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Comparative political economy of long-term care for elderly people: political logic of universalistic social care policy development
- Author:
- HIEDA Takeshi
- Journal article citation:
- Social Policy and Administration, 46(3), June 2012, pp.258-279.
- Publisher:
- Wiley
Despite there being common socio-demographic pressures across industrialised countries, the public elder care programmes tend to vary. This study explored the causal relationship between political institutions and public long-term care programmes. It examined time-series and cross-section data of advanced democracies, from 1980 until 2001. It argued that countries with fragmented party systems have difficulties in developing universalistic public elder care programmes, whereas countries with party-vote-oriented electoral systems and cohesive party systems are likely to develop better elder care programmes. For whilst the former types of political institutions prioritise patronage-based, particularistic benefits, the latter types encourage political actors to appeal to broader constituencies through universalistic welfare programmes. The empirical results suggest that politicians' reliance on personal votes obstruct the expansion of public spending for elder care.
Shifting from fragmentation to integration: a systematic analysis of long-term care insurance policies in China
- Authors:
- ZHOU Wusi, DAI Weidong
- Journal article citation:
- International Journal of Integrated Care, 21(3), 2021, p.11. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Long-term care is an effective intervention that help older people cope with significant declines in capacity. The growing demand for long-term care signals a new social risk and has been given a higher political priority in China. In 2016, 15 local authorities have been selected to pilot the long-term care insurance programme. However, the current implementation of these programmes is fragmented, with a measure of uncertainty. This study aims to investigate the principles and characteristics of long-term care insurance policies across all pilot authorities. It seeks to examine the design of local long-term care insurance systems and their current status. Methodology: Based on the 2016 guidance, a systematic search for local policy documents on long-term care insurance across the 15 authorities was undertaken, followed by critical analysis to extract policy value and distinctive features in the delivery of long-term care. Results: The results found that there were many inconsistencies in long-term care policies across local areas, leading to substantial variations in services to the beneficiaries, funding sources, benefit package, supply options and partnership working. Policy fragmentation has brought the postcode lottery and continued inequity for long-term care. Discussion: Moving forward, local authorities need to have a clear vision of inter-organisational collaboration from the macro to the micro levels in directional and functional dimensions. At the national level, vertical governance should be interacted to outline good practice guidelines and build right service infrastructure. At the local level, horizontal organizations can collaborate to achieve an effective and efficient delivery of long-term care. (Edited publisher abstract)
Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review
- Authors:
- DE LANGE E., VERHAAK P.F.M., VAN DER MEER K.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(2), 2013, pp.127-134.
- Publisher:
- Wiley
Although delirium is relatively common in hospitals, especially in intensive, post-operative and palliative care, its prevalence in the general population is only about 1-2%. The aim of this systematic review was to provide an overview, with the GP in mind, of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalised long-term care. The evidence confirms that the prevalence of delirium among the elderly aged 65+ years is 1–2%. It rises with age, reaching about 10% among a “general” population aged 85+ years. In populations with higher proportions of demented elders prevalence can be 22%. In long-term care, it ranges between 1.4% and 70%, depending on diagnostic criteria and on the prevalence of dementia. Age and cognitive decline are significant risk factors for delirium in all groups. In terms of prognosis, most studies agree that older people who previously experienced delirium have a higher risk of dementia and a higher mortality rate. Population and long-term care studies confirm this tendency. The authors conclude that although delirium in a non-selected population aged over 65 years is uncommon, prevalence rises quickly in selected older groups. They emphasise the need for primary care doctors to be aware of a relatively high risk of delirium among the elderly in long-term care, those over 85 years and those with dementia.
Person-centred communication in long-term care with older people: a scoping review
- Author:
- LOMBARD Daniel
- Journal article citation:
- Journal of Integrated Care, 29(3), 2021, pp.306-333.
- Publisher:
- Emerald
Purpose: Interpersonal skills are increasingly important tools in long-term care with older people, especially against the backdrop of loneliness affecting older people and expectations for a person-centred, joined-up approach. However, the term is used as a composite and its definition lacks shape and focus. In existing literature, participants appear to be selected on the basis of specific illnesses rather than age. Better understanding of the features of everyday communication processes associated with person-centred care can lead to improvements in policy and practice. Design/methodology/approach: A scoping review examined communication features associated with person-centred care for older adults. This identified the extent and nature of literature. Several databases were searched; after screening and hand-searching, 31 were included. Findings were analysed for patterns and contradictions, against the objectives of person-centred and integrated care. Findings: Emotional intelligence and the ability to employ various communication styles are crucial skills of person-centred communication. Such approaches can have positive effects on the well-being of older people. Research limitations/implications: Some studies' validity was weakened by methodological designs being founded on value judgements. Practical implications: Using personalised greetings alongside verbal and non-verbal prompts to keep residents emotionally connected during personal care is considered good practice. Stimulating feedback from people using services and their relatives is important. Originality/value: The role of communication is highlighted in many professional guidance documents on person-centred and integrated care, but the process of implementation is decentralised to individual employers and workers. This paper draws on the findings of contemporary literature, grounded in naturalistic data, with implications for practice and policy. (Edited publisher abstract)
The association between quality of life and nursing home facility for the elderly population: a systematic review and meta-analysis
- Authors:
- LI Yang-Tzu, et al
- Journal article citation:
- International Journal of Gerontology, 15(1), 2021, pp.16-24.
- Publisher:
- Airiti Library
- Place of publication:
- Taiwan
Background: To investigate the association between quality of life and nursing home facility for the elderly population. Methods: The researchers searched the PubMed, Medline, and Cochrane Library for relevant perspective studies without language limitations from inception to 17^(th) June 2020 for relevant publications with a priori defined inclusion and exclusion criteria. Two authors independently selected studies, assessed risk of bias, and extracted data. The disagreement was resolved by discussion with a third author. Results: There are 18 articles involved in the final meta-analysis. The disparities were found of accessing the quality of life (World Health Organization Quality-of-Life, Quality of Life in Last-Stage Dementia, Nottingham Health Profile-Turkish Version, EUROPE Health Interview Survey-QoL , Visual analogue Scales, Flanagan Quality of Life Scale) and the level of independence (Barthel Index, Kahoku Aging Longitudinal Study Scale, Visual Analogue Scales, Activities of Daily Living Scales, Instrumental Activities of Daily Living Scales). Conclusion: The available limited, very low-quality evidence does not support a significant association between quality of life and nursing home facility for the elderly population. Further rigorous and long-term follow-up studies should be conducted with more objective measures. (Edited publisher abstract)
Older adults post-incarceration: restructuring long-term services and supports in the time of COVID-19
- Authors:
- BOUCHER Nathan A., VAN HOUTVEN Courtney Harold, DAWSON Walter D.
- Journal article citation:
- Journal of the American Medical Directors Association, 22(3), 2021, pp.504-509.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Objectives: To describe long-term care services and supports (LTSS) in the United States, note their limitations in serving older adults post-incarceration, and offer potential solutions, with special consideration for the Coronavirus Disease 2019 pandemic. Design: Narrative review. Setting and Participants: LTSS for older adults post-incarceration. Methods: Literature review and policy analysis. Results: Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison. Conclusions and Implications: Long-standing gaps in US LTSS are revealed by the coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults after incarceration. (Edited publisher abstract)
International evidence on care home COVID-19 outbreak responses: summary of key findings
- Authors:
- SALCHER-KONRAD Maximilian, COMAS-HERRERA Adelina
- Publisher:
- International Long Term Care Policy Network
- Publication year:
- 2020
- Pagination:
- 6
- Place of publication:
- London
This note summarises emerging evidence on COVID-19 outbreak responses in care homes, obtained from a “living” systematic review that focused on COVID-19 mortality and spread of disease in long-term care more broadly (Salcher-Konrad & al. (2020). COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence). The review found that outbreaks in long-term care settings varied widely in terms of the number of people affected, and that evidence on the reasons behind this variation is still emerging. It identifies four measures that may have worked in containing COVID-19 outbreaks in care homes: early detection and rapid response after detection of index case; systematic testing of all residents and staff – high prevalence of asymptomatic and presymptomatic cases that would not be detected by a) symptoms screening, and b) one-off testing (if infection has already spread beyond index case); moving high-risk contacts of cases out of the facility; and isolating cases by removing them from the facility or creating separate wards within the facility. (Edited publisher abstract)
Preventing respiratory illness in older adults aged 60 years and above living in long-term care
- Authors:
- RIOS Patricia, et al
- Publisher:
- University of Oxford, Centre for Evidence-Based Medicine
- Publication year:
- 2020
- Place of publication:
- Oxford
This rapid overview of reviews identifies evidence from systematic reviews on infection protection and control measures for preventing respiratory illness (including coronavirus and influenza) in older adults aged 60 years and above living in long-term care. The results of the included systematic reviews suggest that high quality evidence supports treating residents with antiviral chemoprophylaxis with adamantine, as well as adamantine in combination with personal protective equipment. For the rest of the strategies, there was either no evidence of effectiveness (e.g., social isolation) or mixed evidence of effectiveness (e.g., rimantadine, zanamivir, hand hygiene, personal protective equipment). The mixed evidence on hand hygiene and use of personal protective equipment does not imply these should not be used in outbreaks. (Edited publisher abstract)
What do we know about care home managers? Findings of a scoping review
- Authors:
- ORELLANA Katharine, MANTHORPE Jill, MORIARTY Jo
- Journal article citation:
- Health and Social Care in the Community, 25(2), 2017, pp.366-377.
- Publisher:
- Wiley
This article reports selected findings from a scoping review of the literature about care home managers in England. The review was undertaken between December 2013 and April 2014, with searches conducted in December 2013, and completed in July 2014. Its aim was to identify the characteristics of care home managers, descriptions of their leadership and managerial roles, their experience, skills and support, and the managers' perceptions of their work and status and to identify knowledge gaps. The databases searched included Web of Knowledge, EBSCO, ASSIA, Embase, AgeInfo, NHS Evidence, Social Care Online and the publication platforms IngentaConnect, Wiley Online and JSTOR together with specialist sites and national information providers. Sixteen relevant studies directly about care home managers, reported in 24 articles, were identified. A further body of literature pertinent to the questions was located (n = 84), including sector reports, professional press, expert opinion, enquiries and reviews, and other material, which also informed the review. A consultation exercise with stakeholders informed the findings of the review. The review found that, despite frequent allusions to their impact on organisational culture, few studies have focused on care home managers, and, such as there are, mainly relate to managers of care homes for older people. This is despite managers' major responsibilities for the care of many frail and disabled people. (Edited publisher abstract)
The redefinition of the familialist home care model in France: the complex formalization of care through cash payment
- Author:
- BIHAN Blanche Le
- Journal article citation:
- Health and Social Care in the Community, 20(3), May 2012, pp.238-246.
- Publisher:
- Wiley
This article examines French policy measures on the organisation of home-based care for older people, by investigating the balance between formal and informal care. It specifically focuses on the cash for care scheme which is at the core of the French home-based care policy. A detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Findings highlighted the complexity of the process related to the introduction of care allowance and demonstrate. It outlined the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis revealed the importance of the regulation of cash payments on the reshaping of formal and informal care.