Adult Day Care

Adult day care is a developing concept in the United States. Many consider it a viable alternative to institutionalization for older Americans who are incapacitated. When considering the predicted number of Americans age 80 and over to be 8 million by the year 2000, provisions must be developed to cope with this group and their specific needs. The English experience in adult day care represents a successful and cost effective program. A variety of models are functioning well. Model I and Model II Programs are currently in existence in the United States. Growth is slow but steady. The Subcommittee on Health and Long-Term Care of the House Select Committee on Aging, in 1980, recommended the establishment of a national policy on day care, with funds for planning, and a comprehensive restructuring of funds to better implement the day care concept. Recent legislation, in the form of the Economic Recovery Act, effective January I , 1982. and the 1981 Omnibus Budget Reconciliation Act, represents a beginning as far as economic incentives for day care are concerned. The political climate will undoubtedly effect the future of adult day care, and studies are urgently needed to document its cost effectiveness.     

Quality of care: relationship between the perceptions of elderly home care users and their caregivers

The aim was to study the relationship between elderly home care users', and their caregivers', perceptions of the quality of care. The sample consisted of 151 matched elderly home care user-caregiver pairs in a Swedish municipality. The elderly home care users were interviewed and their caregivers filled in questionnaires using an established, theory-based instrument. Results showed that the elderly home care users evaluated most care components more favourably than their caregivers. On ratings of the various care components' subjective importance to the caretaker, the caregivers consistently scored higher than the elderly home care users. Within the subset of elderly home care users who received help at least twice a day, there were greater similarities between caregivers and caretakers. The results are related to comparable research and discussed in terms of caregivers' needs to legitimize their professional identity and actions.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

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.     

Ageing and Family Dependency

The ‘graying’ of Australia's population has generated much debate within government, demographic, health and social service circles in recent times. Current and projected shifts in population structure towards greater numbers of ‘dependent’ populations raise a number of complex issues in regard to resource allocation in both income support and service provision. Service issues revolve around questions of whether public or private provision will resolve the care issues for dependent elderly people. It is argued that contrary to popular opinion, family care is well entrenched within the framework of social care, and that the solution of community care, posited in relation to the rising levels of chronic illness and dependency within the elderly population, is actually an attempt to place more responsibility of care on to the family. It is further suggested that family care is, in fact, care by women who themselves are in a state of dependency. Citing evidence from a study conducted by the authors, the paper argues that family care imposes heavy burdens upon women and families and suggests that social policy should, firstly, actively bolster family care through the provision of supportive and supplementary services; and secondly, broaden its intent by exploring other options of care for elderly people. The latter response is important because without it, family care will only help to reinforce and sustain the dependent status of women.     

市场化、社会转型与城市郊区农村老人的“轮养”——来自子女口述史的分析

通过对河北省保定市郊区农村的深入访谈和问卷调查，本文研究了有两个以上已婚儿子的老年夫妻去世前的生活状况。研究发现，儿子成年之后的独立门户，是这类老年夫妇“宁巢”的前提，而“空巢”又是“轮养”契约得以建立的条件。市场化、社会结构转型、儿媳妇在家庭决策中作用的增强等，使老年人失去了家庭决策权。故“轮养”在生命过程中，实际是被安排的结果，而不是老年父母自己的选择。     

The “Socialization of Elderly Hospitalization” in China: Development,Problems, and Solutions

ABSTRACT

Objectives to analyze the development of the elderly patients with chronic diseases and to make some suggestions for the elderly social hospitalization. Methods By using yearbook data and theoretical analyses, the paper respectively presents the problems and furthermore solutions of China's elderly services. Results The elderly patients with chronic illnesses have formed a new group, and the phenomenon of “socialization of elderly hospitalization” has become a major social risk. Discussions China needs to promote the idea of “long-term care” in elderly social security, establishing long-term care insurance and fostering a private, professional elderly service system.     

Caring for elderly parents and adult children living at home: interactions of the Sandwich Generation family

The study presented here analyzed the patterns of demands made on 66 middle-aged women by their elderly parents and their adult children who were living at home. Factor analyses of the reports of family interactions revealed the presence of five adult children-middle-aged parents interaction factors and four elderly parents-middle-aged parents interactions. These patterns were considerably more complex than previous studies of the Sandwich Generation suggested. As expected, socioeconomic status and health of the elderly parents were related to these family interaction factors.     

How Japanese Families Cope with Fragile Elderly

Coping with caring for ill, fragile elderly is taxing the families in Japan, where longevity statistics predict early in the twenty-first century it will have the highest percentage of aged in the world. Interviews with 20 families revealed that although the culture mandates families care for their elderly, many are having considerable ambivalence and conflict, and caretakers suffer in the process unless they have assumed the defense of a martyr stance. Most do not seek nursing homes but are turning to government for supportive services. The trend in Japan, in spite of tradition, is for adult children to delay taking parents into their homes until they are unable to care for themselves.     

A Functional Classification of Services for Older People

A deductively derived classification scheme is proposed which categorizes the health and social services of a community according to the levels of competence (behavioral functioningj and the levels of independence of the older people they address. Five levels of individual behavioral functioning ranging from simple to complex are specified: life-maintenance and health; perception-cognition: self-maintenance; effectance: and sociol role performance. Three levels of independence (of living arrangements) are specified ranging from the independent to the dependent subgroups of older people: the comparatively well elderly; elderly who require alternatives to prevent premature institutionalization; and elderly whose needs may confer institutional care or its equivalents. The services of a sample community are classified within this two dimensional scheme. The applications of the classification scheme to both community planning and individual treatment plan formulation are discussed.     

Culture change in long-term care: educating the next generation

Long-term care facilities for frail elders are usually based upon the medical model, which is focused primarily on the biological functioning of these elders. The medical model allows for little choice on the part of the residents of these facilities. By way of contrast, culture change is a new approach to long-term care. This model of care seeks to meet a wide variety of needs for the elders and aims to expand their choices. This article presents the observations of college students responding to interactions with frail elders and looks at the implications of culture change for young adult college students.     

Commercial,non‐profit and governmental residential elderly care in Flanders: Differences in client selection and efficiency?

Verschuere B, Moray N, Decramer A. Commercial, non‐profit and governmental residential elderly care in Flanders: differences in client selection and efficiency? Inspired by New Public Management, governments have stimulated competition, outsourcing and privatisation in the public sector. Also, in care of the elderly, there has been a substantial increase in commercial provision. The present study explored the presumed differences in the performance of public (governmental), private non‐profit and private commercial elderly care organisations. We used quantitative indicators on the population of residential elderly care organisations in Flanders (Belgium). Although we found that commercial elderly care facilities tended to be more input‐efficient while non‐profit and public elderly care facilities tended to be more attentive to recruiting and housing residents with high care needs, these results need to be interpreted in light of the regulatory framework in which the different types of elderly care facilities operate.     

Inequality in the welfare state? Local variation in care of the elderly – the case of Sweden

This article uses Sweden as an example to describe and analyse municipal variation in services and care for elderly people. Responsibility for these services lies with the municipalities. National statistical data on municipalities are analysed to map out the variations in old-age care; to study compensating factors in the care system; and to explore the connection with municipal structural and political conditions. The overall finding of the bivariate analyses was that most relations with structure and policy were weak or non-existent. The final multivariate model explained only 15% of the variance. The large differences between municipalities makes it more appropriate to talk about a multitude of 'welfare municipalities' rather than one single welfare state. The article concludes that this municipal disparity constitutes a greater threat to the principle of equality in care of the elderly than gender and socio-economic differences.     

Culture Change in Long-Term Care

Abstract

Long-term care facilities for frail elders are usually based upon the medical model, which is focused primarily on the biological functioning of these elders. The medical model allows for little choice on the part of the residents of these facilities. By way of contrast, culture change is a new approach to long-term care. This model of care seeks to meet a wide variety of needs for the elders and aims to expand their choices. This article presents the observations of college students responding to interactions with frail elders and looks at the implications of culture change for young adult college Students.     

The life satisfaction of elderly Chinese widows living alone and those living with adult children

Care of China's elderly population is of concern due to its projected growth as well as to changes in elder care patterns related to shifting social and economic conditions. Increases in life expectancy and, therefore, in the duration of widowhood, particularly for women, magnifies this concern. Studies that examine the living arrangements and life satisfaction of elderly widows in China are limited. This study of 147 elderly widows, both men and women, examined differences in the life satisfaction of those who live with their adult children and those who live alone. This study also examined whether the relationship between living arrangement and life satisfaction was moderated by levels of family and community support. According to study findings, elderly widows living alone have higher life satisfaction than those living with their adult children, and this effect remains with the introduction of controls for health status, family support, community support, gender, age, income and educational level. Further, neither family nor community support moderate the relationship between living arrangement and life satisfaction, although each exerts a direct effect on life satisfaction.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

THE GROUP

This article describes an effective summer day program for the mentally impaired elderly. It discusses and illustrdtes the helping principles applied in a life model and interactionally oriented group and milieu approach. A sense of self is restored through community, and through providing opportunities for recall through community, and through providing opportunities for recall through doing, talking and sharing common feelings. The provision of a positive here and now experience which recognizes and bolsten strengths makes it more attractive to live more fully here and now. Even the most regressed patients improved in outlook and functioning as a result of the group experience.     

What changes during specialized foster care? A study on adaptive functioning and emotional and social problems

Various models of specialized foster care have been developed, but research on them is limited. This longitudinal, exploratory study analysed data on adaptive functioning, emotional and social problems and self-concept in a specialized foster care service in Sweden. The focus of the study was on the development of the children and young people in placement. The Adaptive Behaviour Assessment System (ABAS-II) was used to measure adaptive functioning, and the Beck Youth Inventories of Emotional and Social Impairment (BYI) was used to measure self-rated emotional and social problems and self-concept. Self-ratings showed significant improvements in disruptive behaviour, anger, anxiety and depression. Adaptive functioning as rated by foster parents improved but not enough to catch up with the non-clinical norm group. The average adaptive functioning among the participants at baseline was considerably below the Swedish norm group. Similar to the results of a previous study of the same treatment model, children and young people rated improvement while their foster parents did not do so to the same extent. Possible explanations for this are discussed in the paper. The study is limited by the lack of a control group and by data attrition.     

Healthcare Provision for Elderly People in Argentina: The Crisis of PAMI

This paper highlights the problems of administering health insurance programmes in Latin America and the difficulties of imposing effective reforms. It examines the development, financial collapse and subsequent restructuring of a health insurance programme specifically targeting elderly people in Argentina. By the 1990s the Integrated Healthcare Programme (PAMI) had become one of the largest components of the country's public welfare system, managing an annual budget of US $2.5 billion. It provided elderly people with a wide range of services, including free and discounted medical care and a national network of day centres. The Programme was widely praised as efficient and innovative both within Argentina and beyond and was considered a model which other developing countries might emulate.
However, in 1994 it was discovered that PAMI had accumulated a deficit of US $1.3 billion and was suffering from a large number of serious structural weaknesses. These included a complete absence of financial accountability (both internally and externally), the piecemeal expansion of services, employment featherbedding, political patronage and corruption. Also, the Programme had contributed to long-standing inequalities between different geographical regions and between insured and uninsured populations. Since then, numerous attempts have been made to reform the Programme, some of which have received funding from the World Bank, but these initiatives are only being very gradually implemented.