Showing papers in "Journal of Aging & Social Policy in 2008"
TL;DR: This policy analysis illustrates the contrast between the primarily European discourse on active aging, which emphasizes health, participation, and well-being, and the U.S. discourse that prioritizes productivity.
Abstract: Active aging is established as the leading global policy strategy in response to population aging. In practice, however, the term active aging serves as a convenient shelter for a wide range of policy discourses and initiatives concerning demographic change. The twin purposes of this article are, first, to examine its European origins and how it has been applied in the world's oldest region. This policy analysis illustrates the contrast between the primarily European discourse on active aging, which emphasizes health, participation, and well-being, and the U.S. discourse that prioritizes productivity. The application of active aging in Europe has, nonetheless, been predominantly in the productivist mold. The examination of the emergence of this key policy concept in Europe is contextualized by an outline of the changing politics of aging in this region. The second purpose of the article is to set out a new, comprehensive strategy on active aging that is intended to realize the full potential of the concept. Understanding of the need for this broad vision of active aging is facilitated by the historical policy review.
243 citations
TL;DR: It is argued that one-size-fits-all aging in place solutions will often not be in the best interests of low-income and frail older homeowners in the United States.
Abstract: This commentary argues that one-size-fits-all aging in place solutions will often not be in the best interests of low-income and frail older homeowners in the United States. This contrarian view runs counter to the reported preferences of this group, various private-sector activities, and U.S. public policies that are increasingly funding home and community-based care. The particular focus is on low-income elderly homeowners living in the oldest housing stock in the country who have demographic characteristics putting them at greater risk of having both unmet care and housing needs, which in turn have spillover effects on their neighborhoods. These vulnerable homeowners would be better served if they relocated to more affordable, easier to maintain, and better designed smaller owned units or rental properties or to planned affordable seniors' rental housing complexes that can offer both light and heavy care. Such residential moves are often not feasible, however, because of the shortage of these ...
101 citations
TL;DR: The evidence presented suggests that the participation of the elderly in local currencies is mutually beneficial, and male and female seniors undertransact with themselves and with one another, generating bridging social capital.
Abstract: Community currency systems attempt to empower the economically marginalized and build social capital. This research explores the role of the elderly in a local voluntary organization. The elderly are potentially very important contributors, yet we know little about their participation in these local exchange networks. Eighty-seven months' worth of transaction data from a "time bank," which has had a total of 950 members, was examined in social network analyses. Measures of quantitative engagement in the system were constructed. The elderly were found to be as active as other members. Qualitative characteristics of the network were also explored. The organization is rather homogeneous, yet exchanges within it tend to connect diverse actors. Male and female seniors undertransact with themselves and with one another, generating bridging social capital. The evidence presented suggests that the participation of the elderly in local currencies is mutually beneficial.
93 citations
TL;DR: Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme for public long-term care in Korea.
Abstract: With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will...
77 citations
TL;DR: Older adults are very aware of age-related changes to driving; they perceive that self-regulation behaviors change with age; and they view transportation alternatives as limited or nonexistent.
Abstract: While much of the research on aging and driving has focused on sensory and motor changes, little is known about older drivers and the actual self-regulation adjustments they employ to continue driving safely. This research looks at how older drivers have made changes to driving patterns and behaviors that have allowed them to continue to drive without compromising their perceived safety, independence, and quality of life. Nine focus groups were held with older men and women aged 58 to 89 years. Some of the major themes that emerged were the following: older adults are very aware of age-related changes to driving; they perceive that self-regulation behaviors change with age; and they view transportation alternatives as limited or nonexistent. Policy implications include developing functional transit programs for older adults and car manufacturer training workshops to educate older adults on the safety features of newly purchased automobiles.
70 citations
TL;DR: While aggregate preferences for long-term care were relatively stable, there was considerable fluctuation in individuals' preferences over time, with just 52.5%, 44.4%, and 44.6% of participants retaining their initial first choice across IADL, ADL, and dementia scenarios, respectively.
Abstract: This study investigates long-term care preferences across three hypothetical scenarios and over one year of time among a sample of disabled older women receiving informal care (n = 420). Unpaid or paid help in one's home was preferred, given scenarios of instrumental activities of daily living (IADL) and activities of daily living (ADL) needs; nursing home care was most preferred for dementia care. While aggregate preferences for long-term care were relatively stable, there was considerable fluctuation in individuals' preferences over time, with just 52.5%, 44.4%, and 44.6% of participants retaining their initial first choice across IADL, ADL, and dementia scenarios, respectively. Implications of study findings are discussed.
67 citations
TL;DR: The findings reveal that late-life productive engagement is widespread, with the majority of older individuals involved in multiple forms of activity concurrently, and non–market-based activities such as caregiving, informal assistance, and volunteering are most prevalent.
Abstract: This study estimates the prevalence of productive engagement among adults aged 60 and over residing in the United States over a nine-year period. We analyze three waves of data from the Americans' Changing Lives Study, which allows the findings to describe the non-institutionalized older American population. Focusing upon five activities—formal paid employment, irregular paid work, unpaid volunteerism, caregiving, and informal assistance to others—we identify changes in the engagement rates, examine the extent to which engagement occurs through single or multiple concurrent activities, and document intra-individual patterns of engagement within and across forms of productive activity, including the continuity, initiation, and cessation of involvement. The findings reveal that late-life productive engagement is widespread, with the majority of older individuals involved in multiple forms of activity concurrently. Non–market-based activities such as caregiving, informal assistance, and volunteering...
61 citations
TL;DR: Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country and covers two major domains of the system: service delivery and financing.
Abstract: The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.
41 citations
TL;DR: Analyzing 1999 American Housing Survey data, this paper finds that poor older homeowners in very old dwellings are more likely to be demographically disadvantaged and to occupy physically deficient dwellings.
Abstract: This paper assesses whether the usually favorable depictions of older homeowners in the United States can be generalized to those who have extremely low incomes and occupy the oldest housing stock. Theoretical treatments and past empirical research findings offer a strong rationale for distinguishing this subgroup of older households. Analyzing 1999 American Housing Survey data, this paper finds that poor older homeowners in very old dwellings are more likely to be demographically disadvantaged and to occupy physically deficient dwellings. The paper calls for public debate on the comparative benefits and costs of governmental programs that help these vulnerable older persons to age in place as opposed to offering them alternative affordable housing options.
40 citations
TL;DR: This essay argues that growing government emphasis on rebalancing long-term care away from nursing homes will founder unless public officials recognize increased burdens on the informal care system.
Abstract: Informal caregivers face difficulties navigating the services and funding sources that constitute long-term care. Indeed, barriers to identifying and accessing even the most basic resources compound the sense of isolation felt by millions of unpaid individuals who provide the bulk of long-term care. Though expansion of home- and community-based options is welcomed, it may also shift additional caregiving burden onto an already overburdened informal care system, especially when the intention is to delay or substitute for institutional care. This essay argues that growing government emphasis on rebalancing long-term care away from nursing homes will founder unless public officials recognize increased burdens on the informal care system.
40 citations
TL;DR: Examining nursing home regulatory activity by the states, assesses interstate variations in the volume and severity of nursing home deficiencies, and explores state-level factors that may account for these differences finds higher deficiency volume was found in states with lower median household income, a lower proportion of residents aged 85 and older, and a Democratic legislature.
Abstract: This study examines nursing home regulatory activity by the states, assesses interstate variations in the volume and severity of nursing home deficiencies, and explores state-level factors that may account for these differences. Nursing home deficiency citation data over a 5-year period (2000–2004) were obtained from the Centers for Medicare and Medicaid Services. We examined interstate variations in regulatory activity and identified predictors of deficiency volume and severity at the state level (demographics, elected officials, industry characteristics, etc.) using the linear mixed model. Deficiency volume remained stable across the 50 states from 2000 to 2004, while deficiency severity decreased significantly. California had the highest volume of deficiencies per nursing home; Wisconsin had the lowest. New Hampshire had the highest percentage of severe deficiencies; California had the lowest. Higher deficiency volume was found in states with lower median household income, a lower proportion o...
TL;DR: The results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.
Abstract: Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N=1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.
TL;DR: It is suggested that voting rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' rights and reasonable accommodations.
Abstract: To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29% ± 28, range 0–100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems. Nearly two-thirds of facilities indicated they assessed residents' voting capacity before the election. However, methods differed and may have disenfranchised residents who were actually competent to vote. Current procedures in many facilities fail to protect voting rights. These data suggest that rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' ...
TL;DR: Five major factors are affecting patterns of international migration among nurses who work in long-term care settings: • Demographic drivers–The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long- term care services.
Abstract: This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.
TL;DR: Post-marketing device reporting needs better data quality and surveillance, which can certainly benefit the Centers for Medicare and Medicaid Services in their efforts to regulate and enforce standards of care that reduce deaths and injuries to vulnerable nursing home residents.
Abstract: Since implementation of The Omnibus Budget Reconciliation Act of 1987, restraint use in American nursing homes has reduced dramatically. The reduction in vest restraints has resulted in an increase in "least restrictive" devices such as waist restraints. Although this analysis of U.S. Food and Drug Administration Adverse Event Reporting Data Files found that waist devices pose the same potential risk for asphyxial death as vest restraints, few health professionals and consumers are aware of this outcome. Post-marketing device reporting needs better data quality and surveillance, which can certainly benefit the Centers for Medicare and Medicaid Services in their efforts to regulate and enforce standards of care that reduce deaths and injuries to vulnerable nursing home residents.
TL;DR: Predictors of older adults' and primary caregivers' willingness to use formal long-term care services to understand possible use patterns of mandatory public LTC insurance programs in Korea focused on views regarding who (adult children or the government) should bear the responsibility for Older adults' care.
Abstract: This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.
TL;DR: The official rhetoric of welfare states unconditionally pays tribute to older people's right to express dissatisfaction as mentioned in this paper, but in practice, users of "older service" in welfare states may be deprived of t...
Abstract: The official rhetoric of welfare states unconditionally pays tribute to older people’s right to express dissatisfaction. In practice, users of ‘older service’ in welfare states may be deprived of t ...
TL;DR: The government's attempt to introduce the MPF on top of the CSSA scheme is studied as a means to illustrate how governments might address their financial responsibilities in providing pension schemes by adopting both the residual strategy- centered reform approach and the collaborative strategy-centered reform approach.
Abstract: In 2000, the Hong Kong government introduced the first compulsory retirement saving scheme intended to protect the entire workforce, the Mandatory Provident Fund (MPF). Prior to the introduction of this scheme, the government's main measure for giving financial protection to retirees was the Comprehensive Social Security Assistance (CSSA) scheme, which is a noncontributory, means-tested financial assistance scheme. This paper studies the government's attempt to introduce the MPF on top of the CSSA scheme as a means to illustrate how governments might address their financial responsibilities in providing pension schemes by adopting both the residual strategy-centered reform approach and the collaborative strategy-centered reform approach. The former approach is concerned with developing noncontributory schemes using residual strategies, and the latter is concerned with developing contributory schemes using collaborative strategies. The paper shows the difficulties involved in carrying out these two reform approaches simultaneously.
TL;DR: It is argued that international law would be a powerful force in defending and protecting older persons, operating as a baseline for establishing underlying values for national aging policies and linking older persons' concerns with other segments of society.
Abstract: Older people face many difficult challenges that amount to a deplorable violation of their basic human rights (poverty, discrimination, denial of social services, etc.). However, the world has been slow to react. Factors that limit global responses to the challenges of aging include: limited political will, the prevalence of neo-liberalism, and NGOs' longstanding advocacy for other seemingly "more" disadvantaged groups. Such oppression of and discrimination against older people require a concerted world-wide response. We contend that the introduction of an international convention on the human rights of older people is most relevant. Reinforced by a potent international monitoring system, the convention should contain comprehensive and legally binding provisions that require participating states to promote older people's rights. It is argued that international law would be a powerful force in defending and protecting older persons, operating as a baseline for establishing underlying values for national aging policies and linking older persons' concerns with other segments of society.
TL;DR: It is found that states' nursing facility and HCBS program quality are not closely related and that state HCBS congregate residential program quality is independent of inclination, capacity, and need.
Abstract: States employ home and community-based services (HCBS) increasingly in Medicaid support of long-term care and rely less on nursing facilities. We examine how states' nursing facilities and HCBS programs compare and whether states' long-term care responses match their ideological inclination toward, material capacity for supporting, and their citizens' need for these public social programs. We use cross-sectional panel data on structural, process, and outcome quality for nursing facilities and HCBS congregate residential programs. We rank states, correlate these measures, and use regression to link inclination, capacity, and need to quality. We find that states' nursing facility and HCBS program quality are not closely related and that state HCBS congregate residential program quality is independent of inclination, capacity, and need. This latter result underscores a need for uniform HCBS standards and better data on quality.
TL;DR: An analysis of the development of the ADS industry using the resource dependence model within a values-based context is provided to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers.
Abstract: The adult day services (ADS) industry continues to grow and develop in providing care to larger numbers of older adults and their caregivers. Despite the growth in the number of programs and the changes in the way services are delivered, a systematic examination of the development of the ADS industry from a policy perspective has not been published since the mid-1990s. This article provides an analysis of the development of the ADS industry using the resource dependence model within a values-based context to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers. Potential directions for the future development of the industry are presented through analysis of the collaborations of adult day providers with the providers of other services for older adults and the effort by public and private funders to connect quality outcomes and resources.
TL;DR: It is argued that the Senior Citizens' Act of 1989 has failed to realize what were declared to be its objectives and has become an empty symbol that hides the fact that the older generation in Israel still lacks the real political power it needs in order to use the law to improve society's treatment of older people.
Abstract: Within the broad and complex framework of those Israeli laws that relate to the social welfare of the older population, this article uses a case study approach to focus on Israel's Senior Citizens' Act of 1989. During its hitherto brief life, this law has undergone numerous transformations, additions, and deletions as well as successes and failures. At the time of its enactment, many hoped that this law would considerably bolster the rights of older people. Echoing legal and political theories of the 1980s, it seemed to reflect the fact that politicians were sensitive to the potential power of the pensioner vote, while echoing the approach to social engineering that advocated the use of the law both as a means for social change and a symbol of power. As of today, however, this article argues that the law has failed to realize what were declared to be its objectives. Instead of promoting social change and providing older people with political power, the Senior Citizens' Act has become an empty symbol that hides the fact that the older generation in Israel still lacks the real political power it needs in order to use the law to improve society's treatment of older people.
TL;DR: Using elements of Hasenfeld and Brock's (1991) political economy policy implementation model, the following sections describe two primary interactions between key policy implementation instruments and internal and external stakeholders that made New York's participation in CCDE not possible.
Abstract: The Cash and Counseling Demonstration and Evaluation (CCDE) tested one of the most autonomous forms of consumer direction for personal assistance services. In the winter of 1996/97, Arkansas, Florida, New Jersey, and New York each received grants to develop and implement CCDE. While Arkansas, Florida, and New Jersey were successful in their efforts of implementing CCDE, New York was unable to do so. Using elements of Hasenfeld and Brock's (1991) political economy policy implementation model, the following sections describe two primary interactions between key policy implementation instruments and internal and external stakeholders that made New York's participation in CCDE not possible. This case study also provides some lessons for other states interested in developing Cash and Counseling models.
TL;DR: AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses, and they provide more services and fewer activities.
Abstract: This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention s...
TL;DR: A systemic family decisionmaking framework is proposed and tested to understand group long-term care insurance (LTCI) enrollment decisions and reveals very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of .687.
Abstract: This study proposes and tests a systemic family decisionmaking framework to understand group long-term care insurance (LTCI) enrollment decisions A random sample of public employees who were offered group LTCI as a workplace benefit were examined Findings reveal very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of 687, and reinforced the contributions of factors within the family system Enrollees were more likely to have discussed the decision with others, used information sources, and had prior experience when compared to non-enrollees Perceived health status, financial knowledge, attitudes regarding the role of private insurance, risk taking, and coverage features were additional factors related to enrollment decisions The findings help to inform policymakers about the potential of LTCI as one strategy for financing long-term care
TL;DR: Findings from this study suggest that impoverished middle-aged and older adults can save if provided an opportunity and incentives, however, success will depend on the characteristics of the programs.
Abstract: This study aims to develop a greater understanding of age differences in savings outcomes within Individual Development Accounts (IDAs). Participant data from the American Dream Demonstration (ADD) are examined for age differences in accumulated net deposits, average monthly net deposits, and deposit frequency. ADD program data are examined for savings match rates, monthly savings targets, direct deposit, and hours of financial education offered. Results indicate that, on average, older IDA participants have better savings outcomes than younger participants. Findings from this study suggest that impoverished middle-aged and older adults can save if provided an opportunity and incentives. However, success will depend on the characteristics of the programs.
TL;DR: A restraint-free culture is becoming a standard practice in the provision of long-term care services for older people, a standard by which licensure and accreditation agencies evaluate providers.
Abstract: A restraint-free culture is becoming a standard practice in the provision of long-term care services for older people, a standard by which licensure and accreditation agencies evaluate providers. Although most health care providers initiate restraint-elimination processes, many fail to achieve the intended result or sustain the practice because of a variety of barriers. Faltering organizations find themselves faced with monumental changes in administrative and supervisory staff, substantial recruitment and retention crises, and inadequate attention to a culture of continuous learning, teamwork, and leadership skill building. This article informs policy makers about the barriers to achieving and sustaining a restraint-free environment and suggests public policy agendas and processes to improve conditions for the aging population.
TL;DR: A new measure, the difference between an age group's share of total employment and its share of the total adult population, is developed and shown to be empirically sensitive to different policy actions.
Abstract: International comparisons of the economic impact of population aging across nations can give valuable insights regarding which policies are most effective in addressing aging-related economic issues. Traditional old-age dependency ratios, by not accounting for differences in labor force participation rates, can be misleading. A new measure, the difference between an age group's share of total employment and its share of the total adult population, is developed and shown to be empirically sensitive to different policy actions. The analysis is built upon readily available and comparable International Labour Organization age-group data on population and labor force participation rates.
TL;DR: This analysis focuses on the privatization provisions of the Medicare Modernization Act, which is largely designed to benefit the corporate health care sector without containing costs or significantly reducing the threat of rising health care costs to the economic security of current and future retirees.
Abstract: This paper describes initiatives to privatize the Medicare program over the last 10 years and the implications of these initiatives for the future of retirement security. Our analysis focuses on the privatization provisions of the Medicare Modernization Act, which is largely designed to benefit the corporate health care sector without containing costs or significantly reducing the threat of rising health care costs to the economic security of current and future retirees. In fact, as designed, the Medicare Modernization Act is likely to increase the threat to retirement security in the years ahead. We conclude with a series of policy alternatives to the neoliberal agenda for the privatization of Medicare.
TL;DR: The National Service Framework for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults.
Abstract: The National Service Framework (NSF) for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults. The NSF arose from broader social and health care reforms that likewise sought the establishment of performance assessment, augmented consumer sovereignty, and greater coherence across health and social services. The United States shares with England similar problems with care for its older adults, strategies for improvement, and obstacles to successful implementation of change.