The emerging role of Financial Counsellors in supporting Older Persons in financial hardship and with management of Consumer‐directed Care packages within Australia

The role of financial counsellors as providers of information, support and advocacy for those in financial difficulty is a well established mechanism in the mainstream welfare landscape in Australia. In general, the role of financial counsellors is in helping people alleviate or resolve their financial difficulties through improvement of their financial literacy. It is recognised as an important component of policy responses to assist low‐income households and individuals in financial stress. The use of financial counsellors for older persons (i.e., those aged 65+ years), however, appears to be underutilised. Financial hardship and abuse of older persons within our community are becoming key issues as the population of Australia “ages”. Existing evidence also suggests that service providers alone do not have adequate skills to address these issues. This paper firstly examines the development of financial counselling in Australia. It then examines the newly emerging role of financial counselling in supporting older persons in addressing barriers to financial literacy and then in navigating the complex landscape of aged care service provision. The current financialisation, marketisation and complexities of consumer‐directed care are identified as key contextual factors. The paper will then discuss an evaluation study of the provision of financial counselling to the older person population designed to support financial hardship and navigation of the complex aged care services system. The findings of the paper are based on an evaluation of the Financial Consumer Rights Council (FCRC), Victoria: Dignity and Debt Financial Difficulty and Getting Older initiative. This pilot initiative included older persons from both community‐based and aged care residential facilities in one regional area of Victoria. The initiative, conducted over 2016, was designed to assess the effectiveness of one‐on‐one financial counselling sessions with older persons that provided consumer advocacy and information about support services and entitlements (including hardship protections) associated with ageing. The evaluation found that the provision of financial counselling to the older person population could be a key mechanism in improving overall financial literacy, avoiding periods of financial hardship and in maintaining financial well‐being, quality of life and positive ageing. Findings also demonstrated a need for an expanded outreach financial counselling model to better service older persons in more isolated living environments and/or with mobility impairments living in the community, and the potential to situate offices of financial counsellors within medical centres (a space often visited by the ageing population), to co‐situate financial health check‐ups as an overall element of health and well‐being. As such, financial counselling was viewed as well placed to support older persons in improvement of financial literacy and in supporting navigation of the increasingly complex marketised and consumer‐directed care (CDC) landscape of aged care service provision in Australia.     

Life after work: older Australians' experiences of early exit from the workforce

Little is known about the experience of those in the baby boom cohort who are outside the labour market. Understanding their experience has the potential to inform policy strategies to support older people to remain longer in the workforce. Using in‐depth interview data from 26 participants, this paper examines the reasons people aged between 50 and 64 years give for being not‐employed, how they perceive it affects their health, how socioeconomic characteristics shape their experience and what would entice them back into paid work. Participants' main reasons for being not‐employed included: feeling financially able and ready to exit, feeling unhappy about workplace reorganisations, disability, or their partner's retirement or ill‐health. The reasons given and the degree to which they had planned to exit the workforce affected their willingness and capacity to consider returning. Key determinants of participants' health and wellbeing after stopping paid work were the extent to which they had planned their exit and the status of their health and wealth at the time of their exit. The paper concludes there is some scope for increasing the number of employed older people if policy makers attend to workforce health and wellbeing as crucial to workforce retention policy development.     

COVID-19 pandemic and the determinants of depressive symptoms among senior citizens of India: An empirical investigation

The COVID-19 pandemic inflicted multiple threats to individuals' physical, mental, and financial health conditions. The pandemic-related restrictive behaviors pose serious consequences for public health and increase the risk of mental illness among individuals, particularly among older citizens. The combination of their pre-existing illnesses, social isolation, COVID fear, and financial adversity frequently aggravates their condition and leads to depression and mental illness. Thus, the present study investigates the mental health status and the determinants of depressive symptoms among older adults of Bhubaneswar during the COVID pandemic context. The study used the Geriatric Depression Scale (GDS-15) to measure their depressive symptoms. The social isolation parameter is measured with the De Jong Gierveld Loneliness Scale. Financial self-efficacy, COVID-19-related psychological fear, and comorbidity health status are other determinants considered. A chi-square test and multinomial logistic regression (MLR) models are adopted to find the probable risk factors that may influence depressive symptoms among older people. The results indicate that comorbidity health conditions, a social isolation mindset, and financial efficacy issues are the significant determinants that drive an older person towards different depression categories. The improvement of these influential factors can lead senior citizens to avoid any health emergency like COVID pandemic. In the event of a public health emergency, such as COVID pandemic, the government could use the study's findings to devise methods for assisting the elderly. Society as a whole should be aware of these findings, which can lead to depressive symptoms, and offer support to the elderly. Future research may concentrate on identifying the causes of depressive symptoms in different age groups or in the presence of specific comorbidity health conditions. Future research may also investigate the factors influencing depressive symptoms in a specific occupation.     

Partnership Working and Eligibility Criteria: What Can We Learn from the Implementation of Guidance on Continuing Health Care?

Current government policy places great importance both on clinical governance and on partnership working between health and social services. Separately and together, these policy emphases require greater clarity in and between organizations about who should provide what care where than has often been achieved in the past. A study of the implementation of continuing health care policies suggests that clarity about appropriate long–term health and social care provision was difficult to achieve in the 1990s quasi–markets, because there were too few financial and structural incentives for agencies to cooperate in developing and implementing precise and comprehensive eligibility criteria. This problematic interplay between financial and structural factors is being addressed by a number of government initiatives designed to stimulate joint working, although the difficulty of drawing a clear boundary between health care (free at the point of delivery) and social care (which can be means–tested) remains.     

Financial Hardship and Shame: A Tentative Model to Understand the Social and Health Effects of Unemployment

Correspondence to Ulla Rantakeisu, Centre for Public Health Research, University of Karlstad, S-651 88 Karlstad, Sweden. E-mail: ulla_rantakeisu{at}kau.se Summary Young unemployed people in six local communities in Sweden wereinterviewed to test the assumption that variations in the socialand health effects of unemployment could be seen as a functionof financial hardship and of experiences of shame. The resultsindicate that there seems to be a link between the health andsocial effects of unemployment, on the one hand, and the degreeof financial hardship and the number of shaming experienceson the other. The group of unemployed people who suffered agreater degree of financial hardship and also experienced agreater number of shaming experiences seemed to exhibit thepoorest health, reported deteriorated health to a greater degreethan other groups, experienced negative changes in their lifestyle,did less in their free time, and had lower self-confidence thanother unemployed persons. The opposite applied for those whoexperienced less financial hardship and less pressure in termsof experiences of shaming. Against this background, we haveformulated a theoretical model based on financial circumstancesand social bonds; a model that could have a wider value in explainingsocial and health problems.     

Research Review: Teenage pregnancy and parenthood: the role of fathers

From the research available in America and Britain it would appear that the men who father children by teenage mothers tend to be a few years older than their teenage partners, although a minority may be significantly older. With regard to the factors associated with fatherhood there are striking similarities to the literature on teenage mothers. Like teenage mothers young fathers tend to be from low socio‐economic backgrounds, experience lower educational attainment and fewer employment opportunities than their childless peers. Similarly they tend to experience greater psychological and emotional difficulties and may have a history of delinquent behaviour. These young fathers are involved in a variety of relationships with teenage mothers, few of which result in marriage and many of which result in the breakdown of cohabitation or the termination of the relationship. This pattern of increasing relationship breakdown over time is related to decreasing paternal contact with children in both America and Britain. Often conflictual relationships with teenage mothers or maternal grandparents and a lack of financial resources are cited by young fathers as barriers to their continued involvement and contact with their children. However, the mothers are much more likely to cite paternal disinterest as the reason for a lack of paternal involvement and there is some indication that mothers and fathers have different views on the level of practical involvement expected from fathers. While most of quantitative data on the subject provides a rather negative picture of paternal involvement, qualitative research highlights how many young fathers genuinely want to be involved with their children and would have more contact and input if they could. While much less is known about the support provided to young fathers in comparison with their female counterparts, there is some suggestion that the support and role expectations provided by the paternal grandmother may influence how involved young fathers are. There is also some indication that a sizeable minority of young men may receive no such support from their family and may also be treated with hostility or ignored by the maternal grandparents. Young fathers also report limited or no contact with midwives, health visitors and social workers.     

Volunteering and its impact on self-identity: results from Chaoyang District in Beijing

Ageism has a negative influence on older peoples’ self-identity and behaviour, forming stereotyped attitudes toward the older population that further aggravate ageism. Volunteerism may reduce ageism by improving older adults’ self-identification. This study examined the association between community volunteering and self-identity, and further explored the relationship between participation level and self-identity among Chinese older adults in Beijing. Logistic regression modelling was applied. After controlling for demographic characteristics, financial security and self-rated health, volunteerism was significantly associated with youthful self-identity. Older people who volunteer at least once a week for no more than two hours at a time are the least likely to identify themselves as being of old age.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Collective Action Among Private Tenants

Summary The paper describes the action of a group of low-income tenants,inexperienced in dealing with bureaucracies or in understandingthe complexities of landlord-tenant law, who attempted to improvetheir living conditions by using the Government's Rent Tribunal While the legal remedies provided under the Rent Acts were effective,the tenants were reluctant to use them until they had organizedas a group. This was because of the particular relationshipthey had with the landlady who made it difficult for them todiscuss with her their rights as tenants. Their only way ofchanging this was through collective action We discuss the use of conflict strategies in a short-term issue;that is, in fighting a landlady for better living conditions(both lower rents and adequate repairs). It illustrates thedifficulty of mobilizing a group of people whose ususal everydayexperiences are that it is difficult, if not futile, to takeaction to improve their situation. This is so in spite of machineryset up by the Government to arbitrate over rents for privateproperty. The difficulty lies in the precarious financial positionin which deprived groups often find themselves, making it easyfor them to fall into rent arrears and therefore be liable toeviction from their accommodation. It is difficult also becauseproperty owners are more likely to have easy access to the legalmachinery. These tenants are usually in no position to holda landlord to his side of the contract because they lack theresources to pay the legal fees entailed     

Participation and health – a research review of child participation in planning and decision‐making

Effective child participation in child protection proceedings has proved difficult to achieve in Norway. Although participation is in principle accepted as a human right and something of benefit to children, when children's health is at stake there is a tendency to view participation in decision‐making processes by children as potentially disruptive to their well‐being. The purpose of this study is to review the research evidence for effects, positive or negative, of participation on health outcomes for children in care. A scoping review of major health and social work research databases was undertaken. Searches in five databases yielded 1830 studies of which 21 were finally included in this review. Studies were included if a relationship between health and participation was evident from the data presented, even if this was not the main objective in the study at hand. We conclude that when participation is successful, it may have beneficial side effects. Chief among these are that participation may improve children's safety, increase the success of care arrangements and increase feelings of well‐being for children involved. Evidence for long‐term effects of successful or failed participation attempts on subsequent health outcomes is however largely absent.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

Unmet Needs and Depressive Symptoms Among Low-Income Older Adults

Previous studies have found that declining health, decreased social interaction, and inadequate financial resources were significant risk factors for late-life depression, and social support from families and friends and religiosity were significant protective factors. In this study, we examined if low-income older adults' perceived unmet need for home- and community-based services for many aging-associated problems would be independently associated with their depressive symptoms, controlling for these known risk and protective factors. We interviewed a total of 213 community-residing older adults to assess their depressive symptoms, using the Geriatric Depression Scale (GDS), and unmet needs in the areas of personal assistance, instrumental and environmental support, emotional support, and other facilitative/enabling services. We found that the number of unmet needs was significantly positively associated with these older adults' depressive symptoms, although it explained only a small proportion of the variance of the GDS scores. Future research and practice implications are discussed.     

Neoliberalism and Austerity in Spain,Portugal and South Africa: The Revolution of Older Persons

ABSTRACT

In Portugal, Spain, and South Africa, there has been a noted anti-neoliberal resistance, marked by the significant participation of the older generation in protest movements. Changing demographics, the global financial crisis, unemployment, poverty, and the reliance of the family nucleus on the pensioner, coupled with neoliberal and austerity-based reductions to welfare programs, pensions, health, and social care, has caused the “silver revolution.” As a population group that is often considered to be less politically active and robust members of society, such resistance is a noteworthy moment in society that needs to be considered and responded to.     

Unemployment and mental health among white‐collar workers – a question of work involvement and financial situation?

We examine whether it is a psychosocial or an economic need for employment that affects mental health among the unemployed. The relevance of both aspects are examined, concentrating on two measures of each dimension. Two perspectives of work involvement – the degree of connection to working life and the perceived employment commitment – and two perspectives on financial situation – economic security and perceived economic concern – have been analysed, using empirical data collected by means of a cross-sectional survey of 1297 unemployed white-collar workers from the public sector in Sweden. The degree of connection to working life was not significantly linked to the mental health of the unemployed, although there was a strong link between the perceived employment commitment and mental health among this group. The stronger the perceived employment commitment, the poorer the state of the person's mental health. Perceived economic concern was also tightly linked to mental health: the greater the economic concern, the poorer the mental health. Economic security also played – at least, partly – a moderate but significant role. The results provide strong support for the existence of both a psychosocial need and an economic need for employment. The analysis demonstrates that it is the perceived assessed measures of work involvement and financial situation that are linked to mental health.     

Subjective experiences of older adults in poverty in urban China and the role of social policy

This study establishes an evidence base regarding the experiences of older adults living in poverty in Beijing. Given the factors that shape the lives of low-income older adults, the findings are relevant for many middle- and low-income countries. Based on a series of in-depth interviews conducted with government officials and low-income older adults in Beijing, the study finds that poverty manifests as cumulative stress arising from four sources: financial strain, poor health, care burden and poverty-related shame. This stress is attributable to the co-existence of individual and structural factors that reflect the framing of anti-poverty policies in China.     

Older People and the Health–Social Care Boundary in the UK: Half a Century of Hidden Policy Conflict

The boundary between health and social care services has been an important focus of both social research and policy reform in many western and northern European countries. In the UK there is a history of particularly sharp divisions between the centrally funded NHS and locally run social services. A consequence for older people, especially those with less acute or "intermediate" needs, is that they may be rationed out, ignored, or treated inappropriately on either side of the boundary. This paper seeks to go beyond explanations in terms of financial, administrative and professional divisions by using now-available public records to show how the boundary between health and social care was set in stone in the immediate postwar years and resulted in a constant battle between the two services over the needs they would meet. The first part of the paper examines a largely hidden history of health and social care policy. The second part examines the new NHS Plan and the extent to which it is likely to resolve the problem of the boundary.     

Taking Financial Relationships into Account When Assessing Research

Many scientific journals, government agencies, and universities require disclosure of sources of funding and financial interests related to research, such as stock ownership, consulting arrangements with companies, and patents. Although disclosure has become one of the central approaches for responding to financial conflicts of interest (COIs) in research, critics contend that information about financial COIs does not serve as a reliable indicator of research credibility, and therefore, studies should be evaluated solely based on their scientific merits. We argue that, while it is indeed important to evaluate studies on their scientific merits, it is often difficult to detect significant influences of financial relationships that affect research credibility. Moreover, at least five factors can be examined to determine whether financial relationships are likely to enhance, undermine, or have no impact on the credibility of research. These include as follows: whether sponsors, institutions, or researchers have a significant financial stake in the outcome of a study; whether the financial interests of the sponsors, institutions, or researchers coincide with the goal of conducting research that is objective and reliable; whether the sponsor, institution, or researchers have a history of biasing research in order to promote their financial goals; how easy it is to manipulate the research in order to achieve financial goals; and whether oversight mechanisms are in place which are designed to minimize bias. Since these factors vary from case to case, evaluating the impact of financial relationships depends on the circumstances. In some situations, one may decide that the financial relationships significantly undermine the study's credibility; in others, one may decide that they have no impact on credibility or even enhance it.     

Powerful Youth: Determining Successful Participation in an HIV Support Group for Youth

In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.