?konomisierung von Pflege in Gro?britannien, Schweden und Deutschland

This article deals with long-term care policies in three different welfare and long-term care regimes. Despite of divergent regime assignments—Great Britain: liberal welfare state und means-tested long-term care regime, Sweden: social–democratic welfare state and social services long-term care regime, and Germany: conservative–corporatist welfare state and subsidiarity long-term care regime—all three countries restructured their long-term care policies during the 1990s in the context of neoliberal economization and marketization. All countries introduced efficiency-oriented measures, foster competition between different social service providers, and increase choices of people in need of elderly care. By analyzing the regulation of long-term care policies since the National Health Service and Community Care Act (1990) in Great Britain, the ?del reform (1992) in Sweden, and the introduction of the long-term care insurance (1994) in Germany, it can be shown that specific, national pathways, which due to the divergence of regimes and the specific long-term care problems within a country, have evolved.     

Towards reform of long-term care in France

Existing proposals to streamline fragmented and inefficient delivery of long-term care address only some of the system’s inadequacies. But the current political climate puts even limited reform in doubt Nicole Kerschen is a senior researcher at theCentre National de la Recherche Scientifique in paris associated with theInstitut de Recherches Juridiques sur l’Entreprise et les Relations professionnelles (I.R.E.R.P.) Her field of study focuses on the interaction between law and social policies on employment, aging and health care.     

Ageing, families and welfare systems: Comparative perspectives

Some convergence between countries may be observed in total welfare spending during the later decades, but while levels are becoming more similar, the profiles are still very different. Some welfare states are high on transfers, others on services, and among services – some give priority to institutions, others invest more heavily in community (home) care. Discussed in this article is how different family cultures are reflected in welfare systems, and conversely – how welfare systems in turn may influence families. The article argues that home care services tend to have lower priority in countries with familistic policies, and higher priority where social policies are individualistic. What model is the more sustainable for the future, given the social and demographic changes to be expected?     

Die Beschäftigung von Migranten/innen in der Pflege

This contribution tries to name key elements for a research agenda to study the increasing importance of the transnational migration for the formation of the social caring processes in the developed part of the world. First, the formal employment of people with migrant background in the German system for the delivery of care is regarded. Right now, there are no reliable data available which could give information about the degree of formal participation of migrants in the health and social care sector. It is agreed that in the future the service branch holds an increasing potential for employing people with migrant background. However, up to now, an initiative to qualify these younger migrant cohorts intensively is needed in order to compensate their educational and social disadvantages. The second part concentrates on the impact and development of informal work structures in care seen as irregular work participation in private households by migrants who are mostly from east-European countries. In a comparison between Germany, Austria and Italy, specific patterns of state policies toward this irregular work are analyzed; the phenomenon of a modern 'care drain' is analyzed and discussed in respect of the welfare state policies as well as of the potentials of action on the part of both migrants and family households.     

Ageing, families and welfare systems: Comparative perspectives

Some convergence between countries may be observed in total welfare spending during the later decades, but while levels are becoming more similar, the profiles are still very different. Some welfare states are high on transfers, others on services, and among services--some give priority to institutions, others invest more heavily in community (home) care. Discussed in this article is how different family cultures are reflected in welfare systems, and conversely--how welfare systems in turn may influence families. The article argues that home care services tend to have lower priority in countries with familistic policies, and higher priority where social policies are individualistic. What model is the more sustainable for the future, given the social and demographic changes to be expected?     

Informal care-giving and the intention to give up employment: the role of perceived supervisor behaviour in a cohort of German employees

Current social policies in the European Union addressing employment, retirement and long-term care are expected to result in increasing employment rates among informal carers. The present investigation contributes to previous research by focusing on how specific work-related factors, in this case supervisor behaviour, may facilitate the fulfilment of the demands arising from paid work and care and ultimately influence the desire to give up employment. To this end, population data from the German Cohort Study on Work, Age, Health and Work Participation conducted in 2011 and 2014 are analysed (n = 3916). Three research hypotheses investigating the associations between care-giving, supervisor behaviour, the intention to give up employment and work-private-life conflict are tested by means of cumulative link models. The results suggest that the intention to give up employment is stronger among employed carers. In addition, the perception that one’s supervisor is considerate towards subordinates and is effective in planning, coordinating work and solving conflicts is found to be negatively related to the desire to give up employment, especially among carers. The statistical analyses reveal that supervisor behaviour mediates the association between the level of work-private-life conflict and the intention to give up employment. It is concluded that the working conditions may exert a substantial influence on the levels of psychosocial load carers experience by facilitating or hindering the extent to which carers are allowed to accommodate their work schedules and job assignments to the conflicting demands of their dual role as workers and carers.

     

Finding the Bloom of the Cactus Generation: Improving the Quality of Life for Seniors by Maggie Walters

ABSTRACT

Using a mixed-methods approach, data were collected from 385 participants attending two separate comprehensive multipurpose senior centers in Tennessee. Based on self-reports, the findings suggest senior centers provide a prominent role in improving the physical and mental health of older clients. In addition to documenting the health and wellness benefits, respondents provided detailed personal accounts of the value and meaning they place on senior center friendships. Participants acknowledged that these social networks provide much-needed emotional support as well as instrumental assistance beyond the confines of the senior center. Using a conceptual framework stressing successful aging, these findings suggest the senior center as serves critical element of the long-term care continuum providing a therapeutic place to thrive in later life.     

The balance of intergenerational family transfers: a life-cycle perspective

The aim of this study is to determine the likelihood and net amount of parent–child transfers over the adult life cycle across European welfare regimes. The study introduces an economic life-cycle model of family transfers to describe the evolution of family exchanges across generations over time, which reveals a nonlinear relationship of age and net family transfers. Furthermore, it refines the method of estimating parent–child net transfers. Data come from the Survey of Health, Ageing, and Retirement in Europe, and include 36,095 parent–child dyads from 11 European countries representing social democratic, conservative, and traditional welfare-state regimes. The findings reveal net value of family intergenerational support follows a nonlinear pattern across the adult life cycle, with positive transfers from parents to adult children decreasing modestly until advanced old age when the decrease intensifies. Net family support benefits individuals and generations with larger relative need. The transition in the net family support pattern starts later and is less pronounced across social democratic welfare-regime countries while the opposite is true in traditional welfare-regime countries. These findings might be interpreted as being linked to differences in the public policies guaranteeing different levels of provision for dependent populations across different welfare regimes. They are consistent with a comparatively smaller role of family support in the intergenerational redistribution of resources in societies with larger public intergenerational support to dependent populations.     

Care of the frail elderly in developed and developing countries: the experience and the challenges

Demographic and epidemiological changes will result in dramatic changes in the health needs of the world's populations. Everywhere there is a steep increase in the need for management of chronic diseases and for long-term care. Therefore, the search for effective policies to care for the frail elderly in general and long-term care (LTC) policies in particular, is one of the most pressing challenges facing modern society. There is no single converging paradigm and countries are experimenting with a number of different approaches. This section of the Monograph presents the experience in several developed and developing countries: Canada, United States, Italy, Germany, Sweden, Japan, Thailand and Chile. This effort is important because there is much to be learned from the experience of developed and developing countries in defining the range of policy options and in identifying successful and unsuccessful practices. In-depth understanding of the existing situations in developed and developing countries, and the nature of the variance among countries are important to provide insight for development of care policies by learning from what already exists. This article focuses on LTC, that is, on addressing the needs of the functionally disabled elderly. Our reflections are based on an international initiative to develop a decision-making framework for LTC policies launched by the World Health Organization (WHO) with the JDC-Brookdale Institute leading this effort.     

Ageing in Asia—The Japan Experience

In Asia, the past two decades have seen rapid demographic changes, including a shift in the population age structure, while increases in urbanization, educational attainment, and nonagricultural employment are affecting the social and economic landscape. All family systems in Asia traditionally faced the problems of generational succession, economic support of the non-active elderly and physical care of the frail elderly, but the structures that provided solutions to these problems were by no means uniform. An example of health service and social welfare for the elderly is the long-term care insurance, which was started in Japan from 2000. Asian societies are starting from an inherently different cultural, social, structural and economic base than the developed countries of the West. The strongly ingrained cultural basis of family responsibility for support and care of the elderly will lead to a transformation quite different from that characterizing the elderly in the Western countries.     

Japan's universal long-term care system reform of 2005: containing costs and realizing a vision

Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies.     

Asian value and aged care

Based on the findings of research studies on the practice of filial piety in East and South-east Asian societies, this paper maps out a new basis for the formulation of aged care policies. Evidence shows that filial piety, while diminishing in influence, remains to be the most important value in regulating the behavior of children towards their elderly parents and relatives. Hence, neither a complete rejection nor a total acceptance of the value is appropriate. It is argued that a policy on care, especially long-term care, for elderly people in East and South-east East Asian societies must recognize the changes that have taken place in the practice of filial piety. The adoption of a community care approach that combines formal and informal support is suggested to be the most effective strategy in enhancing the welfare of the elderly.     

Masters of their own time? Working carers’ visions of retirement

Retirement is often seen as a period dedicated to the enjoyment of one’s own leisure interests after many years of gainful employment. On the other hand, retired people are expected to remain productive by continuing to work, volunteering or by being involved in various caring tasks. When do Finnish working carers plan to retire and how do they envisage the weight of their care commitments related to other activities once they have left full-time work? The 19 female interviewees were born in 1953 or earlier, and they helped their parent(s). They were working full-time or part-time or were semi-retired at the time of the interview. The interviewees were selected from a larger sample of working carers. The future prospects of the interviewees are given in terms of their different visions of retirement activities, and principles of qualitative analysis are applied. Some interviewees indicated that helping their parent(s) would be an essential part of their personal retirement activities, and some of them had chosen or were considering part-time retirement in order to have more time for their parents. However, the interviewees often also stressed that they wanted to have time to pursue their own personal work and leisure interests after leaving full-time employment. Persons approaching their own retirement want to be ‘productive’ but they also want to ensure that they retain a certain amount of individually defined ‘personal-time’. Leaving gainful employment does not necessarily mean leaving ‘productive roles’ as citizens. However, pensioners’ contributions as carers are socially and personally meaningful only if the pensioners’ different valuations regarding the future are respected.     

End-of-life care at group homes for patients with dementia in Japan. Findings from an analysis of policy-related differences

In Japan, the number of group homes for patients with dementia (GHs) has been increasing in recent years. A growing number of elderly people now prefer to spend their final years in group homes or other long-term care facilities, a choice that their families support. The aim of this nationwide study is to clarify the current end-of-life care policies and practices of GHs. The subjects were 3701 managing directors of GHs. Data were collected through mailed, anonymous, self-reported questionnaires in 2003. The content of the questionnaires included: (1) general characteristics of the GH, (2) end-of-life care policies and experiences, (3) available end-of-life care services at the GH, (4) staff education concerning end-of-life care, and (5) types of information provided to users and families. The response rate was 45.6%. Many GHs had implemented progressive policies for end-of-life care. GHs with progressive policies for end-of-life care were found to have different backgrounds than those with regressive policies. Only a few GHs provided end-of-life care education for their staff. GHs with progressive policies for end-of-life care tended to have the following characteristics: availability of medical intervention within and outside of the GH, self-contained physical plant and staff education about end-of-life care. Further research is needed to determine the most effective end-of-life care systems for GHs.     

Health and wellbeing of lone parents in welfare to work: a systematic review of qualitative studies

BackgroundLone parents have worse health than couple parents, which is largely explained by higher levels of poverty. Many high income countries have attempted to address poverty by introducing mandatory requirements to actively seek employment or participate in training for welfare recipients, including lone parents. However, employment might not reduce poverty or improve the health of lone parents. To assess experiences of welfare to work and gain insight into possible mechanisms linking interventions with health and wellbeing, this study systematically reviewed qualitative data from studies of lone parents’ experiences of mandatory welfare to work.Methods21 bibliographic databases were searched (appendix) for articles published between July 16, 2009, and July 6, 2013, with no language restrictions; search-term sets were used for the topics, lone parent and welfare to work. Studies that met the criteria of focusing on lone parents, mandatory welfare to work interventions, and health or wellbeing were imported into NVivo (version 10) for coding. Two reviewers independently screened references, assessed study quality for clarity and appropriateness of methods, and developed the coding framework. Thematic synthesis, a method to facilitate transparency when identifying analytical themes between studies, was used to guide line-by-line coding of the data.FindingsFrom 4703 papers identified, 16 studies (724 participants) from five high income countries were included. Although the balance of evidence was on negative findings—ie, linking welfare to work to negative health effects, such as stress, fatigue, and depression—there were some positive reports of improved self-worth. Available employment was often precarious and poorly paid. The demands of parenting were frequently in direct conflict with employment and welfare to work obligations, and affected parents’ control over major life decisions and everyday routines. Therefore, the concepts of conflict and control seemed to encapsulate how welfare to work affected health. Social support allowed some parents to manage these conflicts, allowing greater control over their circumstances, and for some mediating the adverse health effects of welfare to work.InterpretationParticipation in mandatory welfare to work can result in increased conflict and reduced control for lone parents, leading to negative effects on mental health. The potential benefits of welfare to work are dependent on access to adequate social support and suitable employment opportunities; however these are often unavailable to lone parents in welfare to work.FundingUK Medical Research Council and Scottish Government Chief Scientist Office Informing Healthy Public Policy programme (MC_UU_12017/4).     

Legislating for transnational ageing: a challenge to the logics of the welfare state

Transnational ageing presents fundamental challenges to nationally bounded welfare states, which historically have tended to be organised according to a logic of solidarity among nationals and permanent residents of a given state territory. Nonetheless, the Dutch and French governments have taken steps to break this link between solidarity and territorially bounded consumption of welfare, by providing lifelong income security for older migrants who return to countries of origin on a permanent or semi-permanent basis. This article asks what motivated policymakers to initially develop these novel policy tools for transnational ageing which contradict the territorial logic of the welfare state. Based on interviews with key stakeholders and available official documents, we find that in both France and the Netherlands, policymakers’ initial motivations can be characterised as rather benign, if not beneficent: to facilitate return for those who are willing but unable to afford it. However, two types of obstacle have impeded the delivery of such policies. Non-discrimination clauses and free movement rights in EU law may make it difficult to implement policies for specific categories of older migrants. Electoral realpolitik may also lead policymakers to shelve policies which benefit older migrants, in a European context where public opinion on immigration is less and less favourable. Nonetheless, opposition may be neutralised by the budgetary advantages of these schemes, since older returnees do not consume public services such as healthcare.     

The Threats of Privatization to Security in Long-Term Residential Care

This paper argues that privatization, especially in the form of for-profit, chain ownership, undermines security in old age. Using data from research in Canada and focusing on the specific case of long-term residential care, this paper examines four aspects of security; security of physical access, security of financial access, security of quality and security of employment for those providing care.     

Current admission policies of long-term care facilities in Japan

Background:   The rapidly aging society in Japan is putting demands on long-term care facilities for the elderly who require care. In Europe and the USA, there is ongoing reform of elderly care services, but the establishment of system based on social insurance is still being explored in Japan.
Methods:   Two studies were conducted, the first in 2000 and the second in 2001, involving 91 long-term care facilities located in or around the city of Nagoya. Questionnaires were sent to facility directors, chief administrators or head nurses to inquire about their admission policies for six major patient categories. Two educational lectures on methicillin-resistant Staphylococcus aureus (MRSA) and urinary incontinence were given between the distribution of the questionnaires.
Results:   For all six categories featured on the questionnaire, the acceptance rate in both studies was the highest in geriatric hospitals, and an improvement in acceptance rates was seen in the second study in all three types of care facilities. When the effect the lectures had on changes in admission policies at these facilities was examined, no correlation was found.
Conclusions:   Lectures should be given to facility management and personnel to raise their awareness of key issues and improve their efficiency.     

Nursing in the framework of long-term care insurance as a basic principle of a specific nursing approach of rehabilitation?

Activating nursing based on the criteria of the long-term care insurance may be understood as a second specific and nursing approach of rehabilitation beneath medical rehabilitation. Activating nursing is unspecific, characterized by the norms and guidelines of the long-term care insurance, but defined as the general norm of practical nursing. A professional nursing definition for a specific concept is lacking just as funding of nursing science. Adhering to activating nursing as a nursing complement to medical rehabilitation in the framework of long-term care insurance requires professional development and funding. Furthermore, more support of social law is necessary, which depends on professional nursing and nursing science-based indication and the intervention approach. The article develops an approach--based on a study about rehabilitation of people in need for care--and reflects on implementation and acceptance by people in the need of care.     

Advance care planning by proxy for residents of long-term care facilities who lack decision-making capacity

This report examines whether long-term care facilities should implement policies and procedures to support advance care planning by proxy for residents who lack decision-making capacity. The report focuses on advance care planning in the Department of Veterans Affairs. After reviewing clinical, legal, and ethical perspectives, the authors conclude that advance proxy planning is ethically sound and can improve patient care. However, because experience with advance proxy planning is still fairly limited, the authors do not recommend that a particular standardized approach be mandated at the national level. Instead, local facilities are advised to develop their own policies and then evaluate their effect. The report contains specific recommendations for the advance proxy planning process.