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.     

From reforms to rationing? Current allocative trends in social services in Sweden

In Sweden, the current national deficit is putting immense pressure on all government spending. Economic recession and increased levels of unemployment have jointly altered the image of the welfare state and redirected focus on it as a financial burden. A matter of considerable political and public concern is the consequences of the economic constraints on social services - the part of the welfare programs carried out by local authorities. This article raises concerns of resource allocation, starting from an outline of the impact of economic developments on different sectors of the social services. Expenditure for elderly care, child care and individual and family care is analyzed in the light of demographic changes and coverage rates. A main focus is put on the most recent development and the perceivable strategies for managing the financial cut-backs are discussed in detail. Two strategies stand out as central. One is dilution, which is granting help to an unchanged number or proportion of people granted help, combined with a decreased level or altered quality of the service provided. The other is focusing, where eligibility is defined more narrowly and in the normal case results in a consistent or even improved level of service to the most needy. Dilution seems to be the major strategy for child care and focusing the allocative trend in services for elderly people.     

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.     

A Qualitative Exploratory Study on the Service Delivery System for the New Long-Term Care Insurance System in Korea

ABSTRACT

To cope with the rapid growth in its aging population, the Korean government introduced a new social long-term care insurance (LTCI) system for elderly people beginning in July 2008. This study aims to understand how National Health Insurance Corporation (NHIC) staff and home-visiting service providers experienced and evaluated the new service delivery system. A total of 26 semistructured in-depth interviews were conducted with NHIC staff primarily responsible for the functional assessment of the elderly and the home-visiting service providers responsible for providing direct services to elderly clients. In summary, interviewees had negative experiences with the new service delivery system such as difficulties in carrying out their roles. The findings suggest that Korea's new LTCI service delivery system faces challenges and that a more active role for the Korean government, especially regarding the introduction of a proper care management system, is needed to address the issues. Future research with larger sample sizes is needed to examine and understand the issues in detail.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Depression and Suicide Among Community Elderly

Abstract

The phenomena of hopelessness, depression and, suicidality among the elderly have been long recognized as a social problem. It is commonly agreed that the rates of depression, sense of hopelessness and, suicidality in that age group are higher among older people. Due to its sensitive nature, the gerontological literature has been paid more theoretical and empirical attention to the understanding of such phenomena at the last two decades.

The present study concerned hopelessness, depression and, suicidality among an elderly community population. It aimed at providing a demographic profile of factors contributing to depression and suicidality among old people. At five senior citizen centers at the north of Israel, 316 old people living in the community were randomly selected. Subjects were administered the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (HS), and the Scale for Suicidal Ideation (SSI). The data suggest that four main demographic variables contributed to the explanation of suicidality, depression, and hopelessness among the elderly. Practical implications are discussed.     

Adoption in South Africa: trends and patterns in social work practice

This paper reports findings from a research study on adoption in South Africa conducted in 2009. The research included secondary data analysis of the South African National Adoption Register to establish trends and patterns of adoption in South Africa between 2004 and 2009, and primary data collection through qualitative interviews with key informants in public and private social welfare services to explore attitudes, knowledge and experiences of social work practice related to adoption. The quantitative findings report the number of national and international adoptions along with trends and socio‐demographic patterns of national adoptions. Qualitative findings report on social work practice, systemic barriers and social worker attitudes as barriers to improved social work practice around national adoptions. The paper highlights comparisons to adoption literature in the USA, a country with a similar legislative framework and cultural complexities, but significantly more resources for implementation. Recommendations are offered for social work practice, national data collection and policy implementation efforts to support efforts to increase adoption.     

Policy transfer,social pedagogy and children's residential care in England

Much concern has been expressed about the quality of care and poor outcomes for looked‐after children (‘children in care’) in England, especially regarding residential homes. This paper builds on a recent evaluation of the piloting of the continental European model of social pedagogy (SP) in English residential care. It does three things: it considers the theoretical social policy literature on policy transfer and its implications; discusses European residential care for children and the discipline of SP; and reflects on these debates and the situation of children's residential care in England. The paper concludes that there are some major hurdles to a widespread implementation of SP in England. This particularly concerns the differing social, professional and political context of children's residential services across neighbouring countries.     

Continuum of Care as a Policy Framework for the Social Health Care Needs of the Elderly

For some time the continuum of care has intrigued social planners and policy analysts as a concept with potential for influencing the delivery of social services. More recently, the Older Americans Act, as amended, 1978, includes the mandate to State Units and Area Agencies on Aging to provide a continuum of care for the vulnerable elderly. This state of the art review examines the continuum of care concept by isolating areas of consensus, highlighting points of disagreement, and identifying issues relevant to continuum of care as a conceptual framework for policy decisions and service delivery to the elderly population.     

Restructuring Long-Term Care in Spain: The Impact of The Economic Crisis on Social Policies and Social Work Practice

ABSTRACT

Care needs of the aging population are increasing in Southern European countries. The purpose of this article is to explore the implications of meeting these needs while taking into account the recent economic crisis, which has deeply affected countries such as Spain. This study is part of a European project (ISCH COST Action IS1102) and is based mainly on qualitative information that focuses on in-depth interviews with social service workers (n = 19) who provide the service and program recipients or their caregivers (n = 14). In addition, two discussion groups were conducted with professionals (n = 9) and program volunteers (n = 5), as well as a workshop/discussion group (n = 28) with politicians, service providers, and participants. Six thematic premises were identified with differing views being highlighted relevant to the participants' roles in the program. Future research should explore social service strategies to deal with the increase in care needs as well as community-based responses.     

Public health care in the balance: exploring popular support for health care systems in the European Union

Which factors explain intra‐ and inter‐country variations in levels of public support for national health care systems within the European Union, and why? We propose that public opinion towards public health care is dependent on (1) the type of welfare state regime to which the various European welfare states belong, (2) typical features of the national care system and (3) individual social and demographic characteristics, which are related to self‐interest or morality oriented motives. To assess the explanatory power of these factors, data from the Eurobarometer survey series are analysed. Support for public health care appears to be particularly positively related to social‐democratic attributes of welfare states, whereas support drops with increasing degrees of liberalism and conservatism. Further, support for public health care proves to be associated with wider coverage and public funding of national care services. We also find higher levels of support in countries with scarce social services for children and the elderly, and larger proportions of female (part‐time) employment. Lastly, with respect to individual characteristics, we find remarkably little evidence for self‐interest oriented motives affecting the preference for solidary health care arrangements.     

The Elder Latino Population in Holyoke,MA

Abstract

Holyoke's elderly Latino population's needs, as well as their patterns of service utilization, were explored through detailed interviews of 13 individual elders and a focus group of an additional 10 participants. The research uncovered a gap in the web of resources available, with some services, such as medical care, functioning well. However, there continue to be unmet needs, particularly in the areas of transportation, social and recreational activities, and sense of safety. Negative perceptions of aging and complaints of anxiety, depression, and boredom are also an area of concern.

The barriers to use of services were also explored. Recommendations for the enhanced provision and utilization of services, many suggested by the elders themselves, are offered. Implications for social work research and policy on, and practice with, Latino elders are discussed.     

A Qualitative Evaluation of a Conditional Cash Transfer Program in Turkey: The Beneficiaries’ and Key Informants’ Perspectives

ABSTRACT

Since the 2001 economic crisis, conditional cash transfers (CCTs) have been provided to poor families in Turkey to improve education and health outcomes of children. Under the framework of CCT programs, grants provide an incentive for poor households to use available basic social services. The aim of this study is to explore beneficiaries’ perspectives in relation to a CCT program in Turkey. The in-depth study design entailed semistructured qualitative interviews with beneficiary households and key informants. A total of 397 in-depth interviews were conducted. Analysis results suggest that the CCT program not only positively affected health and educational outcomes, but also contributed to the empowerment of women and improved the self-esteem and self-confidence of beneficiary children. Recommendations for future research are made including the need for an impact evaluation analysis that employs quantitative research methods designed to improve the provision and quality of the basic social services.     

Collective citizenship: From citizenship and mental health to citizenship and solidarity

Although the concept of citizenship is a widely used theoretical framework within political philosophy, its use in the field of mental health remains underexplored. Within this context, citizenship emphasises the social inclusion and participation of people who are marginalized and offers a more social and relational view of services and support for people with mental health problems than has been common in mental health systems of care. At the same time, however, the citizenship approach has operated in the context of systems of care in the United States that favour highly individualized conceptions of, and approaches to, care, and these systems of care operate in the social and political context of highly individualized concepts of the citizen. In this article building on the work of other citizenship scholars, we argue that a collective form of citizenship, grounded in the 5Rs framework, holds the individual and collective in creative tension. Furthermore, the paper applies this model to the domain of mental health, where people are treated in individualistic ways and experience marginalisation, making the collective dimension imperative and promoting participation, empowerment and the contribution for social change to people with mental health problems. Our theoretical framework of collective citizenship, while geared toward the needs of persons with mental health problems, also contributes to recent citizenship theory on the inclusion of marginalized, stigmatised, and excluded groups. We illustrate the application of this approach through an ethnographic-participant observation case study of a collective citizenship group with which we are associated.     

A Comparative Discussion of the Gendered Implications of Cash-for-Care Schemes: Markets, Independence and Social Citizenship in Crisis?

There are moves across many countries away from state-led provision of services for disabled people towards cash-based systems, which have been welcomed by disabled people as increasing choice and control over services and support, and increasing independence and social participation. However, feminist scholars have long warned about the implications of commodifying care for women, and the possible consequences of substituting cash for services for social citizenship have remained underexplored, for both disabled people generally, disabled women and mothers more particularly, and for personal assistants/care workers. This article will attempt to address that gap by carrying out a comparative literature review and policy analysis of the role of policy development and outcomes in cash-for-care schemes, looking comparatively across policy developments in several countries, as well as developed welfare states beyond Europe to examine: (a) the impact of the tensions between various governance levels, particularly local and national government; (b) the gendered impact of such policies on (for example) gendered divisions of paid and unpaid work, citizenship and social participation; (c) the impact such policies have, or are likely to have, on different groups of men and women across the life course and across different social and economic groups; and (d) how such policies can contribute to the well-being and/or detriment of different groups of women (and men) within different social, political, economic and historical contexts.     

Health Care Utilization Among the Elderly

The present study represents and attempt to develop a conceptual framework which provides a theoretical linkage between predisposing, enabling, and need for care factors and the utilization of physicians' services within an elderly population. Multiple regression and path analytic techniques are used to access the relative importance of these factors in determining health care utilization. The findings indicate, among other things, that the measures of morbidity, or the need-for-care, are the most important variables determining use. The substantive findings and their implications for the development of health care policies and programs for future research are highlighted.     

The politics of case management and social work

A case study analysing the introduction of case management into British social services supports the argument that social work is constructed through political processes. In such processes, the interaction among the interests of stakeholders within service innovations influences the construction of the role of social work. Case management was introduced to Britain, but developed in three different forms: social care entrepreneurship, brokerage and multiprofessional case management, including assertive outreach. The forms adopted were affected by the political interaction of stakeholders rather than the professional possibilities offered by case management itself. Evidence for the politics of case management is drawn from analysis of professional literature, the texts of official documents and empirical research outcomes. The introduction of case management led to a debate about how the nature of social work was affected by the innovation. Three alternative views were that social work was improved, or attacked by case management, or made a valid contribution to case management as a different form of practice. It is proposed that to understand the impact of a service innovation on social work, four factors must be considered: the character of the innovation itself; the economic, political and social contexts in which it is introduced; the political and social interests of the stakeholders themselves; and the political and social processes that take place during the introduction of the innovation.     

Social Support for Mothers of Children With Disabilities in China

ABSTRACT.

This article analyzes the gendered parenting experiences of mothers of children with disabilities in China. These mothers struggle to meet their children's needs, including daily care, financial security, and child development. In the context of China's social welfare development, are social services responding to their needs, so that mothers can share responsibility for the needs of their children with disabilities? The research analyzed qualitative data about 6 case-study children in rural and urban China. The data were derived from observation and interviews with their parents and other family and community members. The analysis revealed that the capacity of the mother, community, and local social services had an impact on the rights of the children and mothers. They experienced social discrimination, insufficient social support, and local failure to implement central policy social services and income support. These findings are consistent with international research about disability rights. They reinforce the importance of economic redistribution to enable local implementation of the national disability rights policies, rather than merely relying on ephemeral concepts of cultural change. Further research about the comparative impact of economic and social change in China on mothers and children with disabilities would extend these findings.     

Pension Reforms in Europe and Life-course Politics

In recent years, somewhat drastic pension reforms have taken place in all European countries. The pension systems developed in the last century are no longer considered to be suited to the changing demographic constellations in European countries, and the financial sustainability of these systems is under threat. Moreover, the changing political and economic set‐up in European countries is also used to justify reforming the different pension systems. Different reasons can be given to explain the various pension reform measures without, however, there being any integrated coherence. We suggest that a politics of social policy, and of pension policy in particular, based on a life‐course perspective, facilitates the understanding of the whole range of pension reform measures. In the past, the elaborated pension systems were attuned to a normative standard biography. A new standard biography, with different phases and more transitions and combinations, enables one to understand the variety of the ongoing pension reform measures. Such a life‐course perspective integrates sequences of learning, working and caring considered necessary for the polity. In other words, it is based on a conception of human potential, and it integrates, to some extent, the previously separate domains of labour market policy, education policy, care policy and pension policy. However, recent theoretical and empirical studies of the life course lead to a critical evaluation of the new standard biography, with the conclusion that the new standard is one‐sided and scientifically unsound, entailing challenges for social policy.