Health Service Provider’s Perspectives on Healthy Aging in India

This qualitative inquiry explored the meaning of healthy aging, health status of the elderly they serve, availability of programs and services, and knowledge of policies specific to seniors from the perspective of health service providers in India. To this end, 100 physicians, allied and alternative health care providers were recruited using snowball sampling method and interviewed in person. The health service providers showed an overall tendency toward holistic definitions including aspects of physical, mental and social wellbeing and reported widely prevalent health problems in each of those domains (e.g., physical health problems, social health concerns resulting from changing family structure). In discussing programs and services available to seniors, a wide range was evident; however the need for expanded health and social support was clear. In order to adequately respond to this need, policy development and implementation relating to the aging population is necessary and three key considerations are highlighted.     

Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya

Equity is an important criterion in evaluating health system performance. Developing a framework for equitable and effective resource allocation for health depends upon knowledge of service providers and their location in relation to the population they should serve. The last available map of health service providers in Kenya was developed in 1959. We have built a health service provider database from a variety of traditional government and opportunistic non-government sources and positioned spatially these facilities using global positioning systems, hand-drawn maps, topographical maps and other sources. Of 6674 identified service providers, 3355 (50%) were private sector, employer-provided or specialist facilities and only 39% were registered in the Kenyan Ministry of Health database during 2001. Of 3319 public service facilities supported by the Ministry of Health, missions, not-for-profit organizations and local authorities, 84% were registered on a Ministry of Health database and we were able to acquire co-ordinates for 92% of these. The ratio of public health services to population changed from 1:26,000 in 1959 to 1:9300 in 1999-2002. There were 82% of the population within 5 km of a public health facility and resident in 20% of the country. Our efforts to recreate a comprehensive, spatially defined list of health service providers has identified a number of weaknesses in existing national health management information systems, which with an increased commitment and minimal costs can be redressed. This will enable geographic information systems to exploit more fully facility-based morbidity data, population distribution and health access models to target resources and monitor the ability of health sector reforms to achieve equity in service provision.     

Responding to Mental Health Needs of the Elderly in Rural Areas:

In Iowa, the percentage of elderly persons in rural areas has increased dramatically in the past decade. Although delivery of mental health services to the rural elderly is a statewide and national priority, at present, too few health professionals are adequately prepared to meet this need. The rural elderly have limited access to psychiatrists and are underserved by Community Mental Health Centers. Therefore, general practitioners, public health nurses, social service workers and other core disciplines who participate in Iowa Geriatric Education Center (IGEC) educational and training programs must be able to understand the mental health needs of this population, provide basic care, and make referrals for needed services. From the inception of the Iowa Geriatric Education Center, an effort was made to incorporate clincial and service delivery into the IGEC curriculum. Through affiliation with the Rural Elderly Outreach Program, participants in IGEC programs have an opportunity to learn more about geriatric mental health and service delvery issues in rural settings.     

The health and social system for the aged in Japan

Japan implemented a new social insurance scheme for the frail and elderly, Long-Term-Care Insurance (LTCI) on 1 April 2000. This was an époque-making event in the history of the Japanese public health policy, because it meant that in modifying its tradition of family care for the elderly, Japan had moved toward socialization of care. One of the main ideas behind the establishment of LTCI was to "de-medicalize" and rationalize the care of elderly persons with disabilities characteristic of the aging process. Because of the aging of the society, the Japanese social insurance system required a fundamental reform. The implementation of LTCI constitutes the first step in the future health reform in Japan. The LTCI scheme requires each citizen to take more responsibility for finance and decision-making in the social security system. The introduction of LTCI is also bringing in fundamental structural changes in the Japanese health system. With the development of the Integrated Delivery System (IDS), alternative care services such as assisted living are on-going. Another important social change is a community movement for the healthy longevity. For example, a variety of public health and social programs are organized in order to keep the elderly healthy and active as long as possible. In this article, the author explains on-going structural changes in the Japanese health system. Analyses are focused on the current debate for the reorganization of the health insurance scheme for the aged in Japan and community public health services for them.     

Impact of the Organizational Networks on the Roles of NGOs in Eldercare: Perspectives from HelpAge Ghana Day Centres

Drawing data from the ??Ghanaian Gerontological Social Work Research Project,?? this case study examines the impact of the organizational network of HelpAge Ghana on its roles in eldercare in Ghana. Using an organizational network framework and survey, participatory observation, and document review data collection strategies, it was discovered that Helpage Ghana had provided alternative eldercare when older people face declining family eldercare and inadequate governmental elderly services. A four-level analysis reveals that the selected organization network not only ensures resources and public recognition necessary for organization birth and survival, but also creates independence from long-term partners like HelpAge International and the Government of Ghana. The study concludes that the organizational network of HelpAge Ghana has positively impacted its roles as a developmental organization and a service NGO. By defining aging issues as developmental issues, HelpAge Ghana actively changes the quality of life of older people and eldercare infrastructure through the passage of national healthcare policies, in pursuit of national policy on aging, raising awareness of rights of older people, and empowerment. In gerontological services, HelpAge Ghana Adults Day Centres and other programs have reduced physical, mental, and social health risks of older people. Significances and limitations of the study are also discussed.     

The health system of Argentina

This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar.     

The systems of care for frail elderly persons: the case of Sweden

Sweden has a well-developed welfare system following the Nordic model and it maintains - even though there have been some reductions in the last decade - good economic security and comprehensive services for the elderly. The national policy for the elderly aims at enabling older persons to live independently with a high quality of life. A great majority of the elderly in Sweden live in ordinary homes - very few live with their grown-up children. The municipalities are responsible for providing long-term social services and care for the frail elderly in the form of home help services for those that live in ordinary housing, and special housing accommodation for those with extensive needs. The county councils are responsible for health care and provide home nursing care and rehabilitation. Sweden used to have the oldest population in the world. The proportion of 80+ years old in the population increased from 3% to over 5% between 1980 and 2000. Due to financial restrictions as a result of the economic recession in the last decade, the health and social services for the elderly have not been able to keep up with the population development. The previous generous allocation of care has been replaced by a more restrictive approach. This has mainly affected persons with lesser needs for help, younger elderly, and married persons. The number of elderly persons is expected to increase rapidly in the coming decades. However, due to improved health among the elderly, this will lead to a relatively limited increase of needs. Depending on assumptions concerning the health development, the required increase in volume of health and social services is expected to fall somewhere between 10-30% during the coming 30-year period.     

The health system of Brazil

This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.     

Integrating Information About Hispanic Elderly into Undergraduate Gerontology:

The underutilization of medical and social services by elderly Hispanics has been partly attributed to cultural differences between the elderly and non-Hispanic service providers. Strategies to overcome barriers to service use include sensitizing non-Hispanic providers to the effects such cultural differences can have on Hispanic elderly. A pilot field placement program involving non-Spanish speaking, gerontology students and a bilingual society service agency was designed to integrate information about Hispanic elderly into undergraduate gerontology curricula. The placement was effective in sensitizing future non-Hispanic service providers to issues regarding elderly Hispanics.     

Coordinated-care teams: Improving health and social care for older Israelis

Conclusion Despite the difficulties, professionals involved in the demonstration program at all levels were convinced that this was indeed the most appropriate way to coordinate care within the Israeli system. A decisive majority of field workers participating in the demonstration program were satisfied with the work of the coordinated-care team and felt that teamwork vastly improved the quality of care for the elderly. It seems that the model of inter-organizational and interdisciplinary teams provides the structural conditions that enable professionals to care for the elderly according to their own perceptions of good professional practices. These naturally include comprehensiveness and continuity of care, which enable them to assume more responsibility for all the elderly’s needs. Because the program was based on existing providers of care, it was not difficult to integrate care and case management functions, thereby enabling the teams to reach their professional goals. Acceptance on the part of professionals of shared responsibility capitalized on the advantages of teamwork. This proved to be effective in overcoming previous conflicts among the organizations and helped to structure more clearly the boundaries of responsibility of each team member and each organization. Israel responds to its growing numbers of disabled elderly and their needs for comprehensive services with nurse/social worker teams who share responsibilities and reap professional benefits. Jenny Brodsky, whose background is in sociology, is a researcher at the JDC-Brookdale Institute of Gerontology and Human Development in Israel. In conjunction with Esther Sobol, she conducts research on the evaluation of the quality of long-term care services, case management, and health promotion for the elderly. She is also researching the impact of home care in Israel on the well-being of the elderly, their families, and the service provision system. Esther Sobol, whose background is in social work, is also a researcher at the JDC-Brookdale Institute of Gerontology and Human Development. In addition to her work with Ms. Brodsky on evaluating the quality of long-term care services, case management, and health promotion for the elderly. Ms. Sobol is examining the elderly’s patterns of service utilization, particularly in the area of social care.     

The health system of Venezuela

This paper describes the Venezuelan health system, including its structure and coverage, financial sources, human and material resources and its stewardship functions. This system comprises a public and a private sector. The public sector includes the Ministry of Popular Power for Health (MS) and several social security institutions, salient among them the Venezuelan Institute for Social Security (IVSS). The MH is financed with federal, state and county contributions. The IVSS is financed with employer, employee and government contributions. These two agencies provide services in their own facilities. The private sector includes providers offering services on an out-of-pocket basis and private insurance companies. The Venezuelan health system is undergoing a process of reform since the adoption of the 1999 Constitution which calls for the establishment of a national public health system. The reform process is now headed by the Barrio Adentro program.     

Community-based health services for people with HIV/AIDS: a review from a health service perspective.

Health services for people with HIV/AIDS have been mainly hospital based, but it is now recognized that much care can be provided outside hospitals. There are well documented problems in delivering care in the community to other client groups such as the elderly and the mentally ill, but there are particular difficulties with HIV/AIDS care. These stem in part from the clinical demands of AIDS-related illnesses, but also from the stigma associated with the disease. This review looks at three key areas of relevance to those planning community-based health services for people with HIV/AIDS. These are: the need for collaboration between the statutory and voluntary sectors; the need for co-ordination between providers at the point of service delivery; and whether care should be provided by generic or specialist providers. While certain universal principles apply, and are necessary to ensure a good standard of care, patterns of service delivery will inevitably vary according both to the local prevalence rates and the existing service infrastructure. There is more than one good model of care; all models must be flexible enough to deal with needs on an individual basis.     

Dementia Care Programs and Services for Chinese Americans in the U.S.

The purpose of this study is to provide an overview of development of dementia caregiving models for Chinese Americans in the U.S. This study reviewed some existing programs and interventions for Chinese dementia caregivers that were provided by service organizations and academic institutions. The recommendations for development of dementia care models include: 1) Collaborating with local community agencies that work with the Chinese population; 2) Create, maintain, and expand existing Chinese-language help-lines with individualized counseling, skills training, and support system-building services; 3) Increase caregiving information available in the Chinese language; 4) Sustain adequate funding for existing programs and services; 5) Raise public awareness through ongoing publications, media outlets, and workshops in senior housing and centers; 6) Raise health care and social service providers’ awareness; and 7) Increase program evaluation effort.     

Social Work Mental Health Services and the Long-Term Care Continuum

Mental health services are provided to the elderly by social workers in senior centers, Veterans Administration programs, family service agencies, home health care agencies, and in the private sector. The psychosocial approach is emphasized and the growing need to provide sufficient and appropriate mental health services to older adults is addressed.     

Sexuality in subjects with intellectual disability: an educational intervention proposal for parents and counselors in developing countries

In developing countries, the study of intellectual disability has enormous knowledge gaps, especially in the areas of intervention, utilization of services and legislation. This article provides information not only for aiding in the potential development of sexuality in individuals with intellectual disability, but also for fostering their social integration. In Mexico and the region, in order to develop educational interventions for promoting sexual health, it is necessary to consider the following priorities: a) mental health professionals should have the knowledge or receive training for carrying out a sexual education and counseling program; b) educational interventions for subjects with intellectual disability should be adapted for the different stages of life (childhood, adolescence and adulthood); c) during childhood, educational intervention should emphasize the concept of public and private conducts; d) in adolescence, intervention should consider the actual mental age and not the chronological age of the subjects receiving intervention; e) the expression of sexuality in the adult with intellectual disability depends on the early incorporation of factors for promoting social inclusion; f) for educational interventions to be successful, it is fundamental that sexual educators and counselors, in addition to working with the clients, also work with their parents and other close family members; g) intervention programs should establish development objectives for developing in persons with intellectual disability a positive attitude towards sexuality and the improvement in self-esteem; h) in subjects with intellectual disability, their linguistic comprehension level should be taken into consideration and techniques for open discussion and non-inductive education should be used; i) social integration programs should address the needs of developing countries and their individuals, since it is not feasible to import external programs due to differences in infrastructure and the absence of public policies for promoting development; j) full sexuality in subjects with intellectual disability should be fostered in a comprehensive manner within an independent living program; k) in Mexico and the region, public policies should be instituted for administering independent living programs for people with intellectual disability and should lead to social, familial and economic power for the purpose of being productive. Thus, people with mental deficiency in developing countries can aspire to being integrated into social and work life and to appropriately expressing their sexuality.     

The health system of Costa Rica

This paper describes the Costa Rican health system which provides health, water and sanitation services. The health component of the system includes a public and a private sector. The public sector is dominated by the Caja Costarricense de Seguro Social (CCSS), an autonomous institution in charge of financing, purchasing and delivering most of the personal health services in Costa Rica. CCSS is financed with contributions of the affiliates, employers and the state, and manages three regimes: maternity and illness insurance, disability, old age and death insurance, and a non-contributive regime. CCSS provides services in its own facilities but also contracts with private providers. The private sector includes a broad set of services offering ambulatory and hospital care. These services are financed mostly out-of-pocket, but also with private insurance premiums. The Ministry of Health is the steward of the system, in charge of strategic planning, sanitary regulation, and research and technology development. Among the recent policy innovations we can mention the establishment of the basic teams for comprehensive health care (EBAIS), the de-concentration of hospitals and public clinics, the introduction of management agreements and the creation of the Health Boards.     

Changing access to mental health care and social support when people living with HIV/AIDS become service providers

As people living with HIV/AIDS (PHAs) achieve more stable health, many have taken on active peer support and professional roles within AIDS service organizations. Although the increased engagement has been associated with many improved health outcomes, emerging program and research evidence have identified new challenges associated with such transition. This paper reports on the results of a qualitative interpretive study that explored the effect of this role transition on PHA service providers' access to mental health support and self care. A total of 27 PHA service providers of diverse ethno-racial backgrounds took part in the study. Results show that while role transition often improves access to financial and health-care benefits, it also leads to new stress from workload demands, emotional triggers from client's narratives, feeling of burnout from over-immersion in HIV at both personal and professional levels, and diminished self care. Barriers to seeking support included: concerns regarding confidentiality; self-imposed and enacted stigma associated with accessing mental health services; and boundary issues resulting from changes in relationships with peers and other service providers. Evolving support mechanisms included: new formal and informal peer support networks amongst colleagues or other PHA service providers to address both personal and professional challenges, and having access to professional support offered through the workplace. The findings suggest the need for increased organizational recognition of HIV support work as a form of emotional labor that places complex demands on PHA service providers. Increased access to employer-provided mental health services, supportive workplace policies, and adequate job-specific training will contribute to reduced work-related stress. Community level strategies that support expansion of social networks amongst PHA service providers would reduce isolation. Systemic policies to increase access to insurance benefits and enhance sector-wide job preparedness and post-employment support will sustain long-term and meaningful involvement of PHAs in service provision.     

Health care needs and health care organization for citizens of advanced age

In order to improve the health and well-being of the elderly, it is necessary to develop and assess care programs for the elderly within existing health and social services. An epidemiological approach in assessing the functional health and autonomy are described using the concepts of disability and handicap (according ICIDH). A design for estimating need and for identifying high-risk groups in a population survey are presented.     

Responding to the needs of children with chronic illness. The Title V approach

We have established an approach through Title V which involves 1) the Title V state system; 2) the tertiary level in universities, children's hospitals, and other major institutions; and 3) the community level, with local physicians, school staff, and community health, mental health, and social service providers for building a system of care for specific groups of chronically ill and disabled children using all available resources--public, private, and voluntary. The challenge in the 1990s as we move to the twenty-first century is to use that experience to support a generic system of care; each disease may have medically different consequences but all chronic illnesses share important characteristics for the child and family. The nation will be better served by programs that address children with special health needs as a class than by programs that are duplicated 200 times or more. The system developed cannot be a rigidly controlled or structured system. We live in a free pluralistic society where services to children are provided by public, private, and voluntary resources and by many different agencies and professionals. But it can be a more rational and better developed approach to long-term care based on the experience and knowledge we have gained in the past 50 years.     

COMMUNITY OPTIONS: A NEW APPROACH IN ASSESSMENT AND THE DELIVERY OF SERVICES IN THE AGED CARE FIELD.

This paper draws attention to a pilot programme sponsored by Aged Cottage Homes Inc. in South Australia with the aim of reducing the movement into residential care of elderly people assessed as urgently needing and eligible to enter such forms of care. The programme focuses directly on those factors precipitating movement into residential care. By negotiating with existing service providers, advocating on behalf of users of the programme, establishing new services which are specific to user needs, the Community Options programme has demonstrated that many users of aged accommodation services can be supported to live in their own homes. The benefits of the programme include enhanced lifestyles for elderly people, individuality of specific programs for users, close and continuing contact with users, and the process is cost effective in terms of government outlays.