Resource Allocations to the Aged According to Greatest Social Need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their everyday lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (|ß_i|/Σ|ß_i|) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.     

Living Arrangements and Informal Social Support Among the Elderly

One of the most pervasive patterns in living arrangements observed among today's elderly has been the increasing propensity to live alone. This paper assesses the extent to which living along, living with a spouse, or living with others (no spouse present) affects several dimensions of informal social support. The data for this study are from a 1983 survey focusing on living arrangement choices among elderly persons living in London, Ontario, Canada. Overall, living arrangement is considerably more important as a determinant of instrumental support than social contact. Elders choosing to live alone appear to sacrifice some degree of mutual exchange for privacy and independence. They also tend to rely on friendship to a greater extent than marred elderly or those who co-reside with others. Implications for support services and changes in the family are discussed in the context of living arrangement selection in later life.     

Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Social gerontology in developing countries. A report by participants in the International Short Term Course on Social Gerontology organised by the International Institute on Aging (United Nations,Malta), 17-29 February 1992

Prior to the International Short Term Course on Social Gerontology, organized by the International Institute on Aging in Malta, participants filled in a brief questionnaire regarding their personal views on the socioeconomic situation of the elderly. The questions dealt with: the definition of the elderly as understood by the respondents; availability of statistical data on the elderly regarding gender, marital status, location, immigration, industrialization, and the impact of urbanization; existing training facilities in gerontology in their countries; old age as perceived by the elderly population; socioeconomic problems faced by the elderly; degree of participants' involvement in working with the elderly. An attempt was made to quantify the views expressed by the participants. Countries with more than one representative--Argentina (2), China (4), Jamaica (2) and Malta (13)--each had their responses summarized as one contribution to this survey. The participants' replies were represented by a frequency distribution of 16 countries. In 9 out of 16 responses, elderly was defined as a chronological age. Females were almost always described as the majority gender represented in old age (13 out of 16). The state was identified as the greatest provider of special services, with the exception of religious organizations in only 2 of the countries. The most difficult problems of the elderly were defined as a lack of economic support, ill health, and social isolation. 8 out of 16 respondents described being active as the most important for the elderly. Governments are urged to provide for their senior citizens and their care-giving members who, in turn, are encouraged to support more elderly persons in developing countries.     

Predictors of Use of Senior Centers by Elderly Chinese Immigrants in Canada

Abstract

This study examined the prevalence and predictors of use of senior centers by a random sample of 1,537 elderly Chinese immigrants in Canada. A service utilization model of Andersen and Newman (1973) was adopted as the theoretical framework to examine the predicting effects of predisposing, enabling, and need factors. The findings showed that 28.8% of the elderly Chinese immigrants reported using a senior center within the past year. Having a religion, living alone, having stronger Chinese ethnic identity and stronger social support were the significant predictors identified, as shown in the hierarchical logistic regression findings.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Supportive Housing Initiatives in Arkansas

Abstract

Arkansas has a significant need for improving the availability of affordable housing with access to supportive services for its large population of elderly and persons with disabilities. Factors that contribute to this need are the high level of poverty, general poor health, low employment rate for persons with disabilities, and the geographic and social isolation problems typical of a rural State.     

Naturally Occurring Retirement Community-Supportive Service Program: an example of devolution

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

Demography of Indian aging, 2001-2051

India is the second largest country in the world, with 72 million elderly persons above 60 years of age as of 2001, compared to China's 127 million. One of the objectives of this paper is to assess the emerging scenario of elderly for the first half of the 21st century. According to projections, the elderly in the age group 60 and above is expected to increase from 71 million in 2001 to 179 million in 2031, and further to 301 million in 2051; in the case of those 70 years and older, they are projected to increase from 27 million in 2001 to 132 million in 2051. Among the elderly persons 80 and above, they are likely to improve their numbers from 5.4 million in 2021 to 32.0 million in 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health services and pension and social security payments. Mobilizing resources for geriatric care and providing sufficient maintenance for the elderly will emerge as a major responsibility for heath-care providers and pension economists.     

The effect of age desegregation on environmental quality for elderly living in public/publicly subsidized housing

A random sample of elderly living in age-desegregated public housing for the elderly is compared with a random sample of elderly living in age-homogeneous Section 202 housing in the same urban area. Findings suggest that the current trend of mixing young handicapped persons with elderly tenants is associated with a decline in environmental quality on three dimensions--social networks, territoriality, and global measures of satisfaction. The differences are not explained away by pre-existing factors, such as social and economic resources and service provision.     

Naturally Occurring Retirement Community-Supportive Service Program

Summary

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

Distribution and Utilization of Home- and Community-Based Long-Term Care Services for the Elderly in North Carolina

ABSTRACT

Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Demography of Indian Aging, 2001-2051

Summary

India is the second largest country in the world, with 72 million elderly persons above 60 years of age as of 2001, compared to China's 127 million. One of the objectives of this paper is to assess the emerging scenario of elderly for the first half of the 21st century. According to projections, the elderly in the age group 60 and above is expected to increase from 71 million in 2001 to 179 million in 2031, and further to 301 million in 2051; in the case of those 70 years and older, they are projected to increase from 27 million in 2001 to 132 million in 2051. Among the elderly persons 80 and above, they are likely to improve their numbers from 5.4 million in 2021 to 32.0 million in 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health services and pension and social security payments. Mobilizing resources for geriatric care and providing sufficient maintenance for the elderly will emerge as a major responsibility for heath-care providers and pension economists.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

Eldercare policy between the state and family: Austria

Certain aspects of the Austrian system of social security and public welfare for the elderly, on the one hand, and family caregiving, on the other hand, are reviewed. In 1993, a new attendance allowance act for needy persons is being introduced in Austria. This reform includes cash payments on seven different levels according to the degree of need and is supposed to increase the opportunity of choice for the elderly. This assumption remains dubious; it should not be expected that a significant number of new informal caregivers can be recruited. Furthermore, empirical evidence shows that the elderly themselves clearly prefer the expansion of social services over paid family caregiving. There is a need for more research regarding the effects of interaction among the elderly, the family, and professional caregivers and for the promotion of an empowerment approach.     

Distribution and utilization of home- and community-based long-term care services for the elderly in North Carolina

Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.