Showing papers in "Journal of Aging & Social Policy in 2001"

A Foucauldian analysis of old age and the power of social welfare.

Abstract: It is argued that the question of social welfare is a key, if often overlooked, component in the construction of power relations and identities in later life that can take its place next to debates on bioethics and consumer lifestyle. Foucault's (1977) claim, that identities are kept in place through the deployment of integrated systems of power and knowledge and a routine operation of surveillance and assessment, is critically examined in this context. Trends in social welfare in the United Kingdom are used as a case example that sheds light on wider contemporary issues associated with old age. Finally, implications for the creation of particular narratives about later life are discussed and grounded through Foucault's (1988) notion of “technologies of self.”

Grandparents raising grandchildren: challenges faced by these growing numbers of families and effective policy solutions.

Abstract: (2001). Grandparents Raising Grandchildren. Journal of Aging & Social Policy: Vol. 12, No. 1, pp. 7-17.

The effectiveness of adult day services for disabled older people.

Abstract: Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.

Family support for the elderly in Korea: continuity, change, future directions, and cross-cultural concerns.

Abstract: This article discusses major issues and concerns regarding family support for parents and elderly people in industrialized and urbanized Korea. It summarizes new trends in family support for elderly members, continuing influences of the traditional value of family support (filial piety), growing needs for public services for elderly people and their families, urgent calls for the state to assume greater responsibilities for providing social security and services for the elderly, needs for cross-cultural studies of family support, and certain cultural similarities and differences to be considered. The article concludes with some suggestions for future research.

Flexible Work Schedules, Older Workers, and Retirement

Abstract: Older workers in the United States indicate that they would prefer flexible work arrangements rather than abrupt retirement, yet management has done very little to make this possible. A review of two bodies of literature from the late 1980s is presented: social science writings including sociological, gerontological, and economic literature, and business and management literature. There is a clash between the way jobs are traditionally scheduled and the needs of growing numbers of older workers. Workers continue to be subject to obstacles to phased retirement due to the structuring of health care and pension benefits, downsizing, organizational inflexibility, and "corporate culture." Thus, general views among social scientists regarding the desirability of flexible schedules toward retirement will not produce real changes unless management becomes committed to such changes and they are securely embedded in company policies.

Consumer-Directed Home and Community Services Programs in Eight States: Policy Issues for Older People and Government

Abstract: This study assesses consumer-directed home and community services for older persons by examining public programs that serve this population in eight states These programs give beneficiaries, rather than agencies, the power to hire, train, supervise, and fire workers Most stakeholders interviewed, in addition to the quantitative research, indicate that many older beneficiaries want to and can manage their services, although significant issues arise for persons with cognitive impairments Research results suggest better, or, at least, no worse, quality of life for beneficiaries when they direct their services, although quality of services remains a contentious issue For workers, consumer-directed care has some disadvantages, including fewer fringe benefits With exceptions, state agencies have not provided extensive consumer or worker support of aggressively regulated quality of care (Journal of Aging and Social Policy 2001 12(4); 1-2)

Sweden and the United States: is the challenge of an aging society leading to a convergence of policy?

Abstract: The aging of the population is one of many forces behind a current reconstruction of welfare benefits in both Sweden and the United States. While both countries represent ideological polarities regarding social policy, they are struggling to meet their welfare goals with limited resources, and both are adopting similar strategies, for example, decentralization, targeting, and an increased emphasis on privatization and evaluation. This paper summarizes some of the differences between Sweden and the United States and describes some of the forces at work that are lessening the differences between the two countries in strategies and policy regarding care services for elderly people.

Israel's long-term care insurance law after a decade of implementation.

Abstract: Israel's Long-Term Care Insurance (LTCI) law has been in effect for a decade. It is timely to review the effects of this legislation with a view to identifying possible directions for reform and lessons for other countries considering the introduction of a similar social insurance scheme. The paper considers the law's effects in terms of the size and characteristics of the beneficiary population, the coverage of the scheme, its financial standing, the rate of institutionalization of the elderly, the caregiving burden, the service delivery system, and the overall scope of long-term care services for the aged. Israel's experience has lessons for financing arrangements, target efficiency, service delivery arrangements, and the construction of the burden of care.

Nursing home ownership: an historical analysis.

Abstract: The need to care for dependent elderly in the United States has been a constant since colonial times. Today, as in the earliest days, most care is provided at home by family members. Personal and health services outside the home are sometimes provided by nursing homes. The nursing home industry is large, dominated by private, for-profit ownership, and receives much of its income from public funds. Why are nursing homes publicly funded? Why are nursing homes privately rather than publicly owned? Why is ownership for-profit or proprietary rather than not-for-profit or voluntary? The answers to these questions are found in the history of social policies in the United States.

A Comprehensive Policy Analysis of and Recommendations for Senior Center Gambling Trips

Abstract: Gambling is one of the fastest growing industries in America. Public support is high for legalized gambling among all age groups. Because gambling is growing in popularity as an activity among those 65 and over, many senior centers are beginning to offer group trips to casinos and other gambling attractions such as dog tracks. This paper analyzes senior center casino gambling trips, with particular attention to the number of trips offered, how trips are funded, the policy implications of offering trips, and policy alternatives for state and local policymakers. Data for the study come from personal interviews with activity directors of 16 senior centers across Massachusetts and a formal survey of 30 additional senior centers in Central Massachusetts. Benefits of a new policy option, a public education strategy, are also reviewed.

Providing information to help Medicare beneficiaries choose a health plan.

Abstract: Many Medicare beneficiaries have limited knowledge of the Medicare program and related health insurance options. This is due in part to the complexity of the Medicare program and supplemental health insurance market. A recent congressional mandate through the Balanced Budget Act of 1997 called for broad dissemination of information to educate beneficiaries about their health plan options and to encourage informed health plan decision-making. In response, the Health Care Financing Administration (HCFA) launched the National Medicare Education Program (NMEP) to support the educational objectives of the BBA. This paper provides an overview of the components of the NMEP information campaign. We also review lessons learned from our experience in designing and testing a prototype consumer handbook that explains the different health plan options to Medicare beneficiaries. Through our discussion of the handbook, we highlight several ways to communicate information effectively about a complex publicly fun...

Distribution and utilization of home- and community-based long-term care services for the elderly in North Carolina.

Abstract: Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.

A limited entitlement for community care: how members use services.

Abstract: The goal of this paper is to show how members of three Social HMOs use a limited entitlement for community-based long-term care to meet their needs and solve their problems. The paper is based on in-home interviews with 48 aged Medicare beneficiaries who joined Social HMOs and are eligible for the entitlement. Members' experiences with case management (called service coordination), benefits for covered services, and cost-sharing requirements are explored. Members (and their informal caregivers) are found to have complex lives, into which community care fits (or does not fit) in varied ways, depending on preferences, experiences with providers, informal care, financial resources, and other factors. The paper provides insights into what kinds of problems people want to solve and how community care systems can be better designed to empower service users to solve them.

Taking risks in investing in the equity market: racial and ethnic differences.

Abstract: Some policy makers and policy analysts have proposed that Social Security should be privatized to enable participants to achieve higher returns through investment in the stock market. How well individual retirees would fare financially under a privatized system largely depends on their decision to invest in the equity market, rather than in other types of investment vehicles. For that reason, it is important to investigate the degree to which minority people are currently investing in this market. This article presents the findings of a study that compared the investment behavior of black and Hispanic people aged 51 to 61 with the investment behavior of their white counterparts. The major findings indicate that black and Hispanic people: (a) are less likely to invest in the equity market than are white people, and (b) tend to invest smaller percentages of their assets in the equity market. Implications for policy are discussed.

Home is where the help is: community-based care in Denmark.

Abstract: Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skaevinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.

Economic and fiscal implications of aging for subnational American governments.

Abstract: This article begins with a brief review of the extensive literature dealing with the macroeconomic consequences of population aging in industrialized societies and places the question in the context of the political and economic framework of the United States. Next, we move to the fiscal ramifications of population aging for subnational units of government. The varying demographic sources of aging are then introduced and their economic implications are reviewed. The role of population aging within the context of subnational fiscal impacts is first examined by reviewing patterns of change in demand for state-government-provided public goods and services associated with an older population. These include primarily health care and income security. These considerations on the expenditure side are then extended to substate government, where primary and secondary educations are easily the largest component of public budgets. Finally, the implications of demographic change on the revenue side of state a...

Dementia policy revisited: an analysis of the state laws targeted towards individuals with Alzheimer's disease and other forms of dementia.

Abstract: Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzheimer's disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five actions towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands kn...

Pensioners' political parties in Israel.

Abstract: Involvement and participation of older persons in politics and political systems reflect the extent to which they are integrated into their society. During the last two decades, political parties of pensioners have emerged in a number of countries, including Israel, and have run candidates in national elections. If only 10% of those aged 65 and older had voted for pensioners' parties in Israel, they would have qualified for two “pensioners” seats in the Knesset (Israel's parliament). However, they suffered complete defeat, as has been the case in most other countries. This article first describes the phenomenon of pensioners' political parties in Israel, examines the circumstances around their emergence, and presents their goals. Second, it identifies and analyzes the causes for their political defeat. Third, it discusses alternatives to political parties to promote the interests of the older population. Finally, implications for further research are raised.

Long-term care in the United Kingdom: community or institutional care? Individual, family, or state responsibility?

Abstract: Gillian Dalley is Director of the Centre for Policy on Ageing in London. She has a background in health services research and has written extensively on the development of community care in the United Kingdom. She is author of Ideologies of Caring: Rethinking Community and Collectivism (Macmillan, 2nd edition, 1996). Most recently she has been responsible for the development of regulatory standards for nursing homes for the U.K. Department of Health. Gillian Dalley can be contacted care of the Centre for Policy on Ageing, 25-31 Ironmonger Row, London EC1V 3QP, England (E-mail: gdalley@cpa.org.uk). This article is a slightly revised version of a presentation that was a part of the Ollie Randall Symposium at the Gerontological Society of America’s 52nd Annual Scientific Meeting held in San Francisco, November 19-23. The title of the symposium was ‘‘Social Exclusion and Inequality in Aging Societies: A Comparison of British and American Policy Trends.’’

Primary prevention for older adults: no longer a paradox.

Abstract: Sarita M. Bhalotra is Assistant Professor at the Heller School at Brandeis University. Her work includes studying the management and financing of chronic disease in managed care and fee-for-service settings. Dr. Bhalotra can be contacted at the Heller Graduate School, Brandeis University, Waltham, MA 02454 (E-mail: bhalotra@ brandeis.edu). Phyllis H. Mutschler is Executive Director of the National Center on Women and Aging and Associate Professor and Lecturer at the Heller Graduate School at Brandeis University. Currently, she is conducting studies of midlife and older women’s health insurance coverage, experience with financial planning, and investigating the current and future costs caregivers face in lost wages and retirement benefits. Dr. Mutschler can be contacted at the Heller Graduate School, Brandeis University, Waltham, MA 02454 (E-mail: mutsch1@brandeis.edu).

Human rights enforcement agencies and the protection of older workers against discrimination: the case of the Quebec Human Rights Commission.

Abstract: The article provides insight into the way a human rights enforcement agency, the Quebec Human Rights Commission, implements legal dispositions prohibiting age discrimination in employment. Drawing on data from claims filed before the Commission, the article establishes a quantitative profile of cases and examines the factors that are involved in the decisions made by the Commission. It is argued that (1) the Commission's approach in investigating age discrimination cases and (2) the burden of proof put on respondents are main contributing factors to a very limited number of cases being validated. However, despite apparent shortcomings, the Commission still fulfills an important role in defending and promoting older workers' rights. Its overall impact can be assessed only in connection with other social and employment policies geared at older workers. In conclusion, some recommendations to improve the functioning of the Commission are made.