A Qualitative Study on Home Modification of Rural Caregivers for People with Dementia

Opinions about the responsibility for procuring sheltered housing in Norway have been studied among people 50 and older. Until recently, Norway offered standard public provision, where the state has been the central provider and organizer of care for the elderly. The results indicate great support for public responsibility for providing sheltered housing for the frail elderly, which is only marginally affected by background characteristics. However, older people's attitudes as to whether they would choose private housing provision are affected by income, age, and knowledge of the market, and many are uncertain. Women and low-income groups are overrepresented among those who are uncertain.     

A review of private residential care in Hong Kong: implications for policy and practice

Hong Kong government policy encourages and facilitates families to care for their older members as long as possible by providing families and their older relatives with community support services. Residential care for the elderly is viewed as a last resort. Due to the inadequate supply of community support services, the long period of care required, and the gradual breakdown of values of filial support, families may increasingly give up their caring roles and seek residential care for their dependent elderly relatives. A shortfall in subsidized residential care may lead to needy elderly persons' being cared for in private residential facilities. The demand for private residential care is projected to increase, despite criticism about the standard of care provided. Although an Ordinance, a Regulation, and a Code of Practice for residential care homes are in place to control, monitor, and upgrade private residential care in Hong Kong, problems remain that put the elderly at risk of receiving substandard services. These include the existence of substandard private aged care homes operating either with or without a license; the provision of substandard "places" to the elderly under the government's "bought place" scheme and "enhanced bought place" scheme; ineffective inspection; a lack of grading to indicate the quality of private aged care homes; and a general neglect of the quality of care. We provide recommendations to address these concerns. This requires paying attention to both the quality of care, as well as to the physical environment of homes.     

Sheltered and Supported Employment in the 1990s: the experiences of disabled workers in the UK

Sheltered and supported employment are important areas of social policy provision for disabled people in the UK, but they have received little attention in the sociological literature on disability. This omission is addressed by developing a framework for understanding the state's employment policy for disabled people. It is argued that recent changes in sheltered and supported employment provision must be understood in the context of broader labour market restructuring. This argument is illustrated by an exploratory survey of workers in both programmes. The findings suggest that sheltered and supported employment tend to prioritise the needs of employers over those of disabled workers. In concluding, it is argued that an adequate approach to the employment needs of disabled people needs to go beyond micro-policy debates on the relative merits of existing employment programmes and, instead, engage at a broader level of societal change.     

Understanding the Pattern of Support for the Elderly:

Cross-cultural comparison can offer critical input to analyses of the interplay between formal and informal services for the elderly. Israel and Sweden have very different population structures and represent different points on the spectrum of welfare state development: Sweden has a much higher percentage of elderly, a less traditional family structure, and a much more developed system of public support. In addition, there are thought to be different attitudes toward family ties, with a less family-oriented value structure in Sweden. The natural question is to what extent these differences translate into differences in the extent and nature of family support for the elderly. In this article, family structure, living arrangements, disability rates, and formal and informal sources of help in Sweden and Israel are compared at various points in time. While there is a greater rate of formal service provision in Sweden and some substitution for family support seems to have occurred, informal care has nevertheless remalned important. In both countries, residential palterns are critical: it is when the elderly live alone that the formal system has tended to replace the family. The rate of institutionalization is particularly important in determining the rate of disabled elderly requiring care, both formal and informal, in the community.     

The making of ‘the elderly’: Constructing the subject of care

The provision and arrangement of care for elderly people is one of the main challenges for the future of European welfare states. In both political and public discourses elderly people feature as the subjects who are associated with particular needs, wishes and desires and for whom care needs to be guaranteed and organised. Underlying the cultural construction of the care regime and culture is an ideal type model of the elderly person. This paper analyses the discursive construction of elderly people in the discourses on care in Austria. An understanding of how elderly people as subjects, their wishes and needs and their position within society are constructed enables us to analyse, question and challenge the current dominant care arrangements and its cultural embeddings. The paper demonstrates the processes of silencing, categorisation and passivation of elderly people and it is argued that the socio-discursive processes lead to a particular image of the elderly person which consequently serves as the basis on which the care regime is built.     

Understanding the pattern of support for the elderly: a comparison between Israel and Sweden

Cross-cultural comparison can offer critical input to analyses of the interplay between formal and informal services for the elderly. Israel and Sweden have very different population structures and represent different points on the spectrum of welfare state development: Sweden has a much higher percentage of elderly, a less traditional family structure, and a much more developed system of public support. In addition, there are thought to be different attitudes toward family ties, with a less family-oriented value structure in Sweden. The natural question is to what extent these differences translate into differences in the extent and nature of family support for the elderly. In this article, family structure, living arrangements, disability rates, and formal and informal sources of help in Sweden and Israel are compared at various points in time. While there is a greater rate of formal service provision in Sweden and some substitution for family support seems to have occurred, informal care has nevertheless remained important. In both countries, residential patterns are critical: it is when the elderly live alone that the formal system has tended to replace the family. The rate of institutionalization is particularly important in determining the rate of disabled elderly requiring care, both formal and informal, in the community.     

Keyworkers for elderly people in the community: case managers and care co-ordinators

In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States 'case management' has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a 'keyworker' and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the keyworker role for some of their clients.     

The Quality of Life in the 'Independence' Curriculum

The move towards community care as a humane alternative to institutional provision has brought complications in its wake. Integration, both into community living and into mainstream education, has generally entailed an elaborate process of the selection of those most easily assimilated. I am concerned to examine the opportunities available for those young people who are often rejected within the integration movement, yet who find themselves the recipients of training for independent living in the community. My hypothesis is that such a training can actually impoverish their quality of life.     

The savings approach to financing long-term care in Singapore

Singapore is grappling with provision of services for the current generation of older people at the same time as building the foundation for the coming generations of elderly. In this article, I analyze four sets of factors that are shaping long-term care policy and financing in ways that are almost unique to Singapore. First, current developments can only be understood in the context of the Central Provident Fund (CPF) that was established by the Government of Singapore in the 1950s to ensure that the working population saved for retirement; the Medisave and related schemes for financing health care were subsequently developed alongside the CPF. Most recently, the existing funding arrangements have been extended to some long-term care services, and options for further extensions are under consideration. Second, the government's philosophy of maintaining the primacy of family support for the elderly has been expressed through a number of initiatives that provide financial and other incentives to families, combined with an emphasis on community care. The third factor is the relationship between government and the voluntary welfare organizations that are the major providers of institutional and community services. Finally, a series of government-sponsored reviews and advisory councils have provided for widespread consultation on policy options. These developments are directed to achieving a multi-pillar approach in which intergenerational transfers through taxation will be limited, and the role of individual savings and insurance will be increased.     

Home care for the elderly: the role of relatives,friends and neighbors

We use data from the Survey of Health, Ageing and Retirement in Europe to examine the hours of home care received by the elderly. The existing empirical literature has mostly examined informal home care from children and formal home care. We identify two additional informal home care providers, namely, relatives (other than children) and friends (including neighbors) who provide about 30 % of the hours of informal home care. Our main new empirical finding is that single elderly persons who can rely less on children—and in particular daughters—for their home care receive not only more formal care but also more care from friends and neighbors. These findings suggest that policymakers need to take into account not only home care provision from children but also home care provision from friends and neighbors to obtain accurate projections concerning the increasing costs of formal care programs due to an aging population.     

养老服务的逻辑、实现方式与治理路径

养老服务是不同供给主体将不同内容、质量和价格的养老产品或项目,以不同的方式配送到不同需求老年群体的过程。不同供给主体基于责任驱动和利益驱动,为需求主体提供适应性养老服务,是养老服务的基本逻辑。养老服务的实现,是在特定地域、特定的社会关系网络中,通过优化配置养老服务资源,聚集整合养老服务资本,来保障有质量、有尊严的老年生活。鉴于养老服务供给的多元性和需求的复杂性,养老服务的治理则需要运用先进的合作治理与参与治理理念、选择科学的治理工具和现代化的治理技术,保障养老服务供给与需求的适应性匹配,进而保障养老服务实现方式的有序运行。     

Emergence and evolution of co-operatives for elderly care in Japan

To cope with the unprecedented speed of aging, Japan launched the quasi-market reforms in social welfare policy and the long-term care insurance system introduced competition amongst various kinds of service providers in 2000. Co-operatives have been actively involved in service provision for elderly care combining their business dimension with associational one. There existed distinct patterns of emergence and evolution of co-operative elderly care from grass roots. Consumer co-ops started to train consumer members as care-givers and entered the care business while health co-ops made a substantial investment to build facilities and manpower for elderly care as a natural extension. Workers co-operatives were organized to provide elderly care to the increasing number of care receivers.     

Community work and community care: Links in practice and in education

This article emphasises the individualising nature of much current community care provision and then discusses opportunities which may have been presented by the emphasis on user-empowerment within the community care changes. Drawing on personal experience and written from a perspective that we need a community care provision infused with the practices and values of community work, the article considers how community work needs to change and how community care workers need to change. The implications for social work educators are brought out throughout the article.     

The Savings Approach to Financing Long-Term Care in Singapore

Summary

Singapore is grappling with provision of services for the current generation of older people at the same time as building the foundation for the coming generations of elderly. In this article, I analyze four sets of factors that are shaping long-term care policy and financing in ways that are almost unique to Singapore. First, current developments can only be understood in the context of the Central Provident Fund (CPF) that was established by the Government of Singapore in the 1950s to ensure that the working population saved for retirement; the Medisave and related schemes for financing health care were subsequently developed alongside the CPF. Most recently, the existing funding arrangements have been extended to some long-term care services, and options for further extensions are under consideration. Second, the government's philosophy of maintaining the primacy of family support for the elderly has been expressed through a number of initiatives that provide financial and other incentives to families, combined with an emphasis on community care. The third factor is the relationship between government and the voluntary welfare organizations that are the major providers of institutional and community services. Finally, a series of government-sponsored reviews and advisory councils have provided for widespread consultation on policy options. These developments are directed to achieving a multi-pillar approach in which intergenerational transfers through taxation will be limited, and the role of individual savings and insurance will be increased.     

Ethnicity and Ageing in Singapore

This article examines ethnic differences in the ageing phenomenon in Singapore, emphasising the socio-economic characteristics of elderly Malays. Poverty among elderly Malays is disproportionately high. The adequacies of the social security policy, especially the Central Provident Fund, in the provision of financial protection and retirement income for elderly Malays are explored. The government's strategy of shifting elderly care to the family and ethnic community will further undermine social cohesion by intensifying Chinese chauvinistic attitudes toward the minority groups, especially the Malays, hence, deepening the divisions among ethnic groups. State policy that highlights ethnic differences creates in-group posturing, which promotes a notion that the Chinese are a different species and culturally superior to other ethnic groups.     

关于发展社区养老模式的研究

我国已进入老龄化社会,老年人如何养老已成为我国社会生活中的一个突出问题。由于家庭结构和人口政策的变化,传统的家庭养老和社会养老己不能适应我国社会的现实需要,而社区养老模式以其独特的优势正引起广泛的关注,集中建设的专业化老年社区能更好地行使社区的养老职能,发挥出更大的社会和经济效益。构建和发展社区养老模式,须统筹协调,完善相关扶持政策;注重社区养老产品的差别化,拓宽养老目标群体的覆盖面;强化专业培训,实行养老服务人才资格认证制度;引用社会多种资源,完善社区助老服务设施;开发拓展,加快社区养老服务产业化进程;联合各方力量,加强对公众的宣传、引导。     

Changes in service provision in rural areas. Part 2: Changes in post office provision in mid Wales: A GIS-based evaluation

This paper develops themes set out in Part 1 of this paper relating to the importance of public service provision in rural areas, particularly for potentially vulnerable members of the community such as the elderly, unemployed and single parents. Changes in a key service sector, post office services, in rural mid Wales over a 15-year period are assessed and analysed in relation to the developing sociodemographic profile of the underlying population. A Geographic Information System (GIS) approach is adopted to chart changing levels of post office provision in the study area, and the subsequent impacts on accessibility to those post offices. The policy significance of developing measures of accessibility to services with a view to incorporating these GIS-generated measures into traditional area-based indicators of disadvantage is highlighted.     

Danish home care policy and the family: implications for the United States

This paper provides an overview of reforms in Danish long-term care initiated in the early 1980s, describes the relationship between elder care in Denmark and the family, and considers implications for U.S. policy. The success of Denmark's community-based experimentation with new models of home care and housing for the elderly resulted in a national decision to eliminate new construction of nursing homes and increase access to publicly funded home care. Lingering concern that the provision of paid assistance for the elderly could undermine family structure is allayed by the findings of a recent survey: Three-fourths of the elderly report seeing their children on a weekly or more frequent basis. Findings from the Danish experience provide evidence that community-based services can aid family caregivers, enable the frail elderly to live in the setting of their choice, and be cost-effective from a public policy perspective.     

西方社区养老服务及其对我国的启示

西方社区养老服务对我国应对人口老龄化问题具有重要的借鉴意义。本文首先分析了西方社区养老服务、西方社区照顾与我国社区养老服务的异同,并综述了西方学者在支持家庭照顾者、居家照顾服务、邻里照顾、照顾管理和协作模式等方面的研究成果,以期对我国社区养老服务提供理论借鉴。     

Complaints,Sensitivities and Responsibility: An Ethnographic Investigation into the Debates Concerning the Care of Bangladeshi Mothers in the East End

The subject of this paper is a maternity services awareness day organised by a community centre in the East End of London. In what I interpret as the fractured political landscape of Tower Hamlets (in East London), this event formed a rare focus for the diverse groups of people I worked with in my fieldwork and provides a focal point through which to reflect upon issues of diaspora, culture and health care. This paper attempts to analyse the public voices of a diasporic community which were challenging mainstream health provision. In this paper, I suggest that the voicing of complaint both reified and contested the needs of Bangladeshi mothers specifically, yet did not alter the services provided. The ways in which “culture” is used or discarded as a critical platform on which to base claims about health care are discussed.