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Welfare reform on the web (October 2006): Care of the elderly - Overseas

Devolution and privatization proceed and centralized system maintained: a twisted reality faced by Japanese nonprofit organizations

Y. Suda

Nonprofit and Voluntary Sector Quarterly, vol.35, 2006, p.430-452

This article examines the process of devolution and privatisation of long-term care for older people in Japan, especially focusing on the impact of the Long-Term Care Insurance system introduced in 2000. Changes in relationships between central and local government and between government and private organisations are described using Wagner’s (2000) institutional analysis framework. The findings indicate that the introduction of Long-Term Care Insurance promoted devolution and privatisation although the central government maintained control. This article explains the outcome and also discusses the challenges and opportunities faced by nonprofit organisations operating in the area.

Family support for older people: determinants and consequences

K. Glaser, C. Tomassini and D. Wolf (editors)

Ageing and Society, vol.26, 2006, p.689-782

This special issue presents four empirical studies on the provision of family support to older people in Europe. All four use individual level data and recognise the importance of demographic forces, cultural variations and public policy in shaping patterns of elder care. The European countries examined exhibit several broadly similar demographic trends, but these are superimposed on very different policy regimes. It is argued that progress in understanding comparative patterns of elder care, and in developing policy responses to demographic change, will be facilitated by explicitly linking variations in the policy environment to individual and family-level behaviour.

Managing effective partnerships in older people’s services

H. Nies

Health and Social Care in the Community, vol.14, 2006, p.391-399

The EU Care and Management of Services for Older People in Europe Network (CARMEN) project set out to explore the management of integrated care for older people in 11 countries. Summarising key themes from the project, this paper explores the management of integrated care, the skills required, the mechanisms which aid successful integrated approaches, and future research priorities.

Means testing and the heterogeneity of housing assets: funding long-term care in Spain

J. Costa-Font, O. Mascarilla-Miró and D. Elvira

Social Policy and Administration, vol.40, 2006, p.543-559

Responsibility for health and social care in Spain has been largely devolved to regional governments. Access to publicly funded long-term care for older people is based on needs assessment and means tested, but eligibility criteria vary according to region. This article examines the varying role of housing assets in determining eligibility for publicly funded long-term care across the regions, and presents results of a survey of older people’s willingness to sell their homes in order to partially or wholly fund the care they need.

Time and space in new public management reform: the case of geriatric care

H. Rämö and P. Skålén

International Journal of Public Sector Management, vol.19, 2006, p.513-525

During the past two decades many public sector organisations in OECD countries have introduced new public management change initiatives. This paper presents a case study of a new public management reform programme implemented in geriatric care services in Värmland, Sweden. It shows how the reform created a tension between the principal commissioning body’s demands for increased financial effectiveness and the providers’ desire for good care.

Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons.

D.L. Kodner

Health and Social Care in the Community, vol.14, 2006, p.384-390

This article describes three successful North American models for provision of integrated health and social care for frail older people. Four key elements seem to account for the positive impact of these initiatives:

  • Umbrella organisational structures guide integration on the strategic, managerial and service delivery levels
  • Case-managed, multidisciplinary team care allows for the effective assessment of client needs and planning of care delivery, and provides a single entry point into the health and social care systems.
  • Organised provider networks joined together by standardised referral procedures, service agreements, joint training, shared information systems and even common ownership of resources enhance access to services, provide seamless care and maintain quality.
  • Financial incentives promote preventative services and rehabilitation.
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