The 'Consumer Principle' in the Care of Elderly People: Free Choice and Actual Choice in the German Welfare State

In the mid-1990s, together with new long-term care legislation, the German welfare state introduced care markets and consumer choice between family care and different types of formal care. However, instead of using the new option to choose publicly funded care by long-term care agencies, the majority of elderly people in need of care continued to decide in favour of care exclusively provided by family members. The article examines how the persistence of family care in spite of the new options of consumer choice can be explained, using data from representative surveys on the care of elderly people in Germany and the results of guided interviews by the authors with family members involved in care. The findings indicate that there are two main reasons. The first is that elderly people and their families orient their behaviour towards traditional care values in which the first priority is given to mutual support between spouses and generations. The second reason is that elderly people on the one hand and care agencies on the other have substantially different definitions of a good quality of care.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

Ageing and Family Dependency

The ‘graying’ of Australia's population has generated much debate within government, demographic, health and social service circles in recent times. Current and projected shifts in population structure towards greater numbers of ‘dependent’ populations raise a number of complex issues in regard to resource allocation in both income support and service provision. Service issues revolve around questions of whether public or private provision will resolve the care issues for dependent elderly people. It is argued that contrary to popular opinion, family care is well entrenched within the framework of social care, and that the solution of community care, posited in relation to the rising levels of chronic illness and dependency within the elderly population, is actually an attempt to place more responsibility of care on to the family. It is further suggested that family care is, in fact, care by women who themselves are in a state of dependency. Citing evidence from a study conducted by the authors, the paper argues that family care imposes heavy burdens upon women and families and suggests that social policy should, firstly, actively bolster family care through the provision of supportive and supplementary services; and secondly, broaden its intent by exploring other options of care for elderly people. The latter response is important because without it, family care will only help to reinforce and sustain the dependent status of women.     

Aging in the Third World

The relationships between the generations in Third World countries are changing as migration and industrialization erode traditional family responsibilities for supporting the elderly. It is no longer possible to assume that, as a matter of course, old people will be looked after by their families. Social change leads to an eroding of the support systems. The author finds growing evidence of this breakdown in Asia, particularly in Singapore, Hong Kong, and other highly industrialized centers. Singapore, for example, has reinstituted the compulsory study of filial piety in an attempt to push the younger generation into assuming its traditional responsibility toward the old. There has also been a significant decline in the status, prestige, and support given old people in Indonesia, although politicans insist that the family will always take care of its elderly. 2 reasons for this breakdown are 1) the impact of the mass media and 2) the increasing involvement of the younger generation in non-agricultural jobs which often involve a move to the city and away from dependence on a patriarch. Many Third World countries are in a twilight stage, between the traditionally strong structure of family support and government systems of social security.     

子女需求对城市家庭居住方式的影响

本文使用中国家庭动态跟踪调查2010年初访数据,着重分析了子女需求对城市家庭居住方式的影响。研究发现,子女需求是导致年轻夫妇与父母同住的重要原因,这种需求一方面表现在经济上,尤其是在住房上对父母的依赖;另一方面表现在需要父母分担家务和帮助照料小孩。所以,除了父母的养老需求,子女需求对城市家庭居住选择的影响也同样不容忽视。在现代化和人口流动的背景下,虽然城市家庭有核心化的趋势,但由于当代中国城市家庭依然发挥着不可替代的重要功能,大家庭在未来依然有继续存在的必要性。     

Who is my family?: A comparative study of the family boundary in East Asia

Most Asian countries are regarded as Confucian countries although each has its own historical and cultural background. Little is known about how people in different Asian countries perceive their family boundaries. This study is an attempt to compare the perception of the family in China, Japan, and Korea. We examined the family perception and found substantial differences among the three. Chinese people showed the widest and paternally extended perception of family. Data from people in Korea nearly matched data from China, but family perception developed bilaterally. People in Japan, however, perceived only blood-tied, intimate relations as family members. In addition, the perception of the family was not substantially different between the genders in Japan and China, but in South Korea, men perceived family boundaries more widely than women, implying that women have a greater family burden than men in Korea. Considering the heterogeneity in family perceptions in these countries, this paper tries to explain how social institutions interact with individuals and impact the perception of family. Finally, this paper concludes that it is inappropriate to tie the three East Asian countries as ‘Confucian civilizations’ in terms of family perception.     

SOCIAL CARE FOR THE AGED IN THE UNITED STATES

This paper reviews some of the impact of industrialization on the kinship structure and the shift in familial versus societal role re the elderly. Formal and informal networks of services and relationships are discussed: some needs and gaps in service identified. Thc role of women in filial responsibility within the modern family situation is noted and the need for increased supports identified. The author warns that both formal and informal systems-functioning complementary and optimally, are needed by the increasing number of elderly people.     

市场化、社会转型与城市郊区农村老人的“轮养”——来自子女口述史的分析

通过对河北省保定市郊区农村的深入访谈和问卷调查，本文研究了有两个以上已婚儿子的老年夫妻去世前的生活状况。研究发现，儿子成年之后的独立门户，是这类老年夫妇“宁巢”的前提，而“空巢”又是“轮养”契约得以建立的条件。市场化、社会结构转型、儿媳妇在家庭决策中作用的增强等，使老年人失去了家庭决策权。故“轮养”在生命过程中，实际是被安排的结果，而不是老年父母自己的选择。     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Land Collectivization and the Structural Transformation of Traditional Rural Families

We use oral history materials from elderly rural people aged over seventy to analyze the circumstances of rural family production and daily life prior to collectivization in the mid-1950s; during collectivization in the 1950s to the 1970s; and under the household contract responsibility system of the late 1970s. We find that the transition from the traditional to the nuclear family did not involve industrialization in the traditional Western sense. As an early state industrialization strategy after 1949, rural collectivization fundamentally changed the organizational pattern of traditional family production and daily life and of inter-generational relations and structures under the patriarchal system, launching the historical process of structural transition in the family. This explanation differs from the classic “theory of modernization” of family change.     

The Rules of the Game: The Politics of National Pensions in Korea

This article explores the conditions in which policy changes occur over time. It studies the institutional pathways taken by national pensions in Korea over an extended period by identifying the key moments which have pushed through their development: initiation (1973), implementation (1988) and reform (1998). Public pensions have developed over time in an incremental fashion, bringing an ever‐growing proportion of the population under their umbrella. What accounts for this development? A number of factors may be at work. The elderly population has rapidly increased; the traditional extended family has increasingly become a nuclear one, meaning that what used simply to be a family issue of protecting the elderly has become a social matter; urbanization and industrialization have resulted in an ever‐growing number of life‐time contingencies such as unexpected income losses. Convincing as these socio‐economic accounts may seem, however, they offer only a snapshot, underscoring the politics of national pensions which stretch over long periods. This article seeks to answer how and in whose interest national pensions come on to the political agenda; how they are framed and defined; and how political actors respond to pressures for national pension reform. In each of the three stages, it is suggested, somewhat different institutional rules have operated. Defining institutional rules as ‘the process of who gets represented in the decision‐making processes’, this article identifies the different institutional rules which have played a pivotal role in the social policy‐making processes.     

Caring while living apart

In recent years, researchers have paid increasing attention to the issue of care in the new types of family and partner relationships. The aim of this study is to examine expectations and attitudes concerning care among elderly people in LAT (Living Apart Together)- relationships in Sweden, that is, people who have a long-term intimate relationship, but who do not share a common home. Questionnaires were completed by 116 elderly people in LAT-relationships. Partners are ranked as the main providers of care, especially by men, but there is considerable variation in the answers. This seems to be principally related to the degree of flexibility in this type of relationship. Some individuals see a LAT-relationship as a marriage-like relationship, while others see it primarily as a type of relationship that guarantees them the possibility of maintaining their own independent way of life.     

应对人口老龄化挑战的中国道路

老年人口的养老负担问题、代际关系问题以及价值实现问题是影响中国未来可持续发展的三个关键性问题。从经济学视角看,就是生之者寡和食之者众的关系问题;从社会学角度看,有一个资源和权力分配的代际冲突和老年价值实现问题;从人口学视角看,计划生育弱势老人的比例在上升,今后中国会出现大量的“计划生育老人”,提出“计生老人”概念的意义在于,国家各级政府和部门要凸显人口计生公共服务的公益性和福利性。中国作为一个先老后富的国家,人口老龄化带来的挑战是长期的、多样的。本文提出了成功老龄化的战略构想,包括健康老龄化、积极老龄化、和谐老龄化和幸福老龄化。在应对人口老龄化和老龄问题挑战的过程中,中国社会逐渐走出了一条传统与现代相结合的中国道路,概括说：就是以家庭养老、单位（集体）养老和自我养老为基础,以社区助老、福利助老、慈善助老为补充的中国道路。最后,本文作者对本专题几位学者的观点在“中国问题和中国选择”的框架内进行了综合性的介绍和评论。     

From reforms to rationing? Current allocative trends in social services in Sweden

In Sweden, the current national deficit is putting immense pressure on all government spending. Economic recession and increased levels of unemployment have jointly altered the image of the welfare state and redirected focus on it as a financial burden. A matter of considerable political and public concern is the consequences of the economic constraints on social services - the part of the welfare programs carried out by local authorities. This article raises concerns of resource allocation, starting from an outline of the impact of economic developments on different sectors of the social services. Expenditure for elderly care, child care and individual and family care is analyzed in the light of demographic changes and coverage rates. A main focus is put on the most recent development and the perceivable strategies for managing the financial cut-backs are discussed in detail. Two strategies stand out as central. One is dilution, which is granting help to an unchanged number or proportion of people granted help, combined with a decreased level or altered quality of the service provided. The other is focusing, where eligibility is defined more narrowly and in the normal case results in a consistent or even improved level of service to the most needy. Dilution seems to be the major strategy for child care and focusing the allocative trend in services for elderly people.     

THE USE OF SOCIAL SERVICES BY BLACK AND WHITE ELDERLY

Little is known about the roles of the family, kin, and non-kin support networks in determining the use of social services by the elderly. The purpose of this study was to examine the role of the formal and informal support systems in explaining social service utilization by Black and White elderly. Path analytic procedures are used to test an explanatory model of utilization by a national area probability sample of 3.996 non-institutionalized elderly. The findings indicate that informal family support was more important for Black elderly than White elderly. In addition, family aid was found to be supplementary rather than an alternative support system. In the planning, designing, and delivery of social services to the elderly, it is imperative that racial and cultural differences become explicit input factors. Additionally, future researchers have a responsibility to employ research procedures capable of simultaneously dealing with a comprehensive range of variables in investigating this rather complex phenomenon.     

Care of the Elderly—A Project,a Protest,a Survey and a Plan

Rehousing of elderly people in Australia has generally not been preceded by research into the kind of assistance that is necessary. An example is given of how an attempt was made to discover the needs of the elderly disabled in a small country community. Assessment by observation of people at home revealed the need for assistance for them to stay where they were. Home Care organized from the district hospital is often a more appropriate answer to this problem than the building of expensive and unnecessary institutions.     

This Old Stereotype: The Pervasiveness and Persistence of the Elderly Stereotype

Americans stereotype elderly people as warm and incompetent, following from perceptions of them as noncompetitive and low status, respectively. This article extends existing research regarding stereotyping of older people in two ways. First, we discuss whether the mixed elderly stereotype is unique to American culture. Data from six non-U.S. countries, including three collectivist cultures, demonstrate elderly stereotypes are consistent across varied cultures. Second, we investigate the persistence of the evaluatively -mixed nature of the elderly stereotype. In an experiment, 55 college students rated less competent elderly targets (stereotype-consistent) as warmer than more competent (stereotype-inconsistent) and control elderly targets. We also discuss the type of discrimination—social exclusion—that elderly people often endure.     

老年休闲与居家养老——以上海市某社区老年人休闲为例

截至2008年底,中国60岁以上老年人口近1,6亿,占总人口的12％。迅速到来的老龄化让整个社会聚焦养老问题,通过多年的摸索、试验、论证,各界大多认为社区居家养老是应对人口老龄化挑战的重要方式。老人退休后基本处于休闲状态,那么老年人的休闲活动与居家养老有无内在关系,是否会影响居家养老模式的推行呢？鉴于此,作者通过对老年人日常休闲的调查研究,试图揭示它与社区养老的内在逻辑,并就如何提高老年人的生活质量和顺利推进居家养老模式提出相应的对策。     

The Experiences of Reciprocity among Filipino Older Adults in Canada: Intergenerational,Transnational, and Community Considerations

ABSTRACT

This article illustrates the concept of reciprocity in the context of immigrant families. It recommends that definition of reciprocity account for exchanges beyond the immediate family, and render visible the simultaneous location of older people as care recipients and providers, and care arrangements across generations, borders, community, and time. Adopting a critical ethnographic study on the aging and care experiences of older Filipinos in Canada, this article analyzes data from extended observations and in-depth semi-structured interviews with 18 older people, 6 adult children, and 13 community stakeholders. Findings highlight the unique configurations of care among the Filipino community whereby older people engage in care exchange as active participants across intergenerational, transnational, and fictive kin networks.     

Patterns of Social Support in the Middle Childhood to Early Adolescent Transition: Implications for Adjustment

Children's social networks often include close family members, extended family members, and friends, but little is known about interindividual differences in the patterning of support from these sources. In this study, we used person‐oriented analyses to differentiate patterns of support for children undergoing the transition to adolescence. Social network and adjustment data were collected for an ethnically diverse sample of 691 fourth‐ and sixth‐grade children, with a two‐year follow‐up. Cluster analyses identified one pattern of support from both close family members and friends, a second pattern of support from both close and extended family members, and a third pattern of support primarily from close family members alone. Participants receiving support from close family in combination with either extended family or friends were better adjusted than were those without multiple support resources. The results suggest that a meaningful typology of children's social networks can be developed.