Institutional care for elders in rural China

The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.     

Serving our (in)visible elders: The impact of a LGBTQ+ aging presentation on a rural college campus

ABSTRACT

As the number of individuals 65 and older continues to grow, so too does the richness and complexity of their identity. Specifically, the culture of aging within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community has received little attention in the literature. In order to best serve this population, human service professionals must understand the reality of aging within diverse communities. This article explores the impact of an invited campus speaker focused on LGBTQ+ aging on a rural college campus. Results indicate a general increase in overall knowledge and appreciation for issues directly impacting the aging LGBTQ+ community. Recommendations for practice, grounded in a social justice framework, are shared.     

Managing everyday (in)securities: Normative values,emotional security and symbolic recognition in the lives of Russian rural elders

Qualitative studies of ageing have called for attention to be paid to the diverse experiences of older people and to their agency in negotiating opportunities and constraints. A lack of research into the experiences and subjectivities of rural elders has been noted. Yet, the majority of research concerning elderly people in contemporary Russia continues to treat old age as a category and focus on particular practical and material forms of assistance available to pensioners. This article, aims to contribute to the small but growing body of ethnographic studies which shed light on the lives of elderly people in Russia as subjects in their own right. Based on ethnographic fieldwork from rural Siberia, the article explores the ways in which elderly people experience and interpret day-to-day (in)securities, forms of care and social support. In doing so the article explores three key questions: Firstly, how do lived realities, both past and present, and normative values of rural life intersect in elderly people's experiences of (in)security in post-socialist contexts?; Secondly, what forms of assistance do older people view as legitimate in their everyday lives? In particular, how are emotional exchanges and interpersonal connections interpreted and what securities do they bring?; Thirdly, what is the significance of symbolic support and recognition for elderly people and how do these draw on practices and frameworks from the socialist past?     

Social policies regarding caregiving to elders: Canadian contradictions

In Canada, disparate social policies--to do with health, family, income security, housing, and so forth--influence caregiving to elders. They are contradictory policies because of their different objectives, histories, and jurisdictions. The wider context of societal and socio-demographic changes highlight additional contradictions in the principles on which social policies regarding caregiving rest. Some of these contradictions are discussed in terms of policies, their consequences, whether intended or not, and what the future might hold for Canadian policies and programs with implications for caregiving to elders.     

The health needs of elders within an intentional community

A small-scale survey was carried out on the health needs of those members of the Findhorn Bay Community, in northeast Scotland, who were over the age of 60. The survey asked questions about their health, quality of life, support received and perceived needs in these areas. The responses of the elders are summarised and discussed. Most of the elders had health conditions which affected their quality of life, yet almost all were satisfied with the support they received and over half with their quality of life. Implications for the links between community, family, work and perceived health were identified. Une recherche a ete faite sur les besoins en sante des personnes ages de plus de 60 ans qui vivent dans la communaute de Findhorn Bay dans le nord est d'Ecosse. Il y avait un questionnaire qui leur demandait des informations sur leur sante, et qualite de vie; il leur etait aussi demande si ils se sentaient suffisamment soutenus et comment ils percevaient les differents besoins de leur vie. Les responses de les personnes sont brievement evoquees et discutees. Les implications concernant les rapports entre communaute, famille, travail et sante furent identifiees. La plupart d'entre eux avait des problemes de sante qui affectaient leur qualite de vie, cependant la majorite etait satisfaite du soutien recu, et plus de la moitie avec leur qualite de vie.     

Physical-performance tests to evaluate mobility disability in community-dwelling elders

The purposes of this study were to evaluate community-dwelling elderly adults with different levels of perceived mobility with 5 physical-performance tests, determine the cutoff values of the 5 tests, and identify the best tests for classifying mobility status. The community-mobility statuses of 203 community-dwelling elders were classified as able, decreased, or disabled based on their self-reported ability to walk several blocks and climb stairs. They also performed the functional reach, timed 50-ft walk, timed 5-step, timed floor transfer, and 5-min-walk endurance tests. We found in all tests that the "able" outperformed the "decreased" and that the "decreased" outperformed the "disabled," except on the floor-transfer task. The optimum cutoff values of the 5 performance tests were also reported. The 5-min walk and timed 5-step test could best separate the "able" from the "decreased," whereas the 50-ft-walk-test could best differentiate the "decreased" from the "disabled." The results suggest that community-mobility function of older adults can be captured by performance tests and that the cutoff values of the 5-min-walk, 5-step, and 50-ft-walk tests can be used in guiding intervention or prevention programs.     

Elder abuse and oppression: voices of marginalized elders

The voices of elderly people from marginalized groups are rarely solicited, and the relationship between elder maltreatment and belonging to an oppressed group has not been adequately investigated. This article reviews the literature on oppression and elder abuse and describes findings from the secondary analysis of data from focus group discussions on elder abuse held with marginalized older adults and (quasi)professionals caring for them in two Canadian cities. Participants identified that increased vulnerability to elder abuse was related to oppression experienced as a consequence of ageism, sexism, ableism/disability, racism, heterosexism/homophobia, classism, and various intersecting types of oppression.     

Getting by in the community: lessons from frail elders

This study explores how functionally impaired, elderly persons are able to remain in the community without home- and community- based care (HCBC) under the Medicaid program. Using HCBC administrative data, Medicare data, and survey data, we find the nonparticipants in the community appear to get by through a combination of reliance on informal care, use of Medicare home care, and going without needed services. Despite their efforts to manage their care in the community, non-participants were significantly more likely than the participants to enter a nursing home during the six months following assessment. While our analysis does not allow us to attribute the higher nursing home entry to the absence of HCBC services with certainty, the finding does raise questions about whether the elements of the HCBC program that discourage participation may save Medicaid dollars in the short-run at the expense of future Medicaid costs from more rapid nursing home entry.     

Disappointing and deviant youth and the rage of the elders

A generalized adult hostility toward youth derives from the complexities of the parent/child relationship, often mirrored in the helper/client and therapist/patient dyads. Parents derive considerable or little narcissistic gain from the accomplishments of their offspring, and conversely, are disappointed or even mortified by their failures. This is particularly true of narcissistically vulnerable parents—helpers and therapists as well—and accounts for widespread attitudes of competition, disparagement, and outright hostility toward young people. In the extreme, the pathological situations of emotional exploitation, incest, and physical abuse occur, but lesser forms of exploitation, such as personally gratifying advocacy, political gain, cultism, and enhancement of professional status, point to similar, but seemingly less destructive, forms of narcissistic gain. Youth may respond by conforming, defying, disappointing, and deviating. Adults may be either pleased, or enraged.     

Free tuition for elders: intentions and effects of the Massachusetts policy

This analysis explores the development of the elder tuition waiver in Massachusetts, a policy that established an age-based entitlement to higher education. The research concludes that the original purpose of the waiver was to encourage participation, but that there was no expectation that large numbers of older adults would take advantage of this benefit. Nor, apparently, did advocates of the waiver seek to assure that a diverse group of older adults would take advantage of higher education opportunities through the waiver. A review of the history of the waiver is linked with data on implementation and the results of an exploratory study of motivations of older college students. The discussion points to a need for fundamental examination of the practice of providing social benefits based on age rather than need or universal criteria.     

New rural territories: Regulating the differentiated rural spaces

Taking the differentiating countryside as a major feature of rural spatial change, this paper explores some of the key development spheres which are influencing the process of differentiation with reference to the British case. Combinations of local and non-local networks, supply chains and regulatory systems incorporate different rural spaces. Four particular development spheres: mass food markets, quality food markets, agriculturally related changes and rural restructuring implicate, in their different combinations, the different rural spaces. This analytical framework raises some important concerns for the governance of differentiating rural space in its regional context. In particular, it suggests that notions of integration and holism of rural spaces will be difficult to achieve; and that governance and regulation becomes highly variable according to the relative significance of local/non-local networks. In conclusion, the implications of the analysis are examined in relation to the growing rural development policy discourse. This suggests the need for more regionally and spatially orientated policy which is more customized to the internal and external conditions different regional-rural spaces experience.     

Combination training and resistance training as effective interventions to improve functioning in elders

The purpose of the study was to determine whether resistance training (RT) or a combination of resistance and aerobic training (CT) resulted in the most improvement in measures of functional ability in functionally limited elders. Elderly adults who exhibited some limits in functional ability were randomly assigned to either a CT, RT, or control (C) group. Both RT and CT exercised three times per week for 16 weeks. At Weeks 0 and 17, participants completed six measures of strength and six functional tests. A 3 (group) x 3 (time) ANOVA with repeated measures on the time factor was used to analyze the results. CT and RT scored significantly better than C at Week 17 for biceps curl, elbow extension, chair stand, and time up the stairs. These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations.     

The changing responsibilities of the state and family toward elders in Hong Kong

With a predominantly Chinese population and a cultural tradition of respecting the old, Hong Kong has long relied on the family to support its elderly members. Economic success has, however, not spared Hong Kong from encountering the same problems as other industrial societies, such as the loosening of its traditional values. This article examines the changing responsibilities of the state and the family in Hong Kong in supporting the old, and in particular, the effectiveness of the "care in community" policy, which the Hong Kong Government has adopted since the mid-1970s. The examination concludes that the responsibility must now be shared between the state and the family.     

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.     

Reluctant rural regionalists

Recently, scholars have begun to explore questions of regionalism and regionalization in rural contexts. Regionalism is often understood and presented as a pragmatic solution to intractable problems of fragmentation, inefficiency, accountability, spillover and neglect in the face of economic restructuring and other external threats. These arguments have long been deployed in the top-down restructuring of rural public administration; for example, the amalgamation of service districts to keep schools, hospitals and other facilities open in the face of declining population. At the same time, regionalization may be understood as a ‘means’ or process of becoming through the formation of new and shared regional identities, “structures of expectation” and institutions. Between 1996 and 2004 the number of municipalities in the Canadian Province of Ontario was reduced by more than 40 percent from 815 to 445. Evidence suggests that many of these amalgamations were undertaken reluctantly. In this paper we examine the issue of regionalism from the perspective of one rural municipality—the former silver mining centre of Cobalt, Ontario—that has resisted amalgamation. We argue that its resistance to amalgamation is a consequence of the conflictual social relationships that have been inscribed into the landscape over the past century. Using documentary and archival materials, supplemented by contemporary survey and ethnographic data, we trace how successive generations of miners, mine-owners, government officials, politicians and residents have constructed Cobalt as a distinct place. We show that this oppositional identity belies the extent to which the town and its citizens are embedded in regional housing, labour and consumer markets.