Eldercare Service Redesign in Finland: Deinstitutionalization of Long-Term Care

ABSTRACT

Deinstitutionalization is an important trend in the redesign of long-term eldercare in Finland. It refers to a process where traditional institutional care is partly replaced by home care services and the creation of homelike housing units. The first part of this article provides an overview of eldercare service redesign by using national statistics. The second part consists of qualitative analysis of the deinstitutionalization of eldercare. The data consist of 27 interviews conducted among municipal care administrators and is analyzed using thematic and discourse analysis. Main findings show a deep policy change taking place in eldercare deinstitutionalization discourse lying at its center. A distinction between explicit and implicit deinstitutionalization discourse is made. The former clearly states that institutional care needs to be cut back making it possible for all older people to live at home or in homelike housing facilities. Implicit deinstitutionalization discourse is underpinned by comments of a different type, more critical and problem-centered. Within intensive service housing, for instance, fee policy is reformed. The main results include the observation that explicit deinstitutionalization discourse is in line with the national policy aims of putting home first, while implicit discourse deals with hidden or unexpected consequences. The article discusses future research in the conclusion.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

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.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Community Service Use by Older Adults: The Roles of Sociocultural Factors in Rural–Urban Differences

ABSTRACT

This study examined the influence of sociocultural factors in explaining the rural–urban differences in home and community-based service (HCBS) use among older adults. Survey data of 228 older adults living in Alabama were analyzed. Sociocultural factors included participants’ perceptions of service availability, attitudes toward seeking formal help, informal support, and religious behaviors. Rural older adults were less likely to use HCBS than their urban counterparts (p < .05). An interaction effect between perceived service availability and church attendance was found. These findings suggest a need for collaborations between community aging services with religious organizations to ensure existing programs are accessible to older adults living in rural areas. Future research based upon large probability samples is needed to shed more light on the relation between church attendance and service use.     

The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Consumer direction in long-term care policy: overcoming barriers to promoting older adults' opportunity for self-direction

There has been a growing trend in long-term care policy to offer individuals with disabilities the option of consumer direction (CD), where responsibility of managing care and support services is transferred from agencies to care recipients, thus supporting clients' self-determination. Although CD has been accepted as an option for non-elderly individuals with disabilities, barriers persist to promoting older adults' autonomy through CD. This article reviews the incorporation of CD in long-term care policy, addresses the current barriers to providing older adults the right to self-direct, and makes recommendations for overcoming these barriers through social work practice, policy, and research.     

Assessing Statewide Need for Older Adult Health Promotion Services: The Oklahoma Experience

ABSTRACT

The growing senior population and persistent poor health status of seniors in Oklahoma compels a fresh look at what health promotion services would be well received. Surveys were distributed to a list of registered voters aged 65 and older in Oklahoma with a total of 1,248 surveys returned (19.8%). Survey items asked about interests in services, classes, and activities, plus current barriers to accessing and/or engaging in such programs. To account for survey weighting, Rao-Scott Chi-Square Tests were performed to determine differences by demographic characteristics. We identified services, classes, and activities that were (and were not) of interest to seniors in Oklahoma with legal assistance (52.1%), exercise classes (46.6%), internet classes (40.7%), and indoor exercise activities (45.5%) receiving the highest level of interest. Barriers to interest in participating in programs included not wanting to go and not knowing availability of such services. The results of this survey provide useful data on health promotion gaps for seniors, interests and barriers to engaging in such activities, and guidance for statewide program development. Future program development needs to be focused on areas of interest for older adults, including legal assistance, exercise classes, and internet classes.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Advance Care Planning Throughout the End-of-Life

Abstract

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.     

Home-Based Palliative Care Study

Abstract

Purpose: To examine differences in site of death and costs of services by primary diagnosis for patients receiving home-based palliative care as compared to usual care at the end of life verity of illness, service use, and site of death.

Design and Methods: A nonequivalent group design was employed with 298 terminally ill patients diagnosed with cancer, CHF, or COPD enrolled. The treatment group received an interdisciplinary home-based palliative care program and the comparison group received usual Kaiser Permanente services. Data collected included patient demographics, se-

Results: Among all diseases, patients enrolled in palliative care were more likely to die at home. Enrollment in palliative care was significant associated with cost reductions for patients with cancer, COPD, and CHF. No significant difference was found between diagnostic groups in terms of magnitude of cost savings.

Implications: Provision of interdisciplinary home-based palliative care at end of life can effectively increase the likelihood of dying at home for patients with CHF, COPD, and cancer while realizing significant COSt savings.     

Sexuality in the Nursing Home

Abstract

Despite a growing body of literature that contradicts previous stereotypes, negative myths about late life sexuality have persisted. These attitudes had been more entrenched in nursing homes where residents' sexuality have been perceived primarily as behavioral. At one nursing home, a policy and video training program on sexual expression was developed, with staff training, environmental modifications, and work with families, based on sexual expression as a right of consenting adults. This policy can serve nursing homes which face challenges presented by new cohorts of older adults and their families.     

Assessment of multiple constructs of social integration for older adults living in nursing homes

ABSTRACT

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults’ in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ² = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.     

Homelessness in the Czech Republic

This article discusses homelessness in the Czech Republic. In doing so the authors have used an operational definition common in the European Union. In order to explain homelessness in the Czech Republic, the article examines the relevant laws and governmental policies. Then the article discusses some causes of homelessness in the Czech Republic, a recent census of the homeless in the nation, the activities of service-providing organizations, the financing of social services in the nation, health and health care among homeless people, a new food bank, and the harmonization of the Czech Republic with the common objectives of the rest of the European Union .     

Poverty, Social Exclusion and Social Policy in the Czech Republic

This article analyses the pattern of poverty and social exclusion in the Czech Republic and the impact of social policy on this pattern. The analysis is mostly based on data from the Czech Survey on Social Conditions of Households (2001; 27,000 respondents); Eurostat data provide a benchmark for making international comparisons. The poverty rate in the Czech Republic is among the lowest in Europe. On the other hand, material deprivation, as well as concentration of poverty within specific population groups, is high, with the unemployed facing the highest risk of poverty. Social policy measures in effect reinforce this pattern: while the benefit system is highly redistributive and effectively eliminates income poverty among households of employed persons and among pensioners, incomes of persons outside paid employment are protected less effectively. Labour market policy measures are insufficient in scope and inadequate in targeting groups which are facing the highest risk of labour market exclusion and poverty. We argue that although this practice is effective at present, it is not sustainable in the long term.     

Exploring Formal Service Use by Older Chinese: A Case Study on a Naturally Occurring Retirement Community

ABSTRACT

This study examined secondary data from a naturally occurring retirement community in which 296 older Chinese were interviewed to understand and identify the factors related to formal service usage. Regression analysis found that the importance of perception of formal services impacts predicting service use. The results also indicated older female Chinese participants were more likely to use services. Implications for practice and policy to improve access to services by older Chinese were presented and the development of culturally sensitive services for this group is encouraged.     

Home modification among families with older adults with disability in Korea

Abstract

This study explores psychosocial factors related to the use of home modification among older adults with disabilities and their caregivers in Korea. Using in-depth interviews, this study elaborates specific socio-cognitive factors leading to home modification from the multiple perspectives of care recipients, family caregivers and home care helpers. The study findings are theoretically organised into four domains: structural factors, care recipients’ service needs, socio-cognitive factors, and enabling resources. Practice and policy implications are discussed in the context of underdeveloped housing policies for ageing-in-place in Korea.     

Home-Based Practice with Older Adults

Abstract

Social work with older adults frequently occurs in the client's home. Although practitioners and the professional literature acknowledge the existence of differences between agency-based and home-based practice, little attention has been given to the way the home environment impacts on the intervention process. This exploratory study examined practitioner-identified events that impact on the intervention process in home-based practice. The events elicited two general categories, the context and the process of interventions. Factors subsumed under intervention context are situational and geographic factors, such as practitioner and client comfort, and differences in urban and rural environments. Examples of intervention process categories include setting up home visits, assessment, boundaries, common distractions, and termination in home-based practice.