Home care development in Korea and Germany: The interplay of long-term care and professionalization policies

The aim of the study was to compare the effects of long-term care and professionalization policies on the development of home care infrastructure and the care workforce in reference to long-term care insurance systems adopted in Germany and Korea. A comparative analysis of the effects of the two policy systems allowed us to examine distinct forms of marketized home care service expansion. In both countries, the opening-up of care markets has brought about a significant expansion of home care services through the active participation of mainly for-profit providers. However, a trade-off between the rate of expansion, the quality of care services, and the stability of care infrastructure has emerged. The market-based expansion of home care services has resulted in difficult employment and working conditions for care workers in both countries. The country-specific organization of home care and related professionalization approaches has led to the development of a well-trained care workforce with less precarious conditions in Germany but not in Korea. Despite this difference, less well-trained care workers experience precarious employment in both countries.     

Understanding the Impact of Early-Life Trauma in Nursing Home Residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.     

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.     

Length of inpatient stays and associated factors among middle‐aged and older adults in Korea

Using a nationally representative sample of middle‐aged and older adults in Korea, this study examined the length of inpatient stays and associated factors. The pooled 2008–2012 data were obtained from the Korean Longitudinal Study of Aging, and study sample consisted of 7,805 individuals aged 50 and older. Guided by the Andersen's healthcare utilization model, latent growth curve modeling was conducted. Study results indicate that the average inpatient stay has slightly increased among middle‐aged and older adults in Korea. Furthermore, the severity of functional disability, the number of chronic health conditions, and the level of depressive symptoms were found to be key factors associated with the length of inpatient stays. In particular, respondents who received federal welfare benefits had longer stays than those who did not receive welfare benefits. Being employed and having private insurance were also found to be predictors of increasing length of inpatient stays. However, marital status was not associated with the length of inpatient stays. By understanding the pattern of inpatient stays and associated factors, policymakers should make an effort to develop innovative cost‐effective healthcare programs.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N?=?300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.     

The effects of physical and psychological health on life satisfaction among older adults with a physical disability in South Korea: focus on gender differences

This study aims to investigate whether (a) functional disabilities, self-rated health and depression influence life satisfaction among older adults with a physical disability, and (b) whether the effects of the predictors differ by gender. The study utilises 2008 Korea Welfare Panel Study data. The findings reveal that functional disabilities and depression are negatively associated with life satisfaction, whereas self-rated health is positively related with life satisfaction. In addition, the effects of functional disabilities and income on life satisfaction vary by gender. Implications for practice and policy are discussed.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Factors associated with the preventive healthcare service use among older adults in Korea: Focusing on age variation

The importance of preventive health examinations for older adults has been well emphasized due to an increase in chronic diseases associated with age. In this study, we estimated the preventive health examination participation rate and its associated factors among the elderly with specific focuses on the moderating effects between age and socioeconomic status. We used data drawn from the first to sixth waves (4164 people) of the Korean Longitudinal Study of Aging for the elderly aged 65 and over. A generalized linear model was used to address research questions. The results showed that the participation rate decreased as older adults age. The interaction between age and education was also significant, indicating that older adults with higher education were more likely to use a preventive health examination compared to those with lower education. There were no significant interaction effects between income and age. Based on the findings, implications for theory and practice were discussed with specific focuses on age‐specific approaches in preventive healthcare services for older adults.     

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.     

Employment status transitions among young adults,with and without disability

Employment is a crucial avenue through which young people with disability can experience material wellbeing and social participation. While the low employment rates of young people with disability are well established, little is known about the stability of employment status – that is, the degree to which individuals remain in or move in and out of employment. This article uses longitudinal data from a large Australian national data set to investigate the transitions between full‐time, part‐time and non‐employment for young people with and without disability. Considerable mobility was found between employment states for both young people with and without disability, with young people with disability more likely than their peers without disability to transition to reduced levels of employment and less likely to transition to increased levels of employment. Social background and contextual factors predicted employment for young people with disability; however, disability represented an additional penalty even after taking these factors into account. Findings suggest a need for social policy targeted specifically towards the barriers to maintaining and increasing employment experienced by young people with disability.     

The long arm of the welfare state shortened: Home help in Sweden

Old age care in Sweden expanded greatly in all areas in the 1960s and 1970s. In the 1980s, both institutional and in-home services have retreated. Little substitution between the two kinds of care can be observed. Cutbacks relative to demographic needs, and probably also to actual needs, have occurred, nationally and locally. Home help is analyzed as a metaphor for social services and welfare at large. The strategy has been to give priority to the frailest and oldest clients. Others often have to make do without any services. Also, current recipients of home help services now get different inputs: in the 1980s and earlier, 8 of 10 home help hours were used for homemaking (such as shopping, cooking, cleaning and laundry); in the 1990s about half is used for personal care of the clients.     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Preparedness of representatives for people with dementia in a self-directed program

ABSTRACT

Representatives enact their role as decision-making partners across the intersection of participant direction (PD) and dementia care. Self-rated preparedness for key dimensions of the role endorsed by a panel of experts in PD and dementia was assessed by telephone survey of 30 representatives of persons with dementia in a PD program. The sample (daughters 60%; Black 50%; rural 70%) was diverse in length of time in the role and additional responsibilities. They represented participants with moderate to advanced dementia and ≥ two additional chronic illnesses. Overall preparedness scores were in the pretty well to very well prepared range, with variation across dimensions and between individuals. Preparedness varied according to what has to be done day-to-day in dynamic or unpredictable situations, gauging decisional capacity, anticipating changing needs, ensuring safety, supporting a dementia-capable care team and negotiation. Stress was related to having a safety net of capable back-up supports and dementia care literacy. Areas of strength, individual variation and particular challenges along the trajectory of representing can guide development of support counselor interventions to provide representatives with tailored training and resources as they enable the benefits of PD for persons with dementia.     

The probability of nursing home use over a lifetime in Australia

This article further develops the life table models used in the USA by taking advantage of the superior data available in Australia. The probabilities of nursing home use over a lifetime are estimated for various ages for men and women. The results show that over one-third of the members of a female birth cohort will eventually enter nursing homes for long-term care at least once. The corresponding probability for males is one in five. A woman at age 65 faces a probability as high as 39% of using a nursing home for permanent care before her death compared with 25% for a man at age 65.     

Racial/Ethnic Disparities in Access to Medicare Home Health Care: The Disparate Impact of Policy

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and “other” users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.     

Developments in home help for elderly people in Denmark: the changing concept of home and institution

The official figures on provision of home help in Denmark are compromised in that they include figures for help delivered to people living in assisted-living dwellings, facilities that were formerly considered nursing homes. Furthermore, many municipalities have integrated home help and nursing-home care and report this as home help. This article examines the effect of these administrative arrangements on the provision of home help and the distribution of home help in terms of hours per week. There has been a polarisation in size of care packages: a smaller group of recipients composed largely of people residing in assisted-living dwellings receive larger care packages, whereas the care packages to people living in their own dwellings have decreased in size. However, a sleight of hand of definitions regarding the concept of home has made the official figures on provision of home help look even more generous than they are.     

COVID‐19 and social work practice for older adults in China

After the spread of COVID‐19, the Chinese central government has issued a series of policies and regulations to guide the prevention and control of the epidemic in the elderly care industry. Social workers provided a series of services for older adults in nursing homes and in the community. All efforts made by government agencies and social workers have helped older adults go through the difficult time.