Recent developments in institutional elder care in China: changing concepts and attitudes

This study examines recent developments in institutional care for Chinese elders and attitudinal changes toward institutional care in Tianjin, China. Based on studies in 12 elder home sites and survey interviews with 265 older residents, this study compares institutional differences between government and non-government-owned elder homes, and examines elders' evaluations of elder homes' quality and their level of willingness to stay in elder homes. Findings suggest that government-owned elder homes still enjoy institutional and bureaucratic privileges in funding, staffing, and insurance. Elders' overall evaluation of elder home quality was high. Elders' former living arrangement and financial ability were related to their willingness to stay in the elder home. The unfair competition between governmental and non-governmental elder homes is likely to hinder the development of elder home industry in the free-market system and foster a growing gap between the rich and poor elders in their capability and decisions in elder home care. As adult children become increasingly unavailable due to the one-child policy and geographic mobility, institutional care for aging parents is likely to become one of the major options for parent care.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Obesity and Living Together

As shown by parent-child, sibling and twin correlations and by comparison of the children of different parental fatness combinations, fatness definitely follows family line. Indeed, fatness level can be predicted from grandparental fatness levels and from the number of obese family members living together. However, a purely genetic explanation for the level of fatness and actual obesity is untenable given fatness similarities of spouses, parents and their adopted children, adoptive siblings and of parents and their adult children who no longer live within the home. Comparing fatness levels of genetically unrelated "family" members and measuring synchronies in fatness change among family members who live together (i.e., parents and children and siblings and spouses) it is clear that fatness and obesity are both acquired in the family context. While parental and grandparental models of eating and exercising may well explain levels of energy intake and expenditure that account for differences in fatness differences in children, there is also some evidence that fatness and fatness gain of younger family members may affect the body fat mass of members of the elder generation. The largely-learned family line nature of fatness and obesity becomes important in the early diagnosis of obesity, the prevention of obesity and in programs of fatness reduction and dietary reeducation if they are to be of lasting effect.     

Intergenerational solidarity between parents and adult children: a qualitative research among cohabiting and married children in Italy

The objective of this article is to compare the patterns of intergenerational solidarity between adult children who cohabit or are married and their own parents or their partner's parents through the analysis of 50 in-depth interviews. The research did not reveal any different behavioural patterns between cohabiting and married couples. Financial support provided by own parents or partner's parents and the presence of small children constituted positive factors which intensified the frequency of contacts and improved the quality of the relationship. In the event of illness of a parent, both the married and cohabiting couples provided assistance, especially when the illness was not disabling and there were no other kin relatives. When this was not possible, a private caregiver was hired or close family members provided assistance. Only those respondents who cohabited with a partner awaiting divorce were less willing to maintain contacts with their partner's parents. The presence of a family formed by previously married partners and the old age of the parents of the latter compromised the quality of the relationship and the willingness to provide assistance.     

Exploring Home Sharing for Elders

Research suggests that third party-arranged home sharing (“TPAHS”) enables elders to remain at home in advanced age by connecting elder home owners with suitable live-in “matches.” TPAHS potentially saves elders, their families, and Medicaid budgets millions of a dollars per year in avoided and postponed nursing home costs. In interviews with elder TPAHS participants of one TPAHS program, we found that similarity in values, ability to utilize the TPAHS organization's guidance, and, when relevant, familiarity with their matches' mental health challenges, correlated with said participants' satisfaction with their matches while a lack of these qualities correlated with match dissatisfaction. With these findings in mind, we suggest strategies TPAHS organizations can use to best serve the elderly TPAHS participants who may benefit from intensified match support but may not seek it.     

Predicting supportive behavior of parents and siblings to a family member with intellectual disability living in institutional care

This feasibility study examines whether the theory of planned behavior can predict supportive behavior provided by either parents to their offspring-or adult siblings to their brothers and sisters-with an intellectual disability living in 2 Israeli institutional care facilities. Participants were 67 parents and 63 siblings who were interviewed at baseline regarding their intentions to visit their offspring or sibling in the institutional care facility, to contact the caregiving staff, and to accept visits at home. Parents' and siblings' behavior regarding visitation and supportive behavior was examined after 6 months by caregiving staff. Core findings indicated that subjective norms in siblings and parents predicted frequency of home visits. Perceived behavioral control predicted frequency of contact between siblings and staff. Differences between parents and siblings regarding their supportive behaviors are discussed with respect to social work practice.     

The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Elder abuse in nursing homes: an ecological perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Elder abuse: factors related to perceptions of severity and likelihood of reporting

This study examined factors that affect assessments of abuse as depicted in scenarios in which a caregiving daughter abuses her elderly mother through over-medication. College students (N = 239) read scenarios that varied in terms of the past quality of the caregiver/elder relationship and whether or not the elder adult was depicted as suffering from dementia. The role of the participants' own family caregiving experiences also was explored. Results from a factorial ANOVA showed that individuals who perceived the relationship as difficult and whose parents had served as caregivers rated the behavior in the scenario as more abusive and were more willing to notify authorities than participants in other conditions. Results are discussed with a focus on educating families and those working with elderly populations.     

Elder Abuse in Costa Rica

ABSTRACT

This paper describes how the problem of domestic elder abuse in Costa Rica is being perceived and acted upon by direct service providers and other professionals in the field of aging. Costa Rica is a small Central American democracy in which the family is the central institution and the sense of filial obligation is strong. In this cultural context elder abuse often takes the form of overprotection by family members who deprive elders of their autonomy. Although they suffer from this loss, elders frequently do not define it as abuse, making it difficult for professionals to intervene. A more serious concern was abandonment of elders by families (with or without intent to harm) since there are few facilities or resources to accommodate such elders. Overall we found a mixture, sometimes in the same person, of resignation in the face of a phenomenon that may come inevitably with modernization and committed activism. We illustrate the latter by describing the efforts of two Costa Rican organizations to prevent elder abuse.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

Support Network Connectedness in the Lives of Community-Dwelling Rural Elders and Their Families

Rural elders face challenges when accessing assistance from family, neighbors, and paid helpers. This support is essential to allow them to remain community dwelling as they develop physical challenges that limit their ability to care for themselves. This qualitative study followed a group of 16 rural elders with physical limitations for 1 year. In-depth interviews were conducted with them and eight members of their support networks, including five family members, to explore how rural older adults create and maintain support networks that allow them to remain community dwelling despite physical challenges that limit their self-care. The research question is, “How do members of the support network connect with each other to maximize the effectiveness of the network?” Family members coordinated assistance to maximize the abilities and availability of various network members. In addition, family members worked together with other family members, neighbors, and paid helpers to assist the elder. These strategies enhanced the ability of the network to assist the rural elder and also lessened the burden of care by dispersing it among network members.     

Caregiving and long-term health care in the People's Republic of China

The growing proportion of frail elderly in the People's Republic of China has necessitated policy of the state toward their long-term care. In this decade, there has been an increase in the amount of data available on the care and needs of Chinese frail elders. This article synthesizes these data and traces the patterns of care of frail elders. It distinguishes between urban and rural patterns, and identifies the increasing role of the family and community in the caregiving of elders. State policy, evident from the data, suggests that the state's role in direct care of elders is minor but that it continues to influence and support eldercare as part of its policy of promoting the one-child per couple policy. This process can be seen in support programs for the childless elder, who symbolizes the expected condition of a large number of future elders under the one-child policy. The article identifies four factors that are influencing the changing patterns of long-term care of elders in China: (1) economic reform programs; (2) the political agenda of the Chinese Communist Party; (3) differences in urban and rural economic conditions; and (4) policy directed at long-term investment in health care technology.     

The COVID‐19 Pandemic and Families in Japan

This paper, which is authored by members of the Japanese Association of Family Therapy (JAFT), describes the COVID‐19 pandemic in Japan from a family systems perspective. The authors are active members of JAFT and include current and past presidents and officers. We describe the course of the pandemic and the ways in which government policies to mitigate the pandemic have affected Japanese families. Challenges that affect Japanese families include the inability to participate in family and social rituals, prescribed gender roles that specifically affect women, high suicide rates, and prejudice against those who are at risk of spreading the infection. The need to shelter in place has also forced family homes to function as a workplace for parents, classrooms for children, and day care services for frail elders, which has resulted in psychological distress among individuals and conflicts among families. We discuss ways that therapists have worked with Japanese families using online therapy.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

Visibility Blues: Gender Issues in Elder Abuse in Institutional Settings

ABSTRACT

This article argues that elder abuse in institutional as opposed to domestic settings remains invisible because institutions for elders are mainly all-female spaces where ageism and sexism converge and clients and workers are economically and socially disadvantaged. A general culture of violence that increasingly legitimates the everydayness of abuse and that conforms to dominant gender stereotypes refuses to investigate abuse of women by women. Research is needed into the different kinds of abuse committed in institutional settings by women. Staff and clients need to be enabled to report abuse and effective measures for combating it put in place.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.