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Do assessment tools shape policy preferences? Analysing policy framing effects on older adults’ conceptualisation of autonomy
- Authors:
- DICKSON Daniel, MARIER Patrik, DUBE Anne-Sophie
- Journal article citation:
- Journal of Social Policy, 51(1), 2022, pp.114-131.
- Publisher:
- Cambridge University Press
- Place of publication:
- Cambridge
The concept of autonomy is essential in the practice and study of gerontology and in long-term care policies. For older adults with expanding care needs, scores from tightly specified assessment instruments, which aim to measure the autonomy of service users, usually determine access to social services. These instruments emphasise functional independence in the performance of activities of daily living. In an effort to broaden the understanding of autonomy into needs assessment practice, the province of Québec (Canada) added social and relational elements into the assessment tool. In the wake of these changes, this article studies the interaction between the use of assessment instruments and the extent to which they alter how older adults define their autonomy as service users. This matters since the conceptualisation of autonomy shapes the formulation of long-term care policy problems, influencing both the demand and supply of services and the types of services that ought to be prioritised by governments. Relying on focus groups, this study shows that the functional autonomy frame dominates problem definitions, while social/relational framings are marginal. This reflects the more authoritative weight of functional autonomy within the assessment tool and contributes to the biomedicalisation of aging. (Edited publisher abstract)
Being well enough in old age
- Authors:
- BARNES Marian, TAYLOR David, WARD Lizzie
- Journal article citation:
- Critical Social Policy, 33(3), 2013, pp.473-493.
- Publisher:
- Sage
This article offers a critique of the dominant ways in which well-being has been conceptualized and researched within social policy, focusing in particular on the significance of this for policy relating to older people. It conceptualizes well-being as relational and generative rather than an individual outcome. Normative notions of independence, autonomy and consumerism at the heart of policy on well-being and ageing are critically explored and it is suggested that indexes of older people’s happiness conceal more than they reveal. This theoretical approach is illustrated with empirical material from a participatory study in which older people were co-producers of knowledge about what well-being means and how it can be produced. Working with older people as co-researchers it was found that keeping well in old age involves demanding emotional and organizational labour both for older people and for family and friends. The need for ethical and relational sensibilities at the heart of policy on well-being and ageing is suggested. (Edited publisher abstract)
The myth of independence for older Americans living alone in the Bay Area of San Francisco: a critical reflection
- Author:
- PORTACOLONE Elena
- Journal article citation:
- Ageing and Society, 31(5), July 2011, pp.803-828.
- Publisher:
- Cambridge University Press
In the United States, over five million citizens aged 75 and over live alone; a number which will rise over the coming years. In this paper, Rose's theory that citizens have a duty to be self-reliant and independent, and the political economy perspective serve as frameworks to investigate how discourses around independence are translated into the experiences of 22 older people living at home alone in the Bay Area of San Francisco. Participant observation and in-depth interviews from 2006 to 2010 highlight how being independent can be an essential component of individual identities. Findings through participant narratives painted a very different picture to that often seen in literature – namely that every circumstance is different. While some enjoyed independence, other simply tolerated it because it was part of their make-up. Their narratives shed light on the impact of policies that facilitate or regulate the moral imperative of independence. In conclusion, the findings highlight the need to evaluate how discourses around independence are translated into individual cases, and to promote further studies and initiatives on interdependence.
Extending quality life: policy prescriptions from the Growing Older Programme
- Author:
- WALKER Alan
- Journal article citation:
- Journal of Social Policy, 35(3), July 2006, pp.437-454.
- Publisher:
- Cambridge University Press
- Place of publication:
- Cambridge
This article provides a policy-oriented overview of the five-year ESRC Growing Older Programme of research on quality of life in old age: the largest UK social sciences research endeavour to date in the field of ageing. By way of an introduction to the Growing Older Programme, its main objectives are stated and some of its unique contributions to knowledge and research methods are summarised. Then the bulk of the article focuses on the relationship between research and policy: first in general terms and then specifically with regard to the operation of and outputs from the Programme. The particular methods used by the Programme to engage with the policy process are described, within a broad enlightenment framework. This is followed by an outline of the key elements of a multi-dimensional approach to extending the quality of later life. The five priority elements of this skeletal strategy – inequalities in old age, environments of ageing, economic and family roles, participation and involvement, and frailty and identity – are derived from the Growing Older Programme's comprehensive evidence base. In each case the policy implications of the research evidence are illustrated. Finally, the role of older people in living their own lives of quality is discussed, and the results of the Programme are used to show how aspects of both structure and agency combine to determine the quality of later life.
Getting by in the community: lessons from frail elders
- Authors:
- LONG Sharon K., et al
- Journal article citation:
- Journal of Aging and Social Policy, 17(1), 2005, pp.19-43.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
This study explores how functionally impaired, elderly persons are able to remain in the community without homeand communitybased care (HCBC) under the Medicaid program. Using HCBC administrative data, Medicare data, and survey data, we find the nonparticipants in the community appear to get by through a combination of reliance on informal care, use of Medicare home care, and going without needed services. Despite their efforts to manage their care in the community, non-participants were significantly more likely than the participants to enter a nursing home during the six months following assessment. While our analysis does not allow us to attribute the higher nursing home entry to the absence of HCBC services with certainty, the finding does raise questions about whether the elements of the HCBC program that discourage participation may save Medicaid dollars in the short-run at the expense of future Medicaid costs from more rapid nursing home entry. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Home, independence and community care: time for a wider vision?
- Author:
- MEANS Robin
- Journal article citation:
- Policy and Politics, 25(4), October 1997, pp.409-419.
- Publisher:
- Policy Press
This article begins by looking at past policy assumptions about the importance of home and independence to older people. The second half of the article looks at present day assumptions on this issue as addressed by the 1990 National Health Service and Community Care Act and compares this to what older people themselves have to say. By drawing on research on older households the importance of home as a place of privacy and self identity is illustrated as is the rich and varied lives of these respondents both inside and outside their homes. Argues that local authorities as the lead agencies in community care should help to foster such independence and that this requires them to develop a broad vision of community care which covers issues such as transport, leisure and household maintenance.
Good personal finances or a strong social capital—on different life conditions of importance for an active life when becoming alone in old age
- Authors:
- EMILSSON Ulla Melin, STAHL Agneta
- Journal article citation:
- European Journal of Social Work, 19(5), 2016, pp.749-763.
- Publisher:
- Taylor and Francis
Becoming alone in old age can be a decisive life event that brings major changes depending on various causes as health status, financial resources, family situation, and available welfare services. This article discusses the situation of older people in Sweden who have transitioned from a two-person to single-person household in recent years and what impact this might have on their everyday lives. Through in-depth interviews with 18 older people, age 67–90, their experiences about life conditions and opportunities were examined. Findings showed large differences between the men and women. They all tried to live as they always had done and they used the same personal life strategies that they always had. But the men could live as before on their own financial merits, while the women needed assistance from children, grandchildren and the welfare system. Transportation options were central and clearly related to both private economy and social services available. Shortcomings in the welfare state's way of caring for the elderly were clearly uncovered. The gap between social policy promises of opportunities for autonomy and independence to live an active life in old age and the everyday reality for older people still seems to be wide. (Publisher abstract)
Family care, independent living and ethnicity
- Authors:
- HARPER Sarah, LEVIN Sonya
- Journal article citation:
- Social Policy and Society, 4(2), April 2005, pp.157-169.
- Publisher:
- Cambridge University Press
The UK's national population structure, in line with most Western societies, is ageing rapidly. The combination of falling fertility and increasing longevity is having an impact on family structures and resultant relationships, with the emergence of long vertical multi-generational families replacing the former laterally extended family forms. This is occurring at a time when UK government policy is placing increasing reliance on families to provide health and social care and support for the growing number of frail older people. While there has been extensive research on family care within the majority white population, there is less understanding of the elder family care provision for the UK's growing older ethnic population. This paper discusses the changing demographics, new government policy on promoting independent living and its implications for family care provision, and reviews our current understanding of family care and support for older people within the UK’s varied ethnic minority families.
Older people: a changing approach; independence and well-being 1
- Author:
- AUDIT COMMISSION
- Publisher:
- Audit Commission
- Publication year:
- 2004
- Pagination:
- 52p.
- Place of publication:
- London
In the UK, the 2001 census has shown that, for the first time, there are more people aged 60 and over than children under 16. Ethnic diversity is also increasing rapidly among older people, as the first generation immigrants of the 1950s enter retirement. With increased longevity, the balance of life is changing, with older people now experiencing and expecting many more years of healthy life after retirement than ever before. This shift is going to continue. This report has been prepared in collaboration with Better Government for Older People (BGOP), the partnership that aims to change attitudes towards our ageing population and highlight the contribution that older people make to their communities. It:discusses what independence means for older people; sets out the issues that older people themselves say have the greatest impact on their ability to live independent lives; summarises the national policy framework that can help communities to refocus their approach; and sets out what needs to happen next.
Our homes, our lives: choice in later life living arrangements
- Editor:
- SUMNER Keith
- Publisher:
- Centre for Policy on Ageing/Housing Corporation
- Publication year:
- 2002
- Pagination:
- 208p.,bibliogs.
- Place of publication:
- London
The involvement of older people as active partners in planning their future living arrangements, and elements of care support, must be at the heart of day-to-day practice, policy planning and design. Contributors provide an overview of the current situation faced by older people in terms of policy issues, architectural and design perspectives, and conceptual understandings of autonomy and independence.