stressed. Ethical dilemmas that arise in hospital-based systems are presented.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.     

The challenge of keeping Japanese older people economically active

Japanese society faces serious problems due to population ageing. Both the number and percentage of people aged 65 years old and over are increasing. The ratio of those aged 65+ was 17.3 per cent in 2000, but the estimate of the National Institute of Population and Social Security Research is that the ratio will become 28.7 per cent in 2025 and will reach 40 per cent in 2050. This article consists of four sections. In the first the characteristics of issues associated with population ageing in Japan are discussed. The actual situations of employment and lives of older workers are introduced. The second section analyses government policies to address the ageing of the population. The Japanese government is trying to address the issue through encouraging older people to work longer. The promotion of efforts to extend longer working lives is discussed. In the third section a rehiring system and two cases of Japanese firms are described. Those enterprises are effectively employing older workers. Their experiences would be interesting for those planning to hire older workers. The last section discusses how to resolve challenges associated with population ageing. It is shown that continuous training is one of the most important ways of keeping older people productive.     

The emerging role of Financial Counsellors in supporting Older Persons in financial hardship and with management of Consumer‐directed Care packages within Australia

The role of financial counsellors as providers of information, support and advocacy for those in financial difficulty is a well established mechanism in the mainstream welfare landscape in Australia. In general, the role of financial counsellors is in helping people alleviate or resolve their financial difficulties through improvement of their financial literacy. It is recognised as an important component of policy responses to assist low‐income households and individuals in financial stress. The use of financial counsellors for older persons (i.e., those aged 65+ years), however, appears to be underutilised. Financial hardship and abuse of older persons within our community are becoming key issues as the population of Australia “ages”. Existing evidence also suggests that service providers alone do not have adequate skills to address these issues. This paper firstly examines the development of financial counselling in Australia. It then examines the newly emerging role of financial counselling in supporting older persons in addressing barriers to financial literacy and then in navigating the complex landscape of aged care service provision. The current financialisation, marketisation and complexities of consumer‐directed care are identified as key contextual factors. The paper will then discuss an evaluation study of the provision of financial counselling to the older person population designed to support financial hardship and navigation of the complex aged care services system. The findings of the paper are based on an evaluation of the Financial Consumer Rights Council (FCRC), Victoria: Dignity and Debt Financial Difficulty and Getting Older initiative. This pilot initiative included older persons from both community‐based and aged care residential facilities in one regional area of Victoria. The initiative, conducted over 2016, was designed to assess the effectiveness of one‐on‐one financial counselling sessions with older persons that provided consumer advocacy and information about support services and entitlements (including hardship protections) associated with ageing. The evaluation found that the provision of financial counselling to the older person population could be a key mechanism in improving overall financial literacy, avoiding periods of financial hardship and in maintaining financial well‐being, quality of life and positive ageing. Findings also demonstrated a need for an expanded outreach financial counselling model to better service older persons in more isolated living environments and/or with mobility impairments living in the community, and the potential to situate offices of financial counsellors within medical centres (a space often visited by the ageing population), to co‐situate financial health check‐ups as an overall element of health and well‐being. As such, financial counselling was viewed as well placed to support older persons in improvement of financial literacy and in supporting navigation of the increasingly complex marketised and consumer‐directed care (CDC) landscape of aged care service provision in Australia.     

A Study of a Total Social Services Care Population and its Inter-Agency Shared Care Populations

There are very few large population studies and little informationabout the characteristics of social services populations andthe inter-agency populations that social services departmentsshare with other agencies. This study fills this gap. It examinesa total social services adult care population, excluding residentialcare homes (N = 19,461) in the context of its general co-terminoushealth authority population (N = 646,239). Approximately two-thirds(61 per cent) of the social services population were women,compared to the health authority population of 51 per cent.Sixty-two per cent were over sixty-five years compared to 23per cent of the health authority. Age groupings and genderedpatterns of service use are then identified for different caregroups. The study then examines care populations shared betweensocial services and other agencies, identifying the amount ofshared care and the characteristics of specific shared caresubgroups. Forty-two per cent of the social services populationwere shared with the community health trust and 19 per centwith the mental health trust. The proportion of the social servicespopulation in contact with Criminal Justice and accident andemergency was nearly twice that in the overall health authoritypopulation. The limitations of these data are examined and thepotential of this method to inform inter-agency planning andshared care is discussed.     

Receipt of Formal and Informal Help with Specific Care Tasks among Older People Living in their Own Home. National Trends over Two Decades

Sweden is seen as a typical example of a social democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care‐receipt in older people (77+) living in their own home and with a perceived need for help with two specific tasks: house cleaning and/or food shopping. Trends in care‐receipt were examined in relation to gender, living alone, having children and socio‐economic position. Data from the 1992, 2002 and 2011 data collection waves of the national study, Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), were used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care‐receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care‐receipt, associated with a greater likelihood of formal care‐receipt and a lower likelihood of informal care‐receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.     

人口老龄化背景下的社区养老服务

人口老龄化的趋势不断加快是当前人口发展的态势,在传统家庭养老功能趋于弱化的同时,如何有效地建立满足老年人需求的服务体系是老年工作面临的挑战之一。本文结合老年人的身心特点阐述了社区养老服务的内涵及优越性,在分析了社区养老服务的现状及问题的基础上,提出了社区养老的发展思路和建议。     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Towards Integrated Community Care for the Frail Aged

The growing awareness of family support among the frail aged has yet to be incorporated into a clear strategy for developing comprehensive community care. A starting point is to identify the characteristics of target populations, the range of tasks associated with aged care, and the capabilities of various informal and formal providers. Fully appropriate services would take into account the availability of family support as well as the needs of older people themselves. It is suggested that services be designed to (1) supplement support from spouses; (2) periodically substitute for other co-resident carers; (3) complement assistance from nonresident family; and (4) substitute for the unavailability of family support. Community services currently provide modest supplements, principally to nonresident support, but do little to address the other contexts of care. Suggestions are made for program developments that would provide genuine alternatives to institutionalisation without devolving the social costs entirely onto families.     

Long-term Care in China: Issues and Prospects

One of the major socioeconomic challenges China faces is the rapid aging of its population. China is now an aging society, even though it is still regarded as a middle-income economy. Coupled with the market-driven reform of social services and rapid erosion of family support, the provision of affordable and accessible social care services to older people has already become an urgent issue for the government to address. Looking into the future, the formulation of a sustainable position on long-term care (LTC) will increasingly become the major focus of social policy. This article sets out the background to the demographic shifts resulting in the emerging need for LTC in China. It analyzes the issues facing LTC services and reviews their prospects, including the structure, operation, financing, and interfacing of residential and community-based home care services.     

What do Care Managers do?--A Study of Working Practice in Older Peoples' Services

Correspondence to A. Weinberg, School of Community Health Sciences and Social Care, University of Salford, Allerton Building, Frederick Rd Campus, Salford, Greater Manchester M6 6PU, UK. Summary This paper explores the principal activities of local authoritystaff undertaking the role of care manager. It is based on asample of staff in a social services department specializingin older people's services. Data were obtained by asking staffto complete a diary schedule in which thirty-four job relatedactivities were grouped into five broad categories on the basisof previous research. A 57 per cent response rate was achieved.Analysis of the data revealed several findings of note. First,excluding travel, care managers spent 64 per cent of their workingweek in direct and indirect user and carer related activities.Second, administrative tasks occupied 32 per cent of their time.Third, care managers spent 27 per cent of their time in assessmentactivities compared with 7 per cent in monitoring and reviewingactivities and 5 per cent in counselling and support. Fourth,care managers spent 4 per cent of their time liaising with healthstaff. These findings are discussed in the light of previousresearch and a shift is noted in the nature of the direct contactwith the service user. The methodological limitations of thestudy are explored and the implications of these findings forusers and carers and the development of care management arrangementsare discussed.     

Violence Across the Lifespan: Interconnections Among Forms of Abuse as Described by Marginalized Canadian Elders and their Care-givers

Elder abuse is recognized as a major problem, with profoundeffects on the health and quality of life of older persons.In our aging population, elder abuse represents an escalatingclinical issue for social workers and health care professionalswho provide care to older people. A major gap in our examinationof elder abuse is the potential contribution and applicationof knowledge developed within research derived from other formsof family violence. This paper explores the interconnectionsamong various forms of violence across the lifespan, and theexperiences voiced by marginalized elders and their care providers.We interviewed seventy-seven rarely consulted older adults andforty-three formal and informal care-givers of older adultsin focus groups in Ontario and Alberta, Canada. Study findingsrevealed four major themes that describe interconnections amongtypes of abuse: (i) intergenerational cycles of abuse; (ii)violence across the lifespan; (iii) exposure to multiple subtypesof elder abuse; and (iv) ongoing spouse abuse that shifted intoelder abuse. The results from this study indicate that victimsoften ‘suffer in silence’ and cultural factors,ageism and gender are ubiquitous to elder abuse. Recommendationsto reduce elder abuse include education, formal and informalsupports and services.     

The old‐age pension law in Mexico: The promise of poverty in old age?

In 1997, Mexico replaced its main old‐age pension system with an individual capitalization system. In 2021, the first people subject to the new system will retire. Using a model that projects demographic and labour variables and using Monte Carlo simulations, the findings of this study show that in 2051 the percentage of men not having a pension will increase from 38 per cent to 59 per cent, and that of women from 44 per cent to 66 per cent. The replacement rate for the average Mexican worker will fall from 70 per cent to 30 per cent. The numbers of people in extreme poverty will increase by almost 2.8 million, representing 9.44 per cent of the population. Alternative scenarios are proposed that involve increasing the contribution rate and raising the retirement age.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Cash‐for‐care payments in Europe: Changes in resource allocation

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind?     

Solidarity in Italy's policies towards the frail elderly: a value at stake

The Italian public policies towards the frail elderly are underdeveloped by both quantitative and qualitative standards. The bulk of care responsibilities lies on the family and the private provision of paid care is flourishing. The last decade was characterised by significant signs of improvement – an increase in the public resources committed to long-term care and the rising interest of politicians and scholars towards this issue – but the situation is still highly critical. In such a context several questions on solidarity arise regarding the degree to which this value is actually embedded in the public policies, what are the most relevant issues and how the main actors involved are concerned. The article aims to answer some of these questions, taking into consideration the points of view of the main actors: elderly people, carers and professionals.
In doing so, the article discusses the targets of the public services, differences in their provision across the country, the rise of the care allowance and the private provision of paid care. The article shows the problems regarding solidarity in the Italian policies towards the frail elderly and sets an agenda of issues to deal with in the next decade. How policy-makers will be able to manage these issues will determine whether and how the value of solidarity will shape Italy's long-term care policies in the future.     

The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations

Winterton R, Warburton J, Oppenheimer M. The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations The global phenomenon of population ageing is impacting on how community care is delivered, and a key component of health and social care services for the frail elderly is Meals on Wheels (MOW), a service that has traditionally encompassed delivering meals to older people in their homes. However, aspects of this conceptualisation of MOW are being redefined in order to address challenges posed by tightening global financial contexts, a reliance on volunteers and increasing social isolation among ageing populations. Through a review of the literature and websites from selected countries (UK, USA, Canada, Australia), this article explores and critically evaluates models of MOW delivery addressing these challenges. Findings suggest that MOW services are utilising a marketised approach, moving outside of the home and incorporating diverse volunteer roles. These findings demonstrate how services such as MOW can develop sustainable approaches to service delivery in a contemporary context. Key Practitioner Message: ?A review of innovative MOW highlights service models of broader applicability;?Varied delivery models and more diverse volunteer roles appeal to new sources of volunteers;?Research into the development of sustainable models with positive client social outcomes is now required.