Motivation to provide help to older parents in Norway, Spain, and Israel

We explore from a cross-national perspective three motivations in adult children to provide help to older parents: affectual solidarity, parental need for care, and filial norms. The sample is 1,055 adult children from Norway, Spain, and Israel, countries selected because they represent different family cultures and welfare regimes. Affectual solidarity and parental need for care was found to influence amount of help in all three countries, whereas filial norms was found to have no effect. Country context had a differential impact. In Israel, affectual solidarity was more strongly associated with amount of help. In Israel and Norway, parents' need for care was related to amount of help; in Spain help provided was high, regardless of parents' need for care. We demonstrate the universality of motivations to provide help to older parents and the influence of cultural context on these motivations, taking into account within-country differences.     

Intergenerational solidarity and the family–welfare state balance

The article addresses the strength and character of intergenerational family solidarity under different family cultures and welfare state regimes in order to answer the following two questions: (1) Is intergenerational solidarity stronger under the more collectivist southern family tradition than under the more individualist northern tradition? (2) Is more generous access to social care services a risk or a resource for family care? These questions are explored with data from the OASIS project, a comparative study among the urban populations aged 25+ (n=6,106) in Norway, England, Germany, Spain, and Israel. The findings indicate that the welfare state has not crowded out the family in elder care, but has rather helped the generations establish more independent relationships. Intergenerational solidarity is substantial in both the northern and southern welfare state regimes, and seems to vary in character more than in strength.     

Importance of family for quality of life of the elderly in a social and cultural comparison

This paper explores the role of the family and its contribution to quality of life in old age under a comparative perspective, looking at different European welfare states (Norway, Germany, Spain and Israel). The literature demonstrates a consistent association between well-being and social networks in old age. Intergenerational family relations seem to be of special relevance in their contribution to health and well-being of older family members. Key features of intergenerational relationships include association, help, and support. However, in modern welfare states, certain tasks traditionally performed by families are covered by services. To assess the relative impact of families and the welfare state and to understand the interaction between them both a comparative perspective is needed analyzing diverse cultures and welfare regimes. Cultural and societal contexts are of central importance in exploring and understanding the complex association between family relations and the quality of life of the elderly. It is hypothesized that there is an interaction between family structure and welfare state transfers. This hypothesis states that the relationship between family structure and quality of life depends on the type of welfare state and welfare state transfers and services. Hence, the relationship between quality of life and family support should be strong only in those cases where welfare state transfers are low. The empirical results partly confirm the theoretical assumptions of welfare state regime dependence of the children's effect on the elder's quality of life. Three out of the four analyzed countries show results that strongly support the hypothesis of an intervening effect of welfare state systems on the connection between family and overall quality of life in old age. However, further analyses are needed. First, more sensitive indicators of parent-child relations have to be used. Second, needs and their intervening effects on the direct linkages between children and quality of life have to be taken into account in more complex analyses. Third, more elaborated indicators of "quality of life" should be used in future analyses.     

Intergenerational Family Relations and Life Satisfaction Among Three Elderly Population Groups in Transition in the Israeli Multi-cultural Society

The study aims to illuminate the links between personal and familial resources and wellbeing of elders 65+ in three population groups in Israel: kibbutz members, new immigrants from the former Soviet Union and Arabs—all of whom are undergoing different types of personal, social and economic transitions. About 70 respondents in each group were interviewed regarding life satisfaction, familial relations based on the paradigm of intergenerational family solidarity and personal resources (socio-demographic and physical functioning). The main conclusions of this study are: the lives of the elderly immigrants are much more disruptive by the transitional migration processes they are undergoing and this affects their well-being which was much lower than the other two groups. Additionally they received more help from the family. Family solidarity, mainly opportunity structures and emotional bonds were especially strong among the Arabs, with the lowest level of conflict. The Arab elderly were also different from the other two groups in the lower level of help they provided to their adult children, probably due to their more limited level of personal resources and the differing social expectations. The majority of respondents acknowledged some degree of filial obligations, although much lower among kibbutz members. Personal resources (physical functioning and financial adequacy) had the strongest effect on life satisfaction in all three groups. The dimensions of family solidarity played a less dominant role. The discussion highlights the distinctive family culture of the three groups, the transition they face, and their differential resources with some policy recommendations.

Expectations of Filial Obligation and Their Impact on Preferences for Future Living Arrangements of Middle-Aged and Older Asian Indian Immigrants

Filial obligation, described as culturally-defined rights and duties that prescribe how family members are expected to care for and provide support to each other, is an important variable that influences older immigrants’ preferences for living and care arrangements. This exploratory study examined variables associated with expectations of filial obligation among middle-aged and older, Asian Indian, first generation immigrants and explored the relationship between variations in expectations of filial obligation and expressed preferences for future living arrangements. Data were collected through telephone surveys of 226 English-speaking immigrants in Atlanta, GA. Although no significant relationships were observed between filial obligation expectations and length of residence in the U.S., respondents indicated a variety of preferred future living arrangements. Contrary to current living arrangement patterns found among older immigrants, very few respondents preferred to move in with their children. The most popular preference was to “move closer to children,” followed by “moving to a retirement community” with the majority preferring a retirement community geared to Asian Indians. Other preferences included “not moving” and “returning to India.” Variations in expectations of filial obligation, length of residence in the U.S., and self-rated health were significantly associated with these preferences. Implications are discussed for building capacity within ethnic communities to address living arrangement preferences and their repercussions for caregiving in ethnic families and in communities.     

Factors that Affect Older Japanese People’s Reluctance to Use Home Help Care and Adult Day Care Services

The purpose of this study was to examine the factors related to the reluctance of older Japanese people to utilize home help services and day services. Home help services consist of three different types of services (i.e., assisting in bathing and toileting, doing household choirs, such as cooking and laundry, and counseling) and are provided by visiting home helpers at the homes of older people. Day services are services (e.g., providing bathing and meals, monitoring the health status of older people, and counseling) that are provided at day service centers in the community to improve the physical and psychological functioning of older people and to help the burden of caregiving of family members. The data used in the study came from the first wave of the Nihon University Japanese Longitudinal Study of Aging, conducted in November 1999 (and again in March 2000 for those people who had been unable to respond to the initial survey). Face-to-face interviews were conducted with a national probability sample of 6,700 people aged 65 and older. Logistic regression analyses were used to analyze factors that were thought to be related to older people’s reluctance to use services. Approximately, one half of the respondents indicated reluctance to use home help services, and one quarter of the respondents showed reluctance to use day services. Respondents who were female and who lived in urban areas showed a higher probability of feeling reluctant about using both home-help and day services. Also, respondents who had had caregiving experience using these two types of services showed a lower probability of feeling reluctant about using the services. Furthermore, respondents who were older and had income showed a higher probability of feeling reluctant about using day services, whereas those who had had caregiving experience and who participated in social activities showed a lower probability of feeling reluctant about using day services. According to the 1999 survey, there were still many older Japanese people who felt reluctant about using either type of care service. But it is expected that the quality of services under Kaigo Hoken (the mandatory public long-term care social insurance system) will improve further and that older people’s attitudes toward service utilization will change for the better. In the meantime, professional service providers will have to be sensitive to older people’s perceptions about service utilization if they would like to continue to contribute to the improvement process of Kaigo Hoken as a positive force. This study used data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA). This survey was conducted by the Nihon University Center for Information Networking as one of their research projects.     

The use of social services by community-dwelling older persons who are at risk of institutionalization: a survey

The use of community-based social services additionally to regular home help services to support older persons at risk of institutionalization was studied. Structured interviews were held with 292 persons, who specifically pointed out that they prefer to remain independently at home. Bivariate and multivariate logistic regression models were developed to study the association between social service use and personal, health-related and wellbeing characteristics. 195 respondents indicated that they made use of at least one social service (68%). Only three services (individual care, social-cultural activities and restaurant facilities), out of nine, were used regularly. Those who lived in a sheltered environment or were supported by informal caregivers or who visited day care had a significantly higher probability of using these services. More attention should be given to the nature and accessibility of community-based social services in order to have distinctive added value in enabling older persons to age in place.     

Assistance with personal care activities among the old-old in Israel: a national epidemiological study

OBJECTIVES: The objectives of this study were to (1) estimate rates of difficulty, need for assistance, and receipt of assistance with activities of daily living (ADLs) among the old-old in Israel; (2) describe the living arrangements of the dependent old-old; and (3) gain insight into the caregiving provided to the disabled members of this population. DESIGN: A random stratified sample of 1,820 subjects age 75 to 94 selected from the National Population Register (NPR), a complete listing of the Israeli population maintained by the Ministry of the Interior. The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, 90-94), sex, and place of birth (Europe-America, Middle East/North Africa, Israel). SETTING: National sample of old-old Jewish Israelis. PARTICIPANTS: One thousand eight hundred twenty Israelis age 75 to 94 who were living in the community or in institutions at the time of the baseline interview. MEASUREMENTS: Participants' disability status was classified in terms of difficulty with, needing help with, and receiving help with any of five ADLs (washing/bathing, dressing, transferring, toileting, and eating). Only those receiving assistance from a person (as opposed to a device) were considered to be receiving help. The independent variables used included sociodemographic, health, and social network characteristics of the participants. RESULTS: Twenty-one percent of those age 75 to 94 were found to be receiving personal assistance with at least one ADL. The most dependent were those age 90 to 94, women, those born in the Middle East or North Africa, and those living in an institution. Among those dependent in one or more ADLs, the overall community:institutionalized ratio was 2.4:1. Those who were dependent in three to five ADLs were about twice as likely to live in an institution as were those who were dependent in one or two ADLs. The Middle Eastern/North African born were more likely to be dependent, and at any given level of disability were more likely to be living in the community with a child and receiving the majority of their caretaking from the informal sector, primarily their family. CONCLUSION: We conclude that the families of disabled older people, particularly the Middle Eastern/North African born, provide a great deal of care for their older relatives despite the availability of a full range of services, providing no evidence of withdrawal of family care when state home and institutional care are available. This finding may imply underutilization of services, which should be investigated further to determine if it is caused by barriers to utilization or by the free choice of the disabled old-old and their families.     

Erfahrungen von pflegenden Angehörigen älterer Menschen in Europa bei der Inanspruchnahme von Unterstützungsleistungen

This article presents selected findings of the EUROFAMCARE research project, reporting up-to-date information on the use and accessibility of support services for family carers of older people in six European countries representing different typologies of welfare systems (Germany, Greece, Italy, Poland, Sweden and the UK). Data were collected by means of face-to-face interviews to national samples of about 1000 family carers per country (i.e. 6000 in total), based on a common recruitment and data collection protocol. The reported findings reveal the crossnational usage of different support services - subdivided for comparative reasons in the categories of socio-emotional support, information, respite care, training and assessment services - as well as of available care allowances. The analysis includes the perceived experience of carers in using them, in terms of costs sustained, factors affecting service accessibility - i.e. main obstacles and greatest helps in accessing them - as well as reasons for not using (needed) services or for stopping using (still needed) services. Cross-national differences are relevant, showing a greater availability in Northern European countries, where however higher refusal rates by potential users of available services are recorded, possibly in connection to their lack of flexibility and low customization.     

Families in North-East Asia

The purpose of this paper is to clarify similarities and differences in the family of older people in North-East Asia where there is a common tradition of filial piety based on Confucianism and also now the experience of rapid population aging. Compared with Western countries, in this region many older people are still living with their children. However, the ratio of cohabitation has been declining. Changes in living arrangements affect family relations and family functions. Though older people are still maintaining close relationships with their children, it is getting difficult to rely on children when they become frail. In North-East Asia, the core family caregiver is still a daughter-in-law but the increase in employment and the changing attitudes of women make it difficult to secure family caregivers, and so social services outside the home became inevitable. Now facing population aging and financial difficulties, each country is trying to find an optimum balance between social services and family care in order to maintain a sustainable social security system.     

?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.     

Perceptions of filial responsibility by elderly Filipino widows and their primary caregivers

This study assessed perceptions of filial responsibility among forty older Filipino mothers and their primary caregiver daughters from two urban and two rural barangays in the town of Los Banos (39 miles southeast of Manila). Using parallel standard structured interview measures, perceptions of filial expectations and filial behaviors were gathered across five categories of parental support: financial and material aid; personal care; service provision; respect; and warmth and affection. Intragenerational comparisons (analyses of variance) showed that widows' reports of actual amount of support received significantly exceeded their expectations for most forms of aid. In contrast, daughters' expectations for level of parental support exceeded their behaviors, but only for the more instrumental forms of aid. Intergenerational comparisons (t-test analyses) revealed that daughters held reliably higher filial expectations for almost all forms of support than did their mothers. Comparisons of reports of actual support showed intergenerational consensus on the whole. Implications of these data for research and intervention in this area are discussed.     

The reform of the Israeli health care system: a comparison between older and younger consumers, one year and three years after its implementation

OBJECTIVE: One of the main objectives of the National Health Insurance Law, which was implemented in Israel in January 1995, was to increase equity among different population groups and improve services for weaker populations, such as older people. It is not clear, however, whether the law's goals are being achieved. This study aimed to examine changes in the satisfaction and perceived quality of healthcare services among older people one year and three years after enactment of the law, and to compare the satisfaction and perceptions of older people with those of young adults. DESIGN: Two cross-sectional telephone surveys conducted by the JDC-Brookdale Institute. SETTING: Israel. PARTICIPANTS: Two random samples of the adult residents of Israel at the end of 1995 and at the end of 1997. Two hundred and eighteen older people (of 1,116 respondents) were included in the first survey, and 198 older people (of 1,205 respondents) were included in the second survey. Sixty-seven percent of older respondents in both surveys were 65 to 74 years old and the remaining 33% were 75 years old and over. Forty-three percent were men. Sixty-four percent reported having had at least one chronic illness. There were no differences between the two samples, with the exception of a higher percentage of new immigrants in the second survey. MEASUREMENTS: Perception of changes in the level of services, satisfaction with services, and perceived quality of care (availability, accessibility, early detection procedures). RESULTS: Older people felt there had been an improvement in the level of sick fund (who operate as health maintenance organizations [HMOs] in the United States) services since implementation of the law. The proportion reporting improvement increased from 13% in 1995 to 28% in 1997. At the same time, the proportion of older people who sensed a decline in the level of services also increased, albeit at a much lower rate (4% in 1995 and 8% in 1997). The percentage of younger adults reporting an improvement in services and the percentage reporting a decline were greater than the percentages of older people, in both surveys. Regarding access to services, 69% waited up to 15 minutes to see their physician and 56% received an appointment to see a specialist within one week; this was an improvement. While a higher proportion of younger adults received an appointment within a shorter time span in 1995, the gap had diminished by 1997. Most of the older people felt that the office hours of their family physicians, specialists, administrative services, and laboratories were convenient. The proportion of elderly reporting so increased between 1995 and 1997, and in both surveys was higher than among younger adults. CONCLUSION: The study's findings show that older people perceived an improvement in a number of areas during the first three years of the law's implementation. Their experience was similar to that of younger adults and was even better in some areas. It is necessary to continue monitoring the impact of the law on the need for health services of vulnerable groups such as the chronically ill and disabled older people.     

Cognitive impairment, caregiver burden, and the utilization of home health services

This study addresses the relationship between caregiver burden and the use of home health services among older adults with cognitive impairment. Analyses draw on data from personal interviews conducted with 327 older adults with cognitive impairment and living in the community of their primary caregivers. Using the Andersen-Newman framework, the results of ordinary least squares and logistic regression analyses reveal that caregiver burden and formal home health service use are only weakly related. Possible explanations for the findings are discussed.     

How important is functional status as a predictor of service use by older people?

In studies of older people, it is often assumed that biophysical, or functional, status is the primary determinant of formal service use. This article reports baseline data from a longitudinal study of a community-based, linked random sample of frail elders (n = 635) and their informal caregivers (n = 429) to investigate the relative contribution of social circumstances to the use of community-based formal services. Elder respondents were categorized into three groups defined by their primary source of care: (a) informal only, (b) mixed help with predominantly informal care, (c) mixed help with predominantly formal services. Of the respondents, 79% received most of their help from informal caregivers, whereas 21% relied on formal services for most of their assistance. A series of logistic regression models were developed to identify variables that discriminated between major sources of care. The social factor of living alone is the consistent predictor of reliance on formal services. Only for those elders living alone does the physical factor of level of frailty predict reliance on formal services. Elders who live with a caregiver, particularly a spouse, are likely not to use any formal services regardless of their level of frailty. Finally, elders reliant on formal services receive much less care overall.     

Normative beliefs about sharing housing with an older family member

The aims of this study were: (a) to examine general perceptions of filial obligations toward sharing housing with older parents and stepparents; and (b) to assess the effects of selected contextual factors on those normative beliefs. A national sample of 579 men and 582 women (mean age = 44.6, SD = 17.2) responded to a multiple segment factorial vignette in which an older parent or stepparent was portrayed as needing help with housing. Respondents thought that parents should be helped more than stepparents, younger adults with greater resources were more obligated to help older parents and stepparents than were those with meager resources, and older parents and stepparents with greater need acuity were expected to be helped more than older parents and stepparents with less serious housing needs. Attitudes about co-residence were based on family obligation norms, beliefs about repaying older adults for past help, perceived relationship quality, other demands on the younger adult's resources, the older person's resources, and moral responsibilities to assist.     

Filial responsibility expectations among adult child-older parent pairs

We investigated filial responsibility consensus in a random sample of 144 elderly parent-adult child pairs. Most respondents interpreted the filial role as including a great deal of emotional support and discussion of important matters and available resources. Both generations perceived living close by and writing letters to parents on a weekly basis as less important. Parents, compared to their offspring, were more likely to disapprove of receiving financial assistance from children, living with children, and having children adjust their work schedules to help them. Robinson's A revealed that there was a moderate level of intergenerational agreement on filial responsibility expectations.     

Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter?

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%. DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.