Will You Still Need Me,Will You Still Feed Me?—Paying for Care in Old Age

A major issue for social policy in the twenty-first century will be providing good-quality support and care for older people. However, recent debate about this has been driven more by ideology than by evidence. This paper examines the socio-economic, demographic and policy changes that are influencing the debate, and outlines findings from current research on attitudes towards financial planning for care in old age. This shows that the majority of people feel that the state should provide or pay for care for older people, either through a means-tested system or one which provides some basic level of protection which people can choose to enhance through their own means. However, only a minority would be willing to pay themselves for this, either directly through increased taxation or indirectly through reduced prospects of inheritance of housing capital. The paper concludes with a discussion of the policy implications of these findings.     

Defining responsibility for care: approaches to the care of older people in six European countries

This article examines the social care of older people in six contrasting European countries. Family, institutional and community care are compared, focusing on vulnerability, empowerment and the gatekeeping of resources. The article considers the position of older people in each care system by presenting individual case studies. The six countries include the family-oriented systems of Ireland, Italy and Greece, and the individual-oriented systems of Denmark, Norway and England. To improve the care of older people in any of these welfare cultures, resources need to be developed that work with existing sources of care but extend the rights of older people, at least to assessment and an equitable matching of needs to the care services available. Overall, the different levels of provision of organised social care services are a major aspect of inequality within and between the countries. Whilst there is little prospect for any major policy transfer across national boundaries, there is potential for selective cross-national learning with regard to particular service developments.     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

A Comparative Discussion of the Gendered Implications of Cash-for-Care Schemes: Markets, Independence and Social Citizenship in Crisis?

There are moves across many countries away from state-led provision of services for disabled people towards cash-based systems, which have been welcomed by disabled people as increasing choice and control over services and support, and increasing independence and social participation. However, feminist scholars have long warned about the implications of commodifying care for women, and the possible consequences of substituting cash for services for social citizenship have remained underexplored, for both disabled people generally, disabled women and mothers more particularly, and for personal assistants/care workers. This article will attempt to address that gap by carrying out a comparative literature review and policy analysis of the role of policy development and outcomes in cash-for-care schemes, looking comparatively across policy developments in several countries, as well as developed welfare states beyond Europe to examine: (a) the impact of the tensions between various governance levels, particularly local and national government; (b) the gendered impact of such policies on (for example) gendered divisions of paid and unpaid work, citizenship and social participation; (c) the impact such policies have, or are likely to have, on different groups of men and women across the life course and across different social and economic groups; and (d) how such policies can contribute to the well-being and/or detriment of different groups of women (and men) within different social, political, economic and historical contexts.     

Implications of Subsidiarity for the Care of Older People in Germany

This paper examines definitions and origins of the principle of subsidiarity and its application to welfare systems of the Federal Republic of Germany (FRG) with particular reference to the care of older people. The German corporatist welfare system is influenced by conservative views about status relations and Catholic teachings on family responsibilities. Since unification of Germany in 1990 new care systems based on the principle of subsidiarity have been imposed in eastern Germany. The FRG's social insurance system based on entitlement benefits those fully employed, while women and marginalized groups with low status in the labour market are poorly covered by insurance and may have to rely on stigmatizing means-tested social welfare based on subsidiarity. Access to pluralist, fragmented care services depends on eligibility for funding through insurance or social welfare or else on ability to pay. Social care is poorly developed because of the emphasis on insurance and the medical model as well as on the principles of subsidiarity and self help which place an explicit duty on the family, mainly women, to care.     

Contested Housing Landscapes? Social Inclusion,Deinstitutionalisation and Housing Policy in Australia

Deinstitutionalisation is represented as a major step toward social inclusion through the resettlement of disabled people residing in segregated large‐scale institutions into community‐based homes. By promoting the right to live in ordinary community residential settings, deinstitutionalisation fundamentally changes both the support services and housing arrangements of former institutional residents. In Australia, as in many western countries, debates on community care have tended to focus on the location and nature of non‐housing supports for people leaving dependent care. This focus, however, overlooks the fact that deinstitutionalisation involves a radical rehousing of people in care. This paper explores the character and implications of deinstitutionalisation in Australia as a rehousing process. It is based on a recent national research project that has examined the housing futures of people with intellectual disabilities who have been, or will be, deinstitutionalised. The paper considers the increasingly divergent socio‐political perspectives that have emerged in recent discussions about social inclusion, institutional reform and independent living and their implications for housing and community care policies.     

Globalization, Inequality and Social Policy: China on the Threshold of Entry into the World Trade Organization

Over the past twenty years, social researchers have had increasingly to turn from domestic to international and global perspectives in their efforts to account for growing levels of social inequality and in their search for practical policy solutions. It is against this background that China's recent experience is to be appreciated. The combined programme of economic reform coupled with an open-door policy has achieved much, yet has been accompanied by marked increases in social inequality. Until recently, most experts seemed to believe this trend to be a mere transitional "by-product" of domestic economic reform. Further social reform, backed by sustained economic growth, would be sufficient to resolve the problem. However, the facts now suggest otherwise. Sustained economic growth and reform, especially from the later 1990s, has been accompanied by ever-widening social inequality, with no signs of an end in sight. This is a critical period. China is now on the eve of entry into the WTO, with all the anxieties as well as rewards this signals for the Chinese people. Against this background the present paper weighs up the likely impact of globalization on China's social structure and its systems of social protection. It concludes by offering suggestions for international social policy advance both "longitudinal" (between developed and developing countries) and "latitudinal" (between developing countries in competition with each other). Only by means of such "joint efforts" might China hope to escape the "social protection dilemmas" associated with entry into the WTO.     

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.     

Income security for older people: An Asian perspective

In Asia and the Pacific, as in other developing regions, the continuing growth of the aged population has a great impact on social security programmes generally and, in particular, on the income security of older persons. In societies where traditional support systems are breaking up, their need for social security protection is increasingly important. A system of social security for the elderly population exists in most countries of the region. Many are provident fund schemes, which are basically saving schemes, and their coverage is low. Where social insurance pension schemes exist, the levels of benefits provided are also low. The focus for future development, therefore, lies in converting the savings schemes into multitiered pension schemes, extending their coverage and raising the level of benefits. In this context the critical question concerns the role of the State and the type of schemes used. The need for public pension schemes is great in Asia and the Pacific, where the level of poverty is comparatively high. Building pension schemes, whether public or private, involves a set of issues that need to be addressed. This article considers the systems currently in place and the challenges and limitations faced when considering the future development of social security in this area.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Exploring a blind spot in comparative pension reform research: Long‐term trends in non‐contributory pensions in Europe

Over the past two decades, pension reforms have been high on the agenda of social policy makers in Europe. In many countries, these reforms have resulted in less generous public pensions. At the same time, minimum income protection for older adults has received attention from policy makers, but much less so from social policy researchers. Therefore, this study explored how benefit levels of non‐contributory minimum income schemes for older adults evolved from 1992 to 2012 in 13 ‘old’ EU member states. Building on two cross‐national longitudinal datasets with comparative data on minimum income protection in Europe, the study shows that over the past 20 years, the erosion of the principal safety net of last resort for older persons has been limited. Moreover, a substantial number of European countries have pursued a deliberate policy of considerably increasing minimum income benefits.     

憨老家庭生存状况的个案研究

憨老家庭是指老迈家属照顾智障者的家庭。本研究对憨老家庭物质条件、精神状态、家庭内部支持和家庭外部支持四个方面的生存状况做初步的了解。研究方法：选择三个憨老家庭进行半结构的个案访谈。结果：（1）憨老家庭有居住和经济收入等基本物质保障;（2）老年监护人和残障子女之间有很好的支持;（3）憨老家庭的社会保障和福利主要来源于国家对老年人的政策;（4）社会支持系统对憨老家庭的支持还有欠缺。     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Protecting the Old in a Young Economy: Old Age Insurance in the West Bank and Gaza Strip

Taking the West Bank and Gaza Strip as a reference point, this paper looks at social protection in developing economies, which are beset by economic stagnation, widespread poverty and unemployment. If the main breadwinner dies, is unable to work or is an older person, these factors are prime causes of absolute poverty. This is hardly surprising, since private and public systems of social security are totally inadequate in this area in particular. Current thinking on social security suggests that what is needed is the rapid introduction of a comprehensive system of retirement provision, comprising a mandatory capital-funded insurance component, with defined contributions, administered on a decentralized basis; and a state-administered pay-as-you-go basic insurance component with lump-sum transfers to safeguard the poorest. A system of this kind works to prevent poverty in old age by redistributing funds from some individuals to others and ensuring an income for life, and it represents a compromise between a fair return on what people have contributed and a fair distribution over society as a whole. It is thus a major force for stability in society.     

社区照顾在残疾人社会保障中的运用

社区照顾最早产生于英国,自诞生以来,便以其新型的理念与模式日益受到各国学者和政府的重视。社区照顾作为一种专业化的照顾模式,在残疾人社会保障方面具有广阔的发展空间。本文试图将社区照顾的制度安排应用于我国残疾人社会保障事业,并探析我国残疾人社区照顾的模式,以推动我国残疾人社会保障事业向人性化、社会化、专业化方向发展。     

Sheltered Housing and Community

This paper considers the role of sheltered housing following the introduction of new community care arrangements in 1993 and examines the continuing uncertainty about its exact role as community care continues to develop. It reports on a study conducted in Shropshire, using a postal survey and interviews with older people and service professionals. The study highlights the importance of sheltered housing for older people, particularly in relieving them of concerns about maintenance and repairs, social isolation and security. These factors were crucial for their overall peace of mind and quality of life. While only a small proportion of tenants received help under social services' community care arrangements, the additional support, monitoring and service coordination provided by wardens helped some of them to remain in sheltered housing when residential or nursing home care might otherwise have been necessary. Sheltered housing was overwhelmingly popular with older people — but their satisfaction was closely associated with the availability and quality of the warden service. Although sheltered housing is not currently in vogue in housing policy, the paper argues that it plays a vital role in local provision for older people and needs to be more closely integrated into community care policy, while at the same time preserving the characteristics that make it popular with its residents.     

Choice and control in social care: Experiences of older self-funders in England

This paper considers the experiences of older self-funders in England in the context of policies promoting choice and control. Self-funders are people who are not state-funded; they pay for social care from their own resources. Choice and control have been operationalized through personal budgets, based on the assumption that managing resources enhances ability to access appropriate care and support. This paper uses data from 40 qualitative interviews with self-funders and their relatives, and 19 with professionals. It explores the impact of the financial and social capital that self-funders are assumed to have and asks how older self-funders experience choice and control. The study found that older self-funders drew on personal experiences, family, and friends for information; were reluctant to spend their wealth on care due to competing priorities; and felt they had more control over the timing of decisions than people who were state-funded. Personal wealth appears to be perceived differently to funds “gifted” to people through cash for care schemes.     

Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People

Risk management systems and structures are developing rapidlywithin UK health and personal social services. However, therisk management strategies of organizations need to take intoaccount the conceptual frameworks used by professionals. Thisgrounded theory study used data from nineteen focus groups andnine semi-structured interviews (ninety-nine staff in total)to explore perspectives on risk and decision-making regardingthe long-term care of older people. Focus group participantsand interviewees comprised social workers, care managers, consultantgeriatricians, general medical practitioners, community nurses,occupational therapists, home care managers and hospital dischargesupport staff. Social work and health care professionals conceptualizedrisk and its management according to six paradigms that appearedto be in a state of reciprocal tension: (i) Identifying andMeeting Needs; (ii) Minimizing Situational Hazards; (iii) Protectingthis Individual and Others; (iv) Balancing Benefits and Harms;(v) Accounting for Resources and Priorities; and (vi) Warinessof Lurking Conflicts. The effective translation into practiceof risk management strategies needs to address the complex andoften contradictory issues facing health and social servicesprofessionals.     

Reinvigorating the social contract and strengthening social cohesion: Social protection responses to COVID-19

The COVID-19 pandemic has exposed the vulnerability of those who are inadequately covered by social protection in more and less developed countries alike, and has exacerbated the fragility of a social contract that was already under strain in many countries. A weak social contract in the context of an exceptional crisis poses a very real risk to social cohesion. Nevertheless, many States have reasserted themselves as the guarantor of rights by protecting public health and incomes. By sustaining these measures, economic recovery will be supported which will help minimize risks that may weaken social cohesion. However, this is a fast-moving, inherently unstable and protracted crisis. Social protection stands at a critical juncture. Decisive policy action will be required to strengthen social protection systems, including floors, as one of the cornerstones of a reinvigorated social contract.     

HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.