Design limitations of long-term care insurance schemes: A comparative study of the situation in Spain

Social and demographic changes are gradually transforming the way Western societies cope with old‐age dependency, in particular the provision of long‐term care (LTC). In response to the need for formal care services and financing instruments, this study examines a range of both private and public insurance tools. As a general rule, LTC insurance is markedly underdeveloped. Furthermore, in southern European countries, the role of the public sector in LTC is unclear compared with its role in other, related welfare areas such as healthcare. The study examines the financing alternatives for LTC insurance, taking as its benchmark the Spanish LTC financing reform. It briefly examines some existing, publicly funded LTC financing tools and explores the potential role of private LTC insurance, arguing that it has an active part to play alongside compulsory mainstream insurance schemes and self‐insurance alternatives. As in other European countries, Spanish social attitudes show a preference for some kind of general entitlement to publicly funded schemes, although this preference is subject to significant regional heterogeneity.     

Conflict Outcome as a Function of Parental Accuracy in Perceiving Child Cognitions and Affect.

It is usually maintained that positive family functioning and internalization of parental values are promoted by parents' consistent use of particular discipline strategies or styles of childrearing. In this paper a different position is presented, viz., that parents who can accurately perceive their children's thoughts and feelings during a disagreement will have the most successful outcomes because they can tailor their disciplinary interventions to the particular states of their children at the time. Adolescents and their parents were interviewed about recent disagreements and asked to rate themselves and their partner on measures of anger, blame, acceptability of their own and their partner's behavior, and satisfaction. In families where fathers were accurate in their perceptions of their adolescent's cognitions and affect there were fewer conflicts per week. Accurate perception on the mothers' parts was related to their satisfaction with the outcomes of the disagreements. There was no relation between adolescents' perceptual accuracy and number of conflicts or their satisfaction with the outcomes.     

Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

Means Testing and the Heterogeneity of Housing Assets: Funding Long-Term Care in Spain

The access to publicly funded long‐term care (LTC) in Spain has been traditionally rationed through the use of means tests based on individuals’ current income and needs. However, individuals’ wealth, primarily housing assets, is progressively taken into account. Parallel to this feature, the responsibilities for the organization of LTC services have been devolved to region‐states – autonomous communities (ACs), giving rise to some regional heterogeneity, though limited evidence has been reported on the underlying determinants. This paper examines the current role of housing assets in determining public and private funding for long‐term care in Spain. Secondly, we present a qualitative and quantitative examination of the regional heterogeneity in the provision and public funding criteria determining eligibility for public support for LTC. Finally, we report survey evidence on the individual's willingness to sell (WTS) their housing assets in order to either totally or partially finance the access to LTC. Our findings suggest that housing assets are the main source of wealth accumulation at old age. Yet there is significant regional heterogeneity in the access to LTC resulting from regional differences in the means testing criteria. Progressively, all ACs are considering housing assets in their means testing criteria. Interestingly, individuals’ willingness to sell their housing assets declines with age and is more common among less skilled and widowed individuals.     

It takes a Village: community practice, social work, and aging-in-place

The US population of older adults will increase significantly in the coming decades. Most of these individuals prefer to age in their homes/communities. However, most communities are not prepared to handle the long-term care needs of an aging population. This article examines one model that communities are using to help older adults age-in-place, the Village. A conceptual lens based in community practice and empowerment theory is offered to explicate this model and critically evaluate social work's role in it. It also presents challenges to social work roles in facilitation and evaluation of the model.     

Combining Measures of Risk Perceptions and Risk Activities: The Development of the RAPRA and PRISC Indices

The influence of risk perceptions on risk activities of teenagers is well known, but the development of indices, which combine measures of perception as well as behavioral outcomes, has proved problematical. This article discusses the ways in which this methodological problem was tackled within a five-year, multiphase, multimethod study of factors affecting adolescent risk-taking in Tasmania, Australia, which included an intergenerational comparison of adolescents and parents. The development of the Risk Activity by Personal Risk Assessment (RAPRA) Index combines measures of perceived riskiness of 26 activities identified by young people as involving varying degrees of risk, with the degree of participation by each respondent, through a rectangular model of weights. The Personal Risk Score Category (PRISC) Index summarizes and categorizes an individual's risk-taking profile relative to the group's risk values and risk hierarchy established by the RAPRA Index. The article discusses ways in which technical problems involved in combining measures of risk perceptions and risk activities were addressed during index construction, compared with examples in the literature. Some key findings from analysis of two student and parent samples are presented as exemplars of the methods used and the results produced. Findings demonstrate the widespread nature of risk-taking among teenagers, and the similarity of levels of risk-taking between teenager and parental generations. The indices allow for detailed comparison of particular risk-taking activities and reveal differences among teenagers now compared with parents when they were teenagers, and illustrate the dynamic cultural context of risk-taking perceptions and values.     

Assessment Frameworks: A Critical Reflection

Increasing widespread requirements that assessment practiceconforms to generic guidelines contained in assessment frameworkshas been contentious and critiques offered on individual frameworkshave been assumed to apply to the concept of assessment frameworksmore generally. After comparing four assessment frameworks currentlybeing used in the UK, this paper argues that although some generalizationscan be made, for the most part, they are highly individual documentsin terms of range and depth of content, the extent to whichthey are evidenced and the quality of that evidence and implicitexpectations as to the skill bases of assessors. Furthermore,the introduction of assessment frameworks is not in itself apanacea to ensure good practice. Even with the most comprehensiveframeworks, social workers will still need comprehensive trainingin assessment and supervision of their practice.