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.     

Long-term care reform in Korea: lessons from the introduction of Asia's second long-term care insurance system

Korea was the second Asian country to introduce universal long-term care insurance in an attempt to meet the challenges posed by its ageing population. This article presents an overview of the key issues that were involved in designing and implementing the new Korean system and the lessons that have been learned. Although the government reformed the long-term care system, a number of new challenges have emerged, such as its limited coverage and the unethical behavior of service providers. These problems appear to be closely associated with the scheme's initial design flaws and the government's passive responses to these problems.     

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.     

Administrative Buy-in for User Participation in Managing Social Services

Abstract

This paper reports the findings of a study conducted in Hong Kong on the value position of the social service providers regarding user participation in service management. Using a survey instrument to collect data from 642 service providers in an elderly service organization, the study explored whether or not the value position had an effect on the views of the service providers on the structural set-up for user participation, and whether the value position of the professional staff was significantly different from that of the non-professional staff. Exploratory factor analyses (EFA), confirmatory factor analyses (CFA) and structural equation modeling (SEM) were applied in the analysis. The findings identify that administrative buy-in needed to support shared decision-making with the welfare service users has not been achieved in the studied organization, owing to the absence of value commitment to the user participation cause. As the professional staff was more supportive of values favoring user participation, the paper calls for an acculturation process that would be stimulated and led by professionals to develop a participatory culture. The paper also recommends conducting similar study on a larger scale and qualitative inquiry into factors influencing the formation of values about user participation in future research.     

Elderly Consumers and Social Care Policy

The development of social care policy for elderly Australians is proceeding with little regard for the preferences and perspectives as expressed by the elderly themselves. The likely consequence is a continuation of policies based largely on other people's assumptions about what elderly people actually need and the extension of service categories into which many elderly people do not easily fit. Discussions with 71 elderly consumers during 1983 in Queensland established that they have input to make into policy and service delivery issues such as the provision of information on services, the determination of needs, the extension of choices between alternative services and choice of appropriate service providers. Social care policy should not continue to develop around singular and untested assumptions concerning what elderly people need and prefer.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Lesbian Health Care: Women's Experiences and the Role for Social Work

ABSTRACT

Lesbian patients and their families may be exposed to discriminatory practices in the health care system. This qualitative study of 57 Midwestern lesbian parents used open- and closed-ended questions to examine the experiences the respondents had with their primary and secondary health care providers. Four themes emerged from the data: systemic barriers to health care, coming out to providers, seeking lesbian, gay, bisexual, and transgender-friendly health care providers, and concern about mistreatment and prejudice within the health care system. Implications for service delivery, health care education, and directions in policy and research are explored.     

Overcoming Barriers to Serving the Aging/Mental Health Client

This paper presents a model, based upon a series of state-level initiatives in the Commonwealth of Pennsylvania, for improving coordination between the aging and mental health systems to better serve elderly persons with mental health problems. The mental health needs of the elderly are discussed and service delivery obstacles - systemic, individual, and agency/staff - are reviewed and synthesized. Policy initiatives by the Commonwealth of Pennsylvania that relate to these issues are presented as a case study, with a focus upon a series of regional conferences held around the state for providers in the aging and mental health networks to encourage better coordination of services. The process and outcomes of these conferences are discussed, together with an analysis of the implications for practice, policy, and teaching.     

The Relationship between Public Long-Term Care Insurance Awareness and Preparation for Later Life in South Korea

An increased focus on individual preparation for later life paired with a shift in family support within South Korea makes it necessary to study factors that influence preparation for later life among South Korean adults. This study examined whether the awareness of public long-term care insurance (LTCI) was related to South Koreans' financial, psychosocial, and physical preparations for later life. Data from the third wave (2009) and third supplement wave (2010) of the Korean Retirement and Income Study (KReIS) yielded a sample of 2,487 middle-aged adults. Multiple regression analyses were used to compare the influence of the awareness of public LTCI on financial, psychosocial, and physical preparation by dividing the sample into negative status and positive status groups based on subjective perceptions of current economic, relationship, and health conditions. The results showed that being aware of public LTCI increased preparation for later life in financial, psychosocial, and physical domains. In addition, participants in the negative status group had higher scores for psychosocial and physical preparation than individuals who perceived themselves as being in relatively better situations. These findings suggest that the policy makers and practitioners should include education on LTCI and the risks it targets across various preparation domains as well as account for differences in perception and preparation among sub-populations of middle-aged adults in order to ensure effective social policies for the elderly population.     

Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town

The article reports on an exploratory study that examined access to alcohol and other drug treatment for historically disadvantaged communities in the Cape Town metropole. In-depth interviews were conducted with 20 key informants from various sectors of the alcohol and drug treatment system, including treatment service providers, members of local drug action committees and social workers from district social service offices. Findings highlighted three structural barriers to service delivery: (i) difficulties in developing and implementing a strategic plan relating to alcohol and drug problems due to poor capacity and other infrastructural issues, such as a lack of information, poor intersectoral collaboration and limited consultation with service providers; (ii) limited allocation of resources to alcohol and drug treatment which has restricted the availability of affordable services as well as the capacity of established services to meet increased demand for services in this area; and (iii) fragmented service delivery. The study highlighted the need for further transformation of the South African social welfare system responsible for alcohol and drug treatment service delivery through public–private partnership development and the introduction of a management information system.     

Service Process and Quality in Therapeutic Foster Care: An Exploratory Study of One County System

ABSTRACT

This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers observed failures in service and in adherence to national program model standards and state regulations. The research indicates the need for consistent monitoring of child-placing agencies and the need for additional research linking service quality with foster care outcomes.     

Social Work Education in Mainland China: Development and Issues

The present paper gives an overview of the current trend of social work education in Mainland China, a fast-expanding academic subject of higher education in Mainland China during the last 20 years. This rapid development was brought about by the increasing recognition of the use of social work knowledge in tackling some of the social problems arising from the social and economic changes induced by the open door policy of China. New initiatives were undertaken by government departments, academic institutes and service providers, to explore possible reform of service delivery models in serving the elderly, children and youth, women and other vulnerable groups. It thus creates demands for personnel with new skills and knowledge. It has also led to the promulgation of government policies in 2006, in establishing a strong work force of social work, by setting up an accreditation system for social work as a vocation, making available funding for service development and setting up of NGOs. This paper also highlights some of the imminent issues that cause concern, such as the search for a theoretical model of social training and practices suitable for Chinese society, standardization of curriculum design, teaching and learning, consolidation of accreditation examination and career structure, and creation of a working environment conducive to the professionalization of social work in terms of motivating and retaining social work graduates to stay in the service sector.     

Continuum of Care as a Policy Framework for the Social Health Care Needs of the Elderly

For some time the continuum of care has intrigued social planners and policy analysts as a concept with potential for influencing the delivery of social services. More recently, the Older Americans Act, as amended, 1978, includes the mandate to State Units and Area Agencies on Aging to provide a continuum of care for the vulnerable elderly. This state of the art review examines the continuum of care concept by isolating areas of consensus, highlighting points of disagreement, and identifying issues relevant to continuum of care as a conceptual framework for policy decisions and service delivery to the elderly population.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

Implementation of a Community-Based Approach to Dementia Care in England: Understanding the Experiences of Staff

ABSTRACT

Given the increasing numbers of people living with dementia, it is imperative that new, practical solutions are found to the issues faced by this group of people and their families. This article draws on findings from a qualitative study that explored the implementation of a community-based project to support people living with dementia in one local area in England. This approach has different names; in the United Kingdom it is Shared Lives or adult placement, which would be most comparable to family care in Europe and adult foster care in the United States. Interviews were conducted with 14 staff connected to the Shared Lives project. Interview data were coded using the normalization process theory constructs of coherence, cognitive participation, and collective action. Supportive program factors identified were a dedicated staff member and resources, and the availability of specialist knowledge and skills. Detriments to program success included lack of understanding about the service, perceptions it was a poor fit with existing practice, and wider organizational issues that negatively affected normalization of the intervention. Suggestions for future research go beyond staff opinions, stressing the importance of using a wider range of stakeholders and incorporating measurement of outcomes for people using the service.     

Youth Experiences Survey (YES): Exploring the Scope and Complexity of Sex Trafficking in a Sample of Youth Experiencing Homelessness

ABSTRACT

In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth.     

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.     

End-of-Life Care and Social Work Education

Summary

Social workers are major service providers to people who are facing end-of-life issues including the terminally ill and their families. Yet, exemplary models for social work education and intervention methods are limited in rural states. A statewide survey conducted in Kentucky found only two social work courses dedicated to end-of-life care currently being offered by accredited undergraduate and graduate institutions. Another statewide survey found that many hospice social workers are relatively inexperienced and have a need and desire for more education on death, dying and loss. Also, unique cultural, economic and geographic areas, such as Appalachia are enigmas when it comes to the provision of end-of-life care. This partnership provides a varied perspective on delivery of end-of-life care services with an emphasis on social work interventions and education.     

我国养老机构的地位、性质及运行方式研究

本文从当前养老机构存在的问题入手,通过对服务对象(老人)入住机构的原因和需要的论述,阐明了直接的服务提供主体(养老机构)的地位是长期照顾服务连续体的一个环节,在社会服务体系中发挥托底作用,应该保证较高的服务质量;养老机构在福利社会化的政策背景下兼具福利性和"准市场"性;在运行方式上应该实现各个福利提供主体之间的协调等观点。并通过总结发达国家和地区的相关经验,提出应该明确政府、行业协会、养老机构、市场几个方面的角色地位,协调好相互之间的关系,并注意发展长期性服务项目,进行科学的规划,发展适度普惠型的福利政策等建议。     

Towards Understanding Variations in Social Care for Older People in England

Indicators of the public provision of old age social care are routinely recorded in England and have been used for diverse purposes including performance monitoring. Despite long‐term policy guidance promoting more homogeneous service provision, large variations can still be observed between local authorities (the providers of state‐funded social care). Our aim is to better understand such variations in a small selection of key aggregate indicators. Drawing on multiple data sources and pursuing a two‐step strategy, we first assess the explanatory power of a set of structural predictors and then add to the models a set of specific care management ‘process’ predictors. We find that structural factors beyond the control of local authorities explain a considerable share of the observable variation. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when aggregate indicators of service provision are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. Past attempts to influence the aggregate pattern of service provision – apparently seeking greater ‘territorial justice’– are likely to have had adverse implications for service users and the uniformity of service delivery across England. Questions are raised about the adequate role of central government in a policy environment characterized by longstanding local government responsibility.