Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders’ Views of Policy Implementation

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

Ways of Thinking About the Long-Term Care of the Baby-Boom Cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers-the generational equity/crisis perspective and the generational investment/gradual adjustment perspective-are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

The Politics of Catastrophic and Long-Term Care Coverage

The passage of the Medicare Catastrophic Coverage Act of 1988 represents a milestone in the politics of catastrophic and long-term care. The politics surrounding the passage of that bill were inextricably linked to the larger issue of long-term care and to recurrent debates over comprehensive national health care. Debates over the financing and provision of health care services have occupied U.S. society and government for 50 years. Catastrophic protection is the culmination of public concerns about the health care needs of an aging society. The catastrophic bill set new precedents with the imposition of an income testing mechanism (a supplemental surcharge) for financing the bill and the acceptance by senior citizen organizations of "self-financing." Insider politics characterized the interest group maneuverings over this bill. Key personalities (especially Representatives Dan Rostenkowski and Claude Pepper) played the leadership role, congressional staff played the activist role, and other members of Congress played the role of constituents to be influenced and convinced. The aging organizations were peripheral players, in part due to their divided feelings about the merits of the bill but also due to the involvement of others affected by the politics of long-term care (e.g., the pharmaceutical, insurance, and Medigap industries). The passage of the catastrophic bill was the prelude to an even greater controversy over a home care long-term bill that was eventually defeated. Notwithstanding that defeat, the debates over long-term care served to educate the public and the media about the importance of that issue and also highlighted the refederalization of health care policy.     

The key role of social workers in promoting the well‐being of children in state care — a neglected dimension in reforming policies

Increasingly, policy measures are emerging at national or agency level in different countries to improve the lot of children in state care. Most of these rely heavily on social workers for their implementation. Yet the capacity of social workers to carry out such an ever increasing range of complex tasks seems never to be properly recognised as an issue. This paper argues, from an international perspective, that the continuing central role of social work in the lives of children in care merits much more emphasis in policy and service delivery. The nature of the increasing demands on social workers in this area of work are explored. Possible strategies to help build the capacity of social workers to respond to the needs of children in state care in the new millennium are discussed. Such capacity building necessitates government and agency initiatives to ensure realistic staffing levels, renewed training, and adequate support for social work services to children in state care. Copyright © 2000 John Wiley & Sons, Ltd.     

Thirty years of advocacy in San Francisco: lessons learned and the next generation of leadership

Professional advocacy organizations are often challenged by the question of their authentic community representation and their ability to balance short-term pragmatism with strategic plans for long-term, systemic change. Coleman Advocates, one of the nation's most effective child advocacy organizations, has taken up this challenge under the leadership of a next-generation leader of color who followed a dynamic director of the baby boom generation. In this piece, Coleman's thirty years of social change strategies are analyzed from the perspective of this new executive director, who has facilitated the latest organizational shift that deepens its commitment to building bottom-up grassroots leadership and community power while keeping the best of the professional, staff-led advocacy model. Issues of race, accountability, power, and movement building are addressed through the lens of one organization's evolution, with the goal of building a long-term movement that will achieve racial and economic equity for all children and families.     

'To Teach Them How to Live' The Politics of Public Health from Tuberculosis to AIDS

Abstract The AIDS crisis has aroused considerable interest in the critical examination of public health. Much of this work has come from the perspective of 'cultural analysis', combining postmodernist theories with the politics of radical pluralism'. This work constitutes a rejection of Marxist state theory, and indeed has directed attention away from the state as an object of inquiry. This article is a response to 'cultural analysis', which uses an historical examination of public health in Canada to shows the ways in which it has been oriented around the state, reflecting the character and limits of social policy.     

Preschool Policymaking by Stealth: Application of an Alternative Framework for the Policy Process

This study uses the design and passage of universal preschool in two states, Oklahoma and West Virginia, to present an alternative framework for understanding the policy process, Policymaking by Stealth, and demonstrate its usefulness both in expanding the understanding of the politics of public preschool and as a tool for social work policy practice. An overview of the current state of preschool policy in the United States and the political history of federal preschool policy is presented first to provide context to the analysis, followed by an introduction to the analytic framework, and then a formal analysis of the policy passage processes in the two states via the lens of Policymaking by Stealth. The contributions of this new framework to the study of the policy process in general and the practice of policymaking in complex political contexts are discussed.     

Awakening to the desires of older women: Deconstructing ageism within fashion magazines

Older women's body image is multidimensional, changes across lifespan, and is a significant source of self-esteem. Ageist social practices in popular fashion magazines and the reluctance of the fashion industry to recognize the sartorial needs of female baby boomer cohorts feed into an internalization of naturally aging women's bodies as socially undesirable. Depression and/or eating disorders are associated with negative internalizations of body image. Despite baby boomers being the most affluent female social group in the United States history and the fashion industry's enormous social influence on women's self-image, few studies have examined the depiction of older women in fashion magazines. Visual content analysis of eight fashion magazines revealed that the fashion industry continues to focus its promotional efforts on youthful populations and seldom includes images of women over forty, regardless of the large percentage of such women among their readership.     

Long-term care planning as a cultural system

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

Robin M. Williams Lecture, 1994: Taking society seriously

Civil society provides essential balance to the rising power of national states and market economies. Particularly in the United States, however, the economy and state are squeezing civil society, with negative consequences. One result is that market rationality supplants other moralities, with attendant changes in social practices. Examples are offered from education, health care, and federal tax policy. All three legs of the metaphorical social tripod of civil society, economy, and the state need to be strong. Institutions of civil society sustain individuals and societies, but require structural and cultural support if they are to complement and counterbalance the logic and practices of economy and state.This paper was presented as the First Annual Robin M. Williams, Jr., Lecture at the University of Delaware, February 24, 1994; the Eastern Sociological Society annual meeting, Baltimore, Maryland, March 19, 1994; and the University of North Carolina, Greensboro, North Carolina, March 28, 1994.     

Controlling the supply of long-term care providers in thirteen states

Many states have responded to growing Medicaid long-term care expenditures by limiting the number of long-term care providers through certificate-of-need (CON) programs and moratoriums on new construction or certification for participation in the Medicaid program. This article focuses on the use of these policies in 13 states. Most of the 13 states control the supply of nursing home beds and hospital conversions with CONs or moratoriums, but they are struggling to adapt the role of supply policy to the growth of home health and residential care. As an increasing proportion of Medicaid long-term care spending goes to these nursing home alternatives, supply policy needs to keep pace with the changing provider market and the changing demographics of the consumer market if it hopes to ensure access to long-term care and control Medicaid expenditures.     

Long-Term Care Planning as a Cultural System

Abstract

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

A Leadership Role for Social Work in the Mental Health Transition to Local Care

Current philosophy, policy, and practice involving care of persons with serious mental illnesses are reviewed, with a focus on the movement that is usually called deinstitutionalization. Past efforts and future trends are discussed within the context of public mental health systems at the state level. The paper argues for a greater leadership role for social work in providing mental health care in local communities because of the social work tradition of client empowerment, family involvement, and systems intervention.     

美国应对中东剧变的“奥巴马主义”探析

美国应对中东剧变的政策措施彰显"奥巴马主义",即军事上谨慎用兵,避免直接地面占领或卷入一场针对伊斯兰国家的新战争,而是通过武装反对派推行"阿拉伯人打阿拉伯人",减少人道主义干预的成本;政治上运用所谓美国的"巧实力",让欧洲大国和阿拉伯盟友提出议程设置,充当"急先锋",美国在背后"掌舵",以最廉价的方式延续美国在中东的领导地位;外交上通过议题设置,让联合国人权委员会等国际组织和非政府组织服务于美国政府;经济上运用援助和制裁两手政策来实现政治目标;文化上利用媒体、非政府组织和网络,开展民间外交和网络外交。奥巴马政府试图综合运用军事、政治、外交、经济和文化手段,推动中东反美国家的政权更迭,维护亲美国家的政局稳定。研究表明,无论是主张依靠硬实力的"布什主义",还是主张依靠巧实力的"奥巴马主义",其在中东维持美国领导地位的战略目标,却是一致的。     

Third Sector Social Policy Research in Australia: New Actors,New Politics

Human service NGOs have become central actors in contemporary welfare states. The broadening of the role of NGOs in Australia as both providers of the human services that are an integral part of the welfare state and as lobbyists or advocates and agents of social change has been widely acknowledged; however, this paper focuses on a recent deepening of the role of human service NGOs in the Australian welfare state by exploring an additional dimension of their growth. Based on a recent study, it is evident that there has been increasing involvement by human service NGOs in the production of social policy knowledge through ‘policy research’ activities. The research mapped policy research activities, policy research infrastructure and policy research resources in human service NGOs, and also captured NGO policy researchers’ perceptions of the rationales and motivations driving NGOs in this direction. It was clear that this shift is based on strong beliefs that researchers located within human service agencies are best placed to produce the kind of knowledge that should form the basis of social policies responding to human need. Other drivers identified by policy researchers suggest, however, that the inclusion of third sector organizations in policy processes cannot simply be understood as the ‘opening up’ or ‘democratization’ of social policy processes to include Third Sector participants. The motivations for human service NGOs moving into social policy knowledge production in Australia are thus complex and diverse. Drawing on the findings of our study, Researching the Researchers, this paper reflects on the implications of this reconfiguration of welfare state politics. Who produces the knowledge that influences, moulds, and even determines the allocation of resources for the delivery of human services, and how this knowledge is produced have been ongoing concerns in social policy scholarship. We suggest, that in the case of human service NGOs in Australia, entry into the field of social policy research can be understood as a reconfiguring of the democratic system of policy determination. It may also be one in which the NGOs become ‘experts’ on citizens’ needs through research practices that are fundamentally less, rather than more inclusive, of the subjects of social policy. The implications of a possible shift in power to influence and in some cases determine who gets what in the welfare state is of deep concern in relation to future models of social protection and ultimately the redistributive and democratic processes of nation states. This paper seeks to question the often-unquestioned ascendancy of the third sector in welfare and asks whether this shift is in keeping with the democratic process and whether it is the best way to determine and satisfy human need.     

Administrative Responsiveness to the Disadvantaged: The Case of Children's Health Insurance

Issues of administrative responsiveness to the disadvantaged(as distinct from formal policy responsiveness) possess importantimplications for American democracy. In this regard, the administrativepractices that facilitate or impede enrollment, or take-up,in social programs deserve attention. This study focuses ontwo means-tested programs in the context of American federalism,Medicaid and the State Children's Health Insurance Program.Based on an in-depth analysis of seventeen states, we developan index of administrative responsiveness to the disadvantagedrelated to take-up. We then explore some possible sources ofvariation in responsiveness rooted in the task environment,political ideology, good government culture and practice, andsignals from political principals. Our findings point to theneed to refine and expand upon existing explanations of statevariation in social programs. Among other things, this studysuggests the political importance of international (not interstate)population mobility and gubernatorial leadership (rather thanbureaucratic autonomy) in shaping administrative responsivenessto the disadvantaged. It also points to the need for a contingentapproach in examining whether the greater presence of racialminorities tends to depress such responsiveness.     

Foreign Domestic Workers and Home-Based Care for Elders in Singapore

As with other developed nations where rapid population aging has led to increasing health care and social care burdens, Singapore has searched for ways of paying for and providing long-term care for its increasing numbers of elders. The Singapore state, faced with the prospect of one-fifth of the population aged 65 or older by 2030, has reinforced its basic principle of rendering the family the “primary caregiving unit” and home-based care as the highly preferred option for eldercare. Our paper demonstrates why, despite the range of alternative care arrangements available or emerging on Singapore's eldercare landscape, the employment of live-in foreign domestic workers as care workers for the elderly has become one of the more common de facto modes of providing care for the elderly. In this context, we discuss the politics of eldercare in the privatized sphere of homespace and conclude with policy implications relating to the employment of foreign domestic workers as caregivers for the elderly.