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Welfare Reform on the Web (June 2008): Care of the elderly - overseas

Ageing

S. A. McDaniel (editor)

London: Sage, 2008

The study of ageing is a fundamental issue for social science. Age is seen much less as a 'natural' developmental phase of life and more as a socio-cultural construct. This opens opportunities for new ways to see ageing as a social process and factor in power relations, and for examining, in theory and in empirical research, the intersections of age with class, race, gender and sexuality. These four volumes examine different aspects of ageing as follows:

  • Volume 1: Origins, Theories and Practical Concerns (classic approaches and contemporary thinkers)
  • Volume 2: Forms and Practice (ageing in pre-industrial societies; ageing historically; aging and identity)
  • Volume 3: Key Dimensions (ageing and life course; ageing and work/leisure; ageing and gender; ageing and health; ageing and sexuality; ageing and family; ageing and culture/ethnicity)
  • Volume 4: Key Debates (theory versus practice; ageing bodies; and critical gerontology).

Aging, health expenditure, proximity to death, and income in Finland

U. Hakkinen and others

Health Economics, Policy and Law, vol. 3, 2008, p. 165-195

This study analysed the relationship between health expenditure, age and proximity to death using a large nationally representative Finnish dataset. Results show that total expenditure on health care and care of the elderly increases with population ageing, but the relationship is not as clear as is assumed when a nave model is used in health expenditure projections. The study's conclusion that age has an effect on expenditure is due to the fact that use of long-term care services is included in the analysis. For people using long-term care services, increasing age is clearly associated with increasing expenditure, although this association is attenuated when proximity to death is accounted for. Among older people not in long-term care, a clear positive relationship between age and expenditure was only found for health centre and psychiatric inpatient care. On the other hand, expenditure on somatic care and prescribed drugs clearly decreased with age among deceased individuals. The results suggest that future health care expenditure may be driven more by propensity to move into long-term care and advances in healthcare technologies than by population age and gender alone.

Central versus local service regulation: accounting for diverging old-age care developments in Sweden and Denmark, 1980-2000

D. Rauch

Social Policy and Administration, vol. 42, 2008, p. 267-287

In Sweden and Denmark the development of care services for the elderly followed markedly different paths between 1980 and 2000. In the 1980s in both countries services were universally available to all citizens regardless of social and economic status. This remained the case in Denmark, but in Sweden services became available only to certain target groups. This article attempts to account for these divergent developments by focusing on the balance of regulation between central and local government. In Sweden municipalities enjoyed sufficient autonomy from central government to introduce local retrenchment measures in times of austerity, eventually weakening universal provision of services nationwide. In Denmark municipalities were tightly bound by central government regulation, which prevented them from introducing similar local retrenchment measures in the elderly care sector.

Do nonprofit and government nursing homes enter unprofitable markets?

J.P. Ballou

Economic Inquiry, vol. 46, 2008, p. 241-260

Using data from markets in the rural United States, this study addresses whether nonprofit and government nursing homes locate in markets which for-profit firms cannot profitably enter, thereby extending access to residential care. The results indicate that while nonprofit and for-profit nursing homes typically enter similar markets, government facilities are more likely to enter markets that have too few elderly residents to be attractive to for-profit organisations.

From the workhouse to the home: evolution of care policy for older people in Ireland

V. Timonen and M. Doyle

International Journal of Sociology and Social Policy, vol. 38, 2008, p. 76-89

This article examines the transition from an overwhelming emphasis on institutional care of older persons delivered by the state and by religious and voluntary organisations to a new system of formal domiciliary care delivered by a mix of public, private and non-profit sector providers. It traces the evolution of the Irish care regime towards an emphasis on formal domiciliary care delivered by paid outsiders in older people's own homes. The paper also considers the policy challenges involved in attempts to regulate this complex care mix.

Home care for aging populations: a comparative analysis of domiciliary care in Denmark, the United States and Germany

M. Doyle and V. Timonen

Cheltenham: Elgar, 2007

In recent years a stronger emphasis has been placed in many countries on care of the elderly in the community, and more especially on care in the older person's own home, commonly referred to as home care or domiciliary care, as opposed to institutional care. This book presents an up-to-date comparative analysis of domiciliary care policies for the older populations of Denmark, the United States and Germany with a particular focus on similarities and differences between these care regimes. The book discusses issues of welfare state classification, the changing role of the state as the provider of social care services, the recommodification of the care labour force and the increased emphasis placed on both informal care-giving and consumer power. It contributes to the debate about the future care of older people and provides an informative analysis of the provision of publicly funded domiciliary care services from a cross-national perspective.

Nursing home performance in resident care in the United States: is it only a matter of for-profit versus not-for-profit?

F.H. Decker

Health Economics, Policy and Law, vol.3, 2008, p.115-140

Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. However US nursing home performance may also relate to Medicaid public financing. Using panel data, this study investigated how for-profit and not-for-profit facilities may be similarly affected by:

  1. the percentage of Medicaid funded residents in the home
  2. the Medicaid payment rate
  3. a home's occupancy level

It used two measures of nursing home performance:

  1. the percent of residents with physical restraints
  2. the registered nurse staffing ratio.

Results showed that while profit status may differentiate some operational properties among nursing homes, the effects of percent Medicaid residents, Medicaid payment rates and occupancy levels on performance quality were similar for not-for-profit and for-profit facilities. Poorer performance among US for-profit nursing homes may relate to their having lower occupancy levels, higher Medicaid census, and operating in US states having lower Medicaid payments compared to not-for-profit homes.

When the future comes

A. Mickel

Community Care, May 1st 2008, p. 30-31

This article introduces the National Dementia Strategy, a government project which is to be launched in October 2008 to improve diagnosis, quality of care, and awareness of dementia. GPs, social workers and care home staff need a better understanding of the symptoms of dementia to facilitate early diagnosis. Awareness can be raised by ambassadors who are themselves suffering from the early stages of Alzheimer's.

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