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The place of assisted living in long-term care and related service systems
- Authors:
- STONE Robyn I., REINHARD Susan C.
- Journal article citation:
- Gerontologist, 47(3), December 2007, pp.23-32.
- Publisher:
- Oxford University Press
The purpose of this article is to describe how assisted living (AL) fits with other long-term-care services. The authors analyzed the evolution of AL in the United States, including the populations served, the services offered, and federal and state policies that create various incentives or disincentives for using AL to replace other forms of care such as nursing home care or home care. Provider models that have emerged include independent senior housing with services, freestanding AL, nursing home expansion, and continuing care retirement communities. Some integrated health systems have also built AL into their array of services. Federal and state policy rules for financing and programs also shape AL, and states vary in how deliberately they try to create an array of options with specific roles for AL. Among state policies reviewed are reimbursement and rate-setting policies, admission and discharge criteria, and nurse practice policies that permit or prohibit various nursing tasks to be delegated in AL settings. Recent initiatives to increase flexible home care, such as nursing home transition programs, cash and counselling, and money-follows-the-person initiatives may influence the way AL emerges in a particular state. Implications: There is no single easy answer about the role of AL. To understand the current role and decide how to shape the future of AL, researchers need information systems that track the transitions individuals make during their long-term-care experiences along with information about the case-mix characteristics and service needs of the clientele.
A panel multinomial logit analysis of elderly living arrangements: evidence from aging in Manitoba longitudinal data, Canada
- Authors:
- SARMA Sisira, SIMPSON Wally
- Journal article citation:
- Social Science and Medicine, 65(12), December 2007, pp.2539-2552.
- Publisher:
- Elsevier
Utilizing a unique longitudinal survey linked with home care use data, this paper analyzes the determinants of elderly living arrangements in Manitoba, Canada using a random effects multinomial logit model that accounts for unobserved individual heterogeneity. Because current home ownership is potentially endogenous in a living arrangements choice model, prior home ownership as an instrument is used as an instrument. Prior home care use is also used as an instrument for home care and use a random coefficient framework to account for unobserved health status. After controlling for relevant socio-demographic factors and accounting for unobserved individual heterogeneity, it was found that home care and home ownership reduce the probability of living in a nursing home. Consistent with previous studies, age was also found to be a strong predictor of nursing home entry. Married people, those who have lived longer in the same community, and those who are healthy are more likely to live independently and less likely to be institutionalized or to cohabit with individuals other than their spouse.
How will government defuse the demographic time bomb?
- Author:
- GOULD Mark
- Journal article citation:
- Health Service Journal, 22.11.07, 2007, pp.14-15.
- Publisher:
- Emap Healthcare
With an ageing population, how can the government fund a system of long-term care for the elderly? This article looks at the dilemma and possible solutions in light of next years planned government consultation and green paper.
Free personal care in Scotland: a narrative review
- Authors:
- DICKINSON Helen, et al
- Journal article citation:
- British Journal of Social Work, 37(3), April 2007, pp.459-474.
- Publisher:
- Oxford University Press
The advent of free personal care for older people was a defining moment in the development of UK political devolution. After all the controversy surrounding the 1999 Royal Commission on Long Term Care, Scotland’s decision to implement the main recommendations of the Sutherland Committee was a decisive break from Whitehall’s approach and seemed to offer a key opportunity to learn from the implications of this policy for an English context. Against this background, this paper summarizes the origins, nature and impact of free personal care, providing a narrative review of the policy to date.
Financing long-term care for older people in England
- Authors:
- WITTENBERG Raphael, MALLEY Juliette
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
During a decade of debate on how best to fund long-term care, British analysts have focused more on policy developments in other countries than ever before. Discussing criteria for appraising options, the paper argues that the objectives of the financing system must be considered in the light of the objectives for the long-term care system as a whole. The types of funding mechanisms discussed are private insurance, including private/public partnerships, tax-funded and social insurance models. The differences between tax-funded and social insurance models are discussed. Social insurance with hypothecation of funds is no longer part of the current debate, which now focuses on the three types of options whose properties are described in the paper: free personal care (adopted in Scotland), the retention of means-tested arrangements in some form, and a partnership model as recommended in the Wanless report. The paper agrees with the Wanless report that all three have strengths and weaknesses. Decision-makers have a window of opportunity to make reforms before the baby-boomers reach late old age.
Securing good care for older people: taking a long-term view
- Author:
- DAVIES Bleddyn
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
The paper aims to explain and evaluate two key features of Securing Good Care for Older People, the Wanless Report on alternative mechanisms for funding long-term care of older people. The first is the new elements of the methodology for evaluating the alternatives. The paper argues that more successfully than previously and analyses in other countries, these elements focus attention on what are really the core issues: the means and ends which are the unique foci of long-term care, and estimates of the consequences of alternatives for them. By doing so, the report faces the politicians and policy analysis and research communities with a formidable challenge, to master and contribute to the development of the new framework and evidence. Failure to meet the challenge will increases the risk that the policy system will reinforce rather than weaken causes of gross inequity and inefficiency caused by the under-funding of long-term care seemingly unanswerably demonstrated by the report. The second key feature is the type of funding model the Report recommends given expected changes in the balance between demands and public expenditure. It is argued that the report’s analysis as successfully transforms the state of the argument about this as much as about the framework, methodology and evidence for evaluating alternatives, demonstrating the relative weakness of models widely advocated a decade ago. Part 2 discusses how to build on the Report. It discusses the framing of issues and the analysis of evidence for each of the key foci of the report’s main contribution to evaluation methodology. Finally the paper discusses whether the recommended model would be the wisest choice given the environment likely during the next few decades.
Public spending levels for social care of older people: why we must call in the debt
- Author:
- DAVIES Bleddyn
- Journal article citation:
- Policy and Politics, 35(4), October 2007, pp.719-726.
- Publisher:
- Policy Press
The author debates the funding of social care for older people.
From subsidiarity to ‘free choice’: child- and elder-care policy reforms in France, Belgium, Germany and the Netherlands
- Author:
- MOREL Nathalie
- Journal article citation:
- Social Policy and Administration, 41(6), December 2007, pp.618-637.
- Publisher:
- Wiley
This article analyses the patterns of reform in care policies in Bismarckian welfare systems since the early 1980s. Based on a comparison of France, Germany, Belgium and the Netherlands, the article shows that these reforms share similar logics and trajectories, which can be explained by the shared conservative and corporatist traits of Bismarckian labour markets and welfare state institutions and their impact on labour market adjustment possibilities and preferences. Indeed, we argue that care policy reforms have been very closely linked to specific employment strategies, and the politics of welfare without work and subsequent attempts to shift away from such a labour-shedding strategy go a long way in explaining both the nature and the timing of child- and elder-care policy reforms in Bismarckian welfare systems. The article also shows how a focus on promoting ‘free choice’ in all four countries has justified the introduction of measures that have simultaneously reinforced social stratification in terms of access to the labour market – meaning that some women have much more ‘free choice’ than others – and weakened certain labour market rigidities. To conclude, we argue that care policy reforms have provided a backdoor for the introduction of labour-cheapening measures and for increasing employment flexibility in otherwise very rigid labour markets.
Healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care
- Authors:
- KRISTENSSON Jimmie, HALLBERG Ingalill Rahm, JAKOBSSON Ulf
- Journal article citation:
- Health and Social Care in the Community, 15(5), September 2007, pp.474-485.
- Publisher:
- Wiley
The aim of this study was to investigate healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care at home or in special accommodation and to investigate determinants for healthcare consumption. The study comprised 362 people (aged 65 or over), all subject to a decision about municipal care and/or services during 2002–2003, drawn from the Swedish National Study on Aging and Care (SNAC). Data were collected from three existing registers, the SNAC data covered age, gender, marital status, functional ability, informal care and living conditions and were merged with the Skane County Council's patient administration system PASiS and PrivaStat covering healthcare consumption from the year 2000 and forward. About 50% of the acute hospital stays (n = 392) occurred within 5 months prior to municipal care. The men had significantly longer stays in hospital, more diagnoses and contacts with other staff groups beside physicians in outpatient care compared to the women. The regression analysis showed heart conditions, cancer, musculoskeletal problems, genitourinary diseases, injuries and unspecified symptoms to be significantly associated with various kinds of healthcare consumption. The findings indicated a breakpoint in terms of hospital admissions about 5 months prior to municipal care and service and a share of 15% having several admissions to hospital. Early detection and preventive interventions to these people in a transitional stage of becoming increasingly dependent on continuous care and services seems urgent to prevent escalating acute healthcare consumption.
Does disparity in the way disabled older adults are treated imply ageism?
- Authors:
- KANE Robert L., PRIESTER Rienhard, NEUMANN Dean
- Journal article citation:
- Gerontologist, 47(3), June 2007, pp.271-279.
- Publisher:
- Oxford University Press
Although the nearly one in seven Americans who have disabilities share many characteristics, the attitudes toward and the programs, care models, expenditures, and goals for people with disabilities differ substantially across age groups in ways that suggest ageism. Expenditures per recipient are substantially higher for younger individuals with disabilities, largely as a result of more effective advocacy. Programs that are rejected by younger people with disabilities are considered mainstream for older adults. As demographic, social, and economic circumstances change, preserving the programmatic separation will become more problematic. Increased competition for finite resources may motivate a closer examination of commonalities across disabilities in an effort to achieve greater equity.