A lesson learned from community-based integrated long-term care in Thailand

Abstract

Thailand is the second most rapidly ageing of the Association of Southeast Asian Nations (ASEAN) countries. With this rapid pace of population ageing, the demand for long-term care has increased. Due to lower fertility and migration of adult children, the availability of children as a main source of long-term care has been reduced. In order to retain the traditional lifestyle of ageing-in-place, community-based integrated long-term care has been implemented as an alternative approach in Thailand. The development of such community-based care and its challenges can be used as a lesson for other ASEAN countries in confronting ageing societies.     

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

ABSTRACT

Use of private social care services among older people is increasing in Finland. This study aims to understand why older people choose private care in a comprehensive tax-subsidized social care system and examines whether people choose private service as a free choice or a forced choice as well as what factors contribute toward making these choices. Data for this study (N = 1,436) were gathered in 2010 from people aged 75 and above living independently at home in two Finnish cities: Tampere and Jyväskylä. Data were analyzed with several quantitative tests: chi-squared tests, multinomial regression analysis, and qualitative content analysis (for the open-ended responses from the survey questionnaire). Findings reveal that people chose private services mostly because of the effortlessness involved in its use and of the need for additional services that are unavailable through municipality; for example, cleaning. Majority of the respondents performed a free choice to use private services. People who lived in a city center with a higher level of income and who needed more services were more likely to be constrained toward using private support. Major concern, due to diminishing public service provision, is about service accessibility of economically disadvantaged groups; therefore, more research is required to understand the effects of the growing care market in Finland.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

Commitment of Private and Public Agency Workers to Child Welfare: How Long Do They Plan to Stay?

ABSTRACT

Method: Child welfare professionals completing training to work in foster care were asked about reasons for taking their child welfare position, commitment to their agencies, and commitment to child welfare. Analyses compared responses from new public agency foster care workers (N = 100), public agency workers making lateral transfers to foster care (N = 64), and new private foster care workers (N = 105).

Results: Private agency foster care workers were less committed to their agencies and to child welfare and more likely to have taken the position because it was the only one available.

Conclusions: The practice by public child welfare of outsourcing foster care services to private agencies needs to be evaluated. This practice may not benefit children in care and may create organizational problems for agencies.     

Private Children's Homes

Summary The paper provides survey and intensive research material onthe private children's homes sector. It is shown that this sectoris currently in decline. Private homes are found to be shelteringchildren with long and complex care histories and to adopt adistinctive residential style. Although private homes providevaluable long term continuity, they are less likely to offerthe same range of community services as do residential settingsmanaged by the local authority and voluntary child care agencies.     

Intergenerational Care Perceptions of Older Women and Middle Adolescents in a Resource-Constrained Community in South Africa

ABSTRACT

This study describes intergenerational care perceptions in a resource-challenged community. Ten women (aged 60+) and eight middle adolescents (3 boys and 5 girls) participated in the Mmogo-method®, a visual data-collection method. Textual data were analysed thematically, and visual data by applying Roos and Redelinghuys (2016) proposed steps. Both groups provided physical and instrumental care to the other. Older women cared for adolescents by teaching and disciplining them, while the adolescents cared for them by obtaining an education and by showing respect. Older women felt being cared for when adolescents helped them, obeyed and complied with instructions and discipline, while the youngsters expressed it when their basic needs were addressed and school attendance was enabled. Older women’s expressions of caring about were vague, while the younger people detected, act and elicited reactions from the elders. The adopted care approach informed care perceptions. Joint intergenerational activities are proposed to discover care currencies and contributions of generational members.     

Privileged policies versus lack of care and engagement: the lives of retired veteran cadres in a residential community of Jinan Municipal Party Committee,China

Abstract

The Retirement System for Veteran Cadres (Lixiu) is one part of China’s dual-track retirement system. According to some official policies, retired veteran cadres should enjoy a number of privileges in terms of pension, health care, use of government vehicle, housing and peculiar political rights. Based on participant observation and semi-structured interview, the study looks into the life of the population in a residential community of Jinan Municipal Party Committee, Shandong Province. By incorporating Maslow’s hierarchy of needs theory, the study finds that in China, services for retired cadres still fall short of the expectations of policy. Establishment of ‘big communities’ with the idea of ageing-in-place is suggested.     

Family-Centered Care

Abstract

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider-focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family-centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

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.     

Philanthropy and Government

Abstract

This study examines the effect of characteristics of the caregiving network on the likelihood of using supportive services by dependent older persons. Logistic regression analysis was conducted with a probability sample of community-dwelling elders cared for by their wives or daughters (n = 209). Results indicate that the specific composition of the caregiving networks, including the identity of the primary caregiver (wives vs. daughters), the availability and identity (kin or friends) of secondary helpers determines the likelihood of service use. The findings suggest that elders cared for by their wives alone may be quite isolated and should be the priority for community outreach services.     

Formal Alternative Transportation Options for Older Adults: An Assessment of Need

ABSTRACT

This study measured the need for formal alternative modes of transportation among older adults by applying traditional factors of the Behavioral Model. Survey participants who regularly drove were compared to those who could no longer drive. Race/ethnicity and self-reported health were significant predictors of perceived need for transportation services for both groups. However, income and service awareness were significant predictors only for drivers, while family proximity was a significant predictor only for non-drivers. Results suggest the importance of gaining a better understanding of the factors associated with need for senior-focused transportation services to more effectively plan such programs.     

Facilitating Future Planning for Ageing Adults with Intellectual Disabilities Using a Planning Tool that Incorporates Quality of Life Domains

Abstract

When ageing families of an adult with a lifelong disability embark on a process of planning for the future, they generally think in terms of making hard and fast decisions about: (1) where the person with the disability is going to live when “the time comes”; and (2) who will take on their direct care. However, there is common trepidation among many families when it comes to launching their son or daughter with a lifelong disability. Generally, many families ignore, neglect, or simply do not engage in making any formal plans at all. When ageing families do make plans, they often focus only a place to live. This can mean that other significant aspects of a person's life (i.e., quality of life factors) are negated or neglected. Reviewing population demographics for both the Republic of Ireland and Northern Ireland, it was ascertained that a sizable number of parents will be aging in the near future and that some formalized assistance for future planning was needed. To this end, a planning instrument, What the Future Holds, was developed in order to help families and other carers with planning for the future and involving a variety of quality of life domains, including health, financial, vocational, social, civil, and residential well-being.     

Consumer Direction in Community-Based Long-Term Care

Abstract

Recently, a growing number of community-based long term care programs have been incorporating a concept of consumer direction (CD). Consumer Direction allows long-term care consumers to take more active roles in their care management, by hiring, training, supervising, and firing care providers. A limited number of existing studies show that CD consumers indeed feel they have more choice and control over their care compared to those under the traditional model. However, other studies show problematic working conditions for care providers under CD. Questions also remain unanswered regarding how CD effects different important stakeholders, including family caregivers, formal paid caregivers, and governments. More research, administrative, and practice efforts are needed to ensure CD can benefit all sectors of communities.     

Transformation of Social Care Services for the Elderly in Slovakia

ABSTRACT

The main objective of this article is to present a theoretical framework for the relevant historical, economic, demographic, and political factors influencing the transformation of social care services for the elderly in Slovakia. A major restructuring of the social care services for the elderly is necessitated by the aging of the Slovak population (demographic reason), the path dependency of the current Slovak elderly care system (historical reason), the growing purchasing power of older people and the general population (economic reason), and new requirements formulated by the European Union and the general public (political reason). Historical documents, legislative acts, strategic documents, international project documents, and statistics were reviewed, and 34 open-ended interviews within the framework of two case studies were carried out in order to obtain qualitative and quantitative data. The theoretical framework and the results based on those interviews indicate that the Slovak social care service for the elderly may turn out to become more similar to the advanced Central European systems, but also that prompt legislative and financial changes are required. Nevertheless, the future direction can only be more precisely identified when more case studies can be compared with one another.     

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.     

Transport related social exclusion in New Zealand: Evidence and challenges

Abstract

People without functional access to a car in countries where private vehicles are the predominant form of transport are at a disadvantage. Alternative modes of travel in such settings often do not meet people's mobility needs, creating barriers to participation in work, education, social activities, sport and leisure, and to accessing basic goods and services. In New Zealand, private vehicles have long been prioritised as the mode of personal transport in land transport planning policy. However, this is beginning to change with policy objectives now including improvement of access and mobility for all, and reduction of social exclusion. Despite this there is very little evidence of the experiences of those with mobility or access problems in New Zealand. This article seeks to provide qualitative data about experiences of transport related social exclusion, the efficacy of alternative modes for people's mobility needs, the impacts of these difficulties on people's lives, and the policy implications of these findings.     

Women Really Care

Pressures to contain or reduce public expenditure are giving rise to policies geared to reduce the demand for direct state services. These involve alternative programs featuring the transfer of responsibilities, but not necessarily control, to more local, private, and family bases. Such trends depend upon the availability of the apparently cheap labour of women. Community care generally means care by females, but this fact is usually unacknowledged and the costs of the emerging programs tend to be reckoned only as those accruing to the state. Here we focus on two policy areas in which community and family have been emphasised, family day care and deinstitutionalisation in child welfare.^*     

The unknown soldiers of foster care: Foster care as loss for the foster parents’ own children

Abstract

This paper explores the effects of the foster care experience on foster parents’ biological children. In spite of having been accepted for over 40 years as the best form of residential care for most children and adolescents requiring alternative living arrangements, very little research has been done into the foster care experience. Almost nothing is known about the effects of foster care on either the foster family as a unit or its individual members, yet one of the major concerns foster parents present is the effect of the foster care experience on their own children. This concern leads many experienced foster families to leave foster care and many potential foster families to decide not to foster. This paper discusses the losses experienced by the children of foster parents.     

Transitions of Youth in Mental Health Residential Care to Less Restrictive Settings: The Role of Strengths and Gender

ABSTRACT

Changes in youth's behavioral/psychosocial functioning has been found to play an important role in the transitions from mental health residential care to less restrictive settings, and this functioning differs significantly by gender. However, there has been little attention paid to the roles played by psychosocial strength and gender in transitions out of residential care. The current study examined gender differences in the role of strengths in transitions to less restrictive settings using data on 675 youth's admission and discharge records collected from Illinois Residential Treatment Outcome System during 2005–2007 (Mean age = 15 years, SD = 2.0; 57.5% = boys). The results of multivariate logistic regression model indicated that positive recreational activities and lack of chronic illness were related to a higher likelihood of transitions to less restrictive settings among girls, while appropriate sexual development, psychological strengths, and strong spiritual/religious strengths were related to the transitions among boys. This study demonstrates the potential importance of youth strengths in the provision of mental health services and suggests a need to develop models of outcomes that take gender into account. Additional research based on multiple informants including youth self-report is needed to understand the role of gender in transitions out of residential care.