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The Productivity Commission Inquiry into Aged Care: a critical review
- Author:
- HUGHES Mark
- Journal article citation:
- Australian Social Work, 64(4), December 2011, pp.526-536.
- Publisher:
- Taylor and Francis
The final report of the Productivity Commission Inquiry into Aged Care was handed to the Australian Government in June 2011. The report recommends a substantial restructuring of Australia's aged care system to make it fairer, more responsive to the needs of individual consumers, and more sustainable in the context of population ageing. The aim of this paper is to examine the context for the Inquiry into Aged Care, including some of the key drivers for reform, such as population ageing and inequities in the financing of aged care. It considers the major recommendations of the Inquiry and their reception within the aged care sector. It argues that, while acknowledging the necessity of a safety net and the needs of diverse groups, the recommended reforms continue to advance the neoliberal restructuring of Australia's health and welfare systems. The paper also examines the role and potential of social work in the context of the recommended changes, arguing that the transfer of recommendations into actual policy provides an opportunity for social work to argue its unique contribution and potential in the delivery of aged care.
How European nations care for their elderly: a new typology of long-term care systems
- Authors:
- KRAUS Markus, et al
- Publisher:
- European Network of Economic Policy Research Institutes
- Publication year:
- 2011
- Pagination:
- 6p.
- Place of publication:
- Brussels
Expected future demographic and societal shifts have put the improvement of quality and efficiency of long-term-care (LTC) systems on the agenda of virtually every EU member state. ANCIEN (Assessing Needs for Care in European Nations) is a research project that concerns the future of long-term care (LTC) for the elderly in Europe. It aims to investigate how needs, demand, supply and use of LTC develop, and how different systems of LTC perform. This policy brief summarises findings from Work Package 1 of the ANCIEN project. This research comprised the collection of comprehensive information on national LTC systems in a number of EU member states, and the production of national reports describing the structure of these systems. Two typologies of LTC systems were developed. The first approach focused on the organisation and financing of care, relied on qualitative information, and included 21 EU member states. The second approach focused on use and financing of care, used quantitative variables, and included 14 EU member states. The typologies resulting from the 2 approaches were ordered according to attractiveness of their systems for elderly in need of care, yielding the same result for 10 out of the 14 countries. Implications for policy and recommendations are discussed.
Gone for good?: prefunded insurance for long-term care
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2011
- Pagination:
- 65p.
- Place of publication:
- London
In the debate on how to fund long-term care in England and Wales, some stakeholders have advocated a central role for financial services, and pre-funded consumer insurance in particular. This report examines this approach by considering: the potential role that pre-funded insurance could take in funding long-term care; and the extent to which the pre-funded long-term care insurance market can help policymakers achieve key strategic policy objectives for social care. It examines the demand and supply-side barriers to the use of pre-funded long-term care insurance, noting the last UK provider exited the market in 2010 citing a lack of demand. No country has achieved an effective market in pre-funded long-term care insurance, with France having the highest rate at 15%. The report argues that even if the UK were in the future to achieve a take-up of 15% this would still result in outcomes that failed to meet many policy objectives for long-term care funding, particularly associated with ‘catastrophic costs’, fiscal pressures and the incidence of means-testing. It concludes by outlining some of the multiple other roles that the financial services industry could take in funding social care, particularly around delivering and servicing a state-sponsored insurance scheme for long-term care, akin to the schemes found in countries such as Singapore and the Netherlands.
Impairment and abuse of elderly by staff in long-term care in Michigan: evidence from structural equation modelling
- Authors:
- CONNER Tom, et al
- Journal article citation:
- Journal of Interpersonal Violence, 26(1), January 2011, pp.21-33.
- Publisher:
- Sage
A number of risk factors are known to be associated with elder abuse in long-term care. This study aimed to provide a model to place these risk factors in a causal structure that relates the factors to each other and to whether abuse occurs. Nine hypotheses focusing on cognitive impairment, physical impairment, behaviour problems, and age were generated regarding the susceptibility to abuse among the elderly in long-term care. In 2006, a random digit dial survey in Michigan was completed by 1,002 respondents who were knowledgeable relatives of, or adults responsible for, a person in long-term care. The survey measured the level of impairment of the person in long-term care, covering various health-related problems and the ability to do activities of daily living. The survey also asked about the incidence of staff abuse over the previous 12 months, including physical, caretaking, verbal, emotional, neglect, sexual and material abuse. The results were used in the construction of a structural equation model which corresponds to the 9 hypotheses and specifies the relationships between factors and from factors to susceptibility to abuse. In this model, susceptibility to abuse, physical impairment, and cognitive impairment are latent variables, and behaviour problems and age are directly measured. The article concludes by discussing the pattern of relationships between these risk factors for abuse.
LGBT older adults in long-term care facilities: stories from the field
- Authors:
- NATIONAL SENIOR CITIZENS LAW CENTER, et al
- Publisher:
- National Senior Citizens Law Center
- Publication year:
- 2011
- Pagination:
- 32
- Place of publication:
- Washington, DC
This publication is the result of a survey undertaken by six organisations seeking to better understand the experiences of LGBT older adults in long-term care settings. The survey also sought to capture personal comments that describe some of the varied experiences of LGBT older adults, their loved ones, and the providers who care for them. The majority of respondents believed that staff would discriminate against an LGBT elder who was open about his or her sexual orientation. More than half felt that staff would abuse or neglect an LGBT elder and other residents. Of the 769 individuals who completed the survey, 328 reported 853 instances of mistreatment, including staff harassment and staff refusals to provide basic services or care. The report sets out key recommendations for policy-makers and consumers as well as long-term care providers, including: raising staff awareness and conducting self-assessments of facility's culture and quality of care; undertaking in-depth studies of resident experiences; and developing cultural competency training programmes for staff and agencies receiving public funding. Includes an appendix outlining legal protections for LGBT older adults in long-term care facilities and providing basic information about procedures for seeking relief if a problem occurs. (Edited publisher abstract)
Politics and the care conundrum: why does England have a problem funding social care?
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2011
- Pagination:
- 29p.
- Place of publication:
- London
This discussion paper explores the underlying causes of England's long-term care funding problem. It argues that the state, the older population and wider society have sufficient wealth to finance a properly funded social care system. The persistent problem of funding care in England therefore poses what can be termed the ‘care conundrum’. This paper seeks to explain this 'care conundrum', and its root causes in issues of politics and governance. Using ideas and theories drawn from political science, the paper identifies multiple factors that may explain the 'care conundrum'. These factors include: the varied, ‘indefinable’ nature of social care; the illogical, complex ‘mess’ of institutions overseeing social care policy; public ignorance of what social care is and what outcomes represent quality; and the interests of politicians in avoiding unpopular measures. The paper calls for the creation of an Office for Care and Living which would undertake a number of strategic functions, such as public education and data provision, in order to address the failure of democratic accountability alone to ensure a properly funded social care system. It argues that, even in the face of voter disinterest toward social care, the government does have an opportunity to reposition public and political discourse on care funding to create the conditions for sustainable long-term reform.
Determinants of obtaining formal and informal LTC across European countries
- Authors:
- STYCZYNSKA Izabela, SOWA Agnieszka
- Publisher:
- Center for Social and Economic Research
- Publication year:
- 2011
- Pagination:
- 35p., bibliog.
- Place of publication:
- Warsaw
The aim of this study was to identify patterns of utilisation of formal and informal long term care (LTC) across European countries and discuss possible determinants of demand for different types of care. Specifically, the research attempts to measure the volume of different types of care in European countries and the conditions under which different types of care are obtained. The conditions include demographic factors, especially aging of the society, health status and limitations caused by poor health, family settings and social networking. The analysis is provided across all European countries separated into 4 clusters. Estimates of the probability of obtaining formal care are based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data for 2006. The analysis reveals substantial differences in obtaining LTC across European countries depending on the tradition and social protection model that determine availability of institutional care and provision of informal care. In the Nordic-type countries with high state responsibility and high provision of institutional care, informal care is of less importance and, if received, is mostly care provided on a irregular basis from outside the family. Countries of the continental Europe are less unified with high share of people using formal settings of care, but also combining formal and informal care. In Mediterranean countries, provision of informal care, including personal care, plays a much greater role than formal LTC.
Effects of the program of all-inclusive care for the elderly on hospital use
- Author:
- MERET-HANKE Louise A.
- Journal article citation:
- Gerontologist, 51(6), December 2011, pp.774-785.
- Publisher:
- Oxford University Press
This study investigated the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE creates incentives to reduce the use of costly services. An emphasis on preventative care and regular monitoring provides a mechanism for reducing unnecessary hospital use while maintaining quality of care. The study compared hospital use by PACE enrolees with a comparison group of community-dwelling older adults. Findings revealed that PACE effectively controlled hospital use. Enrolees spent an estimated average of 0.2 days in the hospital per month compared with an estimated average of 0.8 days in the hospital per month by comparison subjects. The author concluded that PACE provided a model for reducing unnecessary hospitalisations through effective care management. The benefits of reduced hospital use offset the cost of other services while maintaining quality.
Resident-directed long-term care: staff provision of choice during morning care
- Authors:
- SIMMONS Sandra F., et al
- Journal article citation:
- Gerontologist, 51(6), December 2011, pp.867-875.
- Publisher:
- Oxford University Press
This study aimed to develop a protocol to assess the quality of staff-resident communication relevant to choice, and describe staff-resident interactions to assess current nursing home practices related to offering choice during morning care provision. The study included 73 long-stay residents in 2 facilities in the United States who were observed for four consecutive morning hours during targeted care activities, for twelve weeks. Interactions were observed of staff offers of choice and residents’ responses. Findings revealed that staff offered residents choice during only 18% of the morning care activities. The authors concluded that nursing home staff could use a simplified version of the tool to measure staff-resident interactions related to choice as a first step toward improving care practice.
Bridging the intergenerational gap in therapeutic activity delivery between younger professional caregivers and older adults living with dementia
- Authors:
- STERNS Anthony A., et al
- Journal article citation:
- Journal of Intergenerational Relationships, 9(2), 2011, pp.161-175.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia
Younger caregiving staff may face a challenge in getting older adult care recipients with dementia to participate in interactive activities in long-term care settings. However, many older individuals have cohort-specific knowledge, and providing the caregivers with materials that draw out the existing knowledge, history and experience of the older adults can make it possible for the younger caregivers to successfully facilitate satisfying, interactive programmes. This article describes an activity intervention, Memory Magic Program, designed using Montessori principles which aims to key into the remaining abilities of those with dementia. In 12 long-term care facilities, the experimental intervention using the Memory Magic Program was scheduled twice a week for at least 12 weeks and compared with another standard group activity. Forty activity directors and staff aged 25–50 years completed a questionnaire designed to evaluate intervention outcomes for their older adult participants as well as themselves. The findings indicated positive responses to the activity intervention and demonstrated increases in positive attitudes toward the cognitively impaired, elderly residents.