Long-term Care System Research Articles

Austria’s Long-Term Care System: Challenges and Policy Responses

Approaches to design comprehensive support systems for people in need of long-term care (LTC) have appeared on the policy agenda of European countries from the 1990ies. Austria was one of the first to implement such a system separate from health care. In this last significant expansion of its social protection system, the country established a universal and tax-funded LTC system, departing from Austria’s Bismarckian tradition while carrying along the familialist logic and federalist structure in this policy field. Thirty years later, Austria now joins other countries in creating solutions to important contemporary challenges by discussing another major revamp of its LTC system. This paper renders a country case study to explain the development of Austrian LTC policies in greater depth and from a dynamic perspective. The two-step approach, starts with presenting the logics and major building blocks of Austria’s LTC system, and provides an update on its benefits and services. The second part identifies and discusses a raft of current and planned measures for three areas that appear critical in terms of future proofing LTC: (i) responses to staffing challenges, (ii) policy pilots to support informal carers, and finally, (iii) the role of digital transformation for LTC in Austria. This showcase exercise fosters policy learning and thus supports innovation and refinement of LTC systems. It could also serve as a futile starting point for comparative LTC policy research that moves beyond the outer hull of care-regime typologies to explore more specific system features and policy interventions.

Time trends in psychotropic drug prescriptions in Dutch nursing home residents with dementia between 2003 and 2018.

ObjectiveSeveral European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long‐term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia.MethodsThe study used data from nine studies, comprising two cross‐sectional studies, one cohort study, and six cluster‐randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti‐dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs.ResultsThe absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti‐dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year. The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018.ConclusionsAmong Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti‐dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern.

Differences in the Use of Formal and Informal Care Services among Older Adults after the Implementation of the Dependency Act in Spain

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the aim of this study is to infer the impact that the Spanish System for Personal Autonomy and Dependency might have on formal and informal care use through the performance of logit random-effects regression models by applying a differences-in-differences approach. Dependency levels were created depending on the limitations on the performance of instrumental and basic activities of daily living. Formal care consisted on home help and nursing home care, whereas informal care referred to the reception of care by relatives or friends, from inside or outside the household. Additional covariates, such as socioeconomic characteristics and health status variables, were included. Our results show that the negative dependency effects on informal care reception are intensified after the implementation of the Dependency Act, as the interaction between being a moderate dependent and wave 4 (year 2010) is significant and positive. In case of formal care, the joint assessment of the implementation of the DA and the different dependency levels did not report a significant effect, although they were significantly associated with formal care use independently. Bearing in mind the demographic ageing, our results highlight the need for the efficient planification of long-term care systems and social support services, especially for informal caregivers, in order to satisfy the care demands and reduce the caregiving burden.

Difficulties and Needs of Adolescent Young Caregivers of Grandparents in Italy and Slovenia: A Concurrent Mixed-Methods Study.

Many adolescent young caregivers (AYCs) care for a grandparent (GrP) with chronic disease, especially in countries with no or low developed long-term care systems and/or level of awareness of and policy responses to young caregivers. This mixed-methods study aimed at shedding light on the needs and difficulties faced by a sample of 162 adolescents aged 15–17, caring for GrPs, living in Italy (87) and Slovenia (75), respectively. A multiple linear regression model was built for the quantitative data. Qualitative data were content analysed using an open coding process. Italian and Slovenian respondents reported a moderate amount of caring activity and relatively high positive caregiving outcomes. Nevertheless, one out of three AYCs reported health problems due to their caring responsibilities. Compared to their Italian counterparts, Slovenian respondents were supported to a lesser extent by public services. Italian respondents faced communicative and practical problems; Slovenian AYCs experienced mainly emotional discomfort. AYCs from both countries requested emotional and practical support from formal services and family networks. Further, Slovenian AYCs requested emotional support and a personalized learning plan from schoolteachers. Support measures aimed at training AYCs of GrPs on geriatric care are recommended to address specific issues related to ageing and long-term care needs.

Do ageist attitudes affect home care workers’ job satisfaction and retention?

ABSTRACT With the rapid increase of older adults, attracting and retaining home care workers in the long-term care system will be critical to meet demands. This study examined how intrinsic and extrinsic factors of job satisfaction affect home care workers’ intention to stay and determined whether ageist attitudes had a mediating effect on the relationship between job satisfaction and intention to stay. The stratified random cluster sampling method was applied in this study and self-administered questionnaires were distributed to 400 home care workers from home service units in one city in southern Taiwan. Overall, 380 participants completed the measures of job satisfaction, ageist attitudes, and intention to stay in their current job. The monthly wages of NT$30,000 to NT$39,999 were significantly related to home care workers’ intentions to stay. Both intrinsic and extrinsic factors of job satisfaction were significantly associated with the retention of home care workers. However, the ageist attitudes’ separation and affective attitude factors were mainly related to their intention to stay. Ageist attitudes have a significant mediating effect between the intrinsic factors of job satisfaction and intention to stay but have no significance for extrinsic factors. Therefore, we suggested that improving the extrinsic and intrinsic factors of job satisfaction could increase the retention of home care workers. Additionally, providing accurate aging-related knowledge to raise awareness of ageist attitudes may enhance the relationship between the intrinsic factors of job satisfaction and retention. These findings could be valuable for improving the retention of the workforce in long-term care.

The Slovak Long-Term Care System

Declining relative size of the working-age population, decreasing family-based care supply due to higher female labor force participation, and reduced family size will increase the demand and cost of long-term care (LTC). Governments in European countries have responded differently to these challenges.

Do older adults with multimorbidity prefer institutional care than those without multimorbidity? The role of functional limitation

BackgroundPopulation ageing and social transformation present tremendous challenges to the informal support system of older adults, which engendered institutional care in China. This study aimed to examine the association between multimorbidity and institutional care willingness, and investigate whether there is an interaction effects between multimorbidity and functional limitations on institutional care willingness among Chinese older adults.MethodsData were obtained from the sixth National Health Service Survey of Shandong province, China. The sample included 8583 older adults (age ≥ 60 years; 51.7% women), 44.8% without chronic diseases, 34.8% and 20.4% with one chronic condition and multimorbidity, respectively. Multivariable logistic regression models and marginal effects analysis were used to the interaction effects analysis.ResultsA total of 666 (7.8%) participants had institutional care willingness in Shandong, China. Participants with multimorbidity were more likely to have institutional care willingness than their peers without chronic condition (OR = 1.25, 95% CI = 1.06, 1.55) after adjusted for confounders. Marginal effect analysis showed that under the condition that other variables remain unchanged, the probability of them with multimorbidity choosing institutional care for older adults with functional limitations was 6.9% lower than those without multimorbidity (95% CI = -0.128, -0.010, P = 0.023). The interaction effect between chronic health conditions and functional limitation for older adults to choose institutional care was statistically significant, and the average interaction effect was 4.83% (Z = -2.70, {S}_{overline{x} } = 0.0189, P < 0.05).ConclusionsThis relationship between multimorbidity and institutional care willingness varied by functional limitations. To better meet the care needs among older adults with multimorbidity and functional limitations, more resources and incentives should be provided to encourage the building-up of eldercare institutions. The governments should also establish long-term care system and to provide better home-based care for older adults, as older adults who prefer home care remain the majority.

Evaluating caregivers\u2019 service quality perceptions: impact-range performance and asymmetry analyses

BackgroundThis study aimed to analyze family caregivers’ (FCs) dementia care service perceptions to identify the various attributes impacting FCs satisfaction and dissatisfaction.MethodsThis is a cross-sectional survey study using convenience sampling methods. A self-completion questionnaire was developed from the Service Quality scale and distributed using a convenience sampling method to family caregivers in community-based dementia care centers to determine their perceptions of service quality in dementia care. Both exploratory factor analysis and reliability analysis were conducted to confirm the validity and factor structure of the scale. This study employed Impact Range Performance Analysis (IRPA) and Impact Asymmetry Analysis (IAA) to analyze the data obtained from FCs across five attribute dimensions (Tangibles, Reliability, Responsiveness, Assurance, and Empathy). Priorities for service improvement were derived using a three-step analytical framework.ResultsThis study reported that the overall perceived performance of service provided is high. The results indicated that practitioners should focus on attributes such as demand coordination, appropriate services, timely service, barrier-free environment, care-giving process, fire and safety compliance, professional knowledge, and reliable services, which have a higher range of impact on customer service and low impact-asymmetry and attribute performance scores.ConclusionThis study used expectation and perceived performance to suggest that the priorities for improvement and resource allocation in dementia care centers vary across different attributes. Thus, attentiveness toward satisfying user demand could improve patient care and caregiver satisfaction. The dimensions and attributes identified by our study can serve as basic data for future research on the long-term care system.

Lived Experiences of Long-Term Care Administrative Staff Responsible for the Admissions Process.

The process of admission of, typically, older residents into long-term care (LTC) has been greatly examined from the perspectives of the residents and their family members/caregivers. However, the viewpoint of the administrative staff directly involved has been left relatively unexamined. This article highlights findings from a qualitative study focused on exploring the lived experiences of LTC administrative staff working with residents-to-be and families/caregivers during the admissions process. Data from semi-structured interviews with seven participants indicate that these individuals often take on roles/tasks that go beyond the scope of their official work descriptions. Participants acknowledged the heavy toll of the stressful nature of their work on their health/well-being, but often normalized the pressures as part of their professional, if not personal, responsibilities to help others. Recommendations on improving the admissions process highlighted the lack of critique of the LTC system, despite its responsibility for the challenges that shape their day-to-day work.

Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica.

The aging of the world's population is a reality. People are living longer, not just in high-income countries, but it remains unclear whether their extra years will be lived in better health. In fact, an increasing number of older adults will probably require help to perform activities of daily living. Within the framework of its Global Strategy and Action Plan on Ageing and Health, the World Health Organization has called on all countries to create suitable and equitable long-term care systems that meet the needs of older people. The challenge is particularly acute in Latin America. The region is aging faster than other areas in the world, and its less-prepared social protection systems suffer from limited economic resources. Costa Rica is one the first middle-income countries to create a national long-term care system. This article describes the main characteristics of this system and discusses it from an international perspective. The results show that it has been designed to prioritize severity of dependency and cost containment, and to reinforce the formalization of care. The outcome of its implementation will affect the decisions of neighboring countries and those with similar economic conditions concerning the development of their own long-term care systems.

Monetary cost estimation of care for functionally dependent older adults in Mexico

This study estimates the monetary cost of caregiving - assumed by society and government - for functionally dependent older adults in Mexico. It is a secondary database analysis based on the Mexican Health and Ageing Study 2015 and the National Survey of Household Income and Expenditure 2016. The component costs included were: loss of labor income among unpaid caregivers, paid caregiver expenses, avoidable hospitalizations for primary care conditions, expenses on nursing homes, lost educational opportunities among underage caregivers and retired individuals providing care. Results indicate that the lack of a long-term care system for older adults in Mexico causes an annual cost of 2.430 billion dollars. This study aims to be an input to elaborate public policies by showing several major expenses that are mainly carried out by Mexican families.

How does long‐term care impact the psychological wellbeing of older adults in different care policy contexts in the Netherlands?

Receipt of long‐term care (LTC) is generally associated with worse psychological wellbeing for community‐dwelling older adults. In addition to objective features of care use (e.g. formal vs. informal care), the subjective evaluation of care provision in terms of perceived sufficiency might be particularly predictive of one's wellbeing but is seldomly considered in the literature. Substantial changes in the availability of long‐term care in past decades raise the question to what extent these effects, if present, are consistent over historic time. The present study, therefore, aims at better understanding the associations between types of LTC use and perceived care sufficiency on psychological wellbeing in a changing LTC context in the Netherlands. Data from the Longitudinal Aging Study Amsterdam (LASA) were used from three points in time: 1998 (N = 582), 2008 (N = 459) and 2018 (N = 415). At each wave, participants were between 75 and 85 years of age and living independently. The results show that after adjusting for age, gender, education and health, using formal LTC had a negative effect on depressive symptoms only in 2018, but that this effect was not significantly worse compared to previous cohorts. Perceived care sufficiency was consistently negatively associated with depressive symptoms in all three points in time. This suggests that despite a less generous Dutch LTC system, psychological wellbeing among LTC users remains stable. Perceiving care provision as sufficient, however, can help older adults maintain psychological wellbeing and should be considered by researchers and policymakers that aim to improve care recipients’ wellbeing.

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation.

In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

A Comparative Perspective on Long-Term Care Systems

A Comparative Perspective on Long-Term Care Systems

Ambient Intelligence Supporting Health and Social Care Services in Smart Care Settings: Literature Review and Research Agenda

In ageing cities and communities, there are increasing numbers of frail and disabled older adults suffering from multimorbidity and declining functional abilities. This deterioration can cause difficulties in carrying out essential activities of daily living and put older adults at risk of accidents. Age-friendly smart urban environments, supported by telecare services with embedded ambient intelligence, will be an essential part of how ageing societies will maintain and improve the quality of life of the growing number of residents with declining functional abilities and reduce the public financing of the long-term care services - reducing the needed number of caregivers. A review of relevant literature has shown that telecare supported by smart environments is an under-researched topic and that a central gap includes the lack of research on the integration of telecare services into the healthcare and long-term care systems. In the numerical example we also show how it influence a possible reduction of human resources in rural areas.

A Comparative Perspective on Long-Term Care Systems

A Comparative Perspective on Long-Term Care Systems

Integration of Telecare into the National Long-term Care - System The Case of Slovenia

In Europe and beyond, there are countries that are only now working intensively on the integration of remote care into home care, while in other countries the use of information and communication technology (ICT) is already routine. Among these countries is Slovenia, which in December 2021 adopted a systemic Long-term Care (LTC) Act, which formally introduces the right to e-care in home care. The integration of ICT services are essential to ensure adequate home care. This has been demonstrated by the LTC pilot projects in Slovenia, financed by the European social found which provided financial support for testing solutions that were later adopted in the LTC Act. The pilot projects drew attention to areas that still need to be researched, especially in rural communities. From this point of view, projects are an important starting point for the further development of social infrastructure in local communities. This paper shows what has directly conditioned and influenced the development of the LTC system in Slovenia and the consequent integration of e-Care in home care system. The case shows that the integration of ICT in LTC depends less on the actual needs that may influence the redirection of budget spending towards health and social care and more on the will of each government to do its "core business" in the struggle for how much, to whom and when to allocate resources to enforce the rights. The article draws attention to shortcomings that would be useful to take into account when developing a sustainable system of long-term care for an aging society.

Identification of Long-term Care Challenges in Europe

Background: Changes in demographic structures and especially the dynamic ageing of the population lead to an increased demand for care services. Finding ways to provide them efficiently has become one of the challenges for developed countries. The choice of the research issue is a consequence of recognising the fact that in recent years it has increasingly emerged as an area of practical and theoretical reflection in many scientific disciplines, including management and health sciences.&#x0D; Research objectives: The aim of the study is to characterize characterising selected aspects of the organisations and functioning of long-term care in EU countries, describing the related initiatives taken by the European Commission and identifying the challenges faced by decision-makers and managers in the said service sector.&#x0D; Research design and methods: The paper is based on the analysis of European documents, Eurostat database and literature review. It provides numerical analysis of current and prospective variables such as: average population age in EU 28, projected population age structure, population aged 65+, long-term care expenditure.&#x0D; Results: Analysis of the available statistical data unambiguously confirms that increasing life expectancy, combined with low birth rates, leads to a significant quantitative increase in the proportion of older people in the overall population structure of EU countries. There is also no internationally accepted and standardised definition of what constitutes long-term care and thus no possibility of reliably identifying needs in this area. In many Member States, long-term care systems are characterised by horizontal interdependencies with health care and social care systems. Consequently, they may and do apply different criteria for long-term care eligibility, needs assessment, social protection scope and the catalogue of services and benefits offered.&#x0D; Conclusions: The evolving social structures, the increasing introduction of artificial intelligence solutions and the situation after COVID-19 are changing the conditions of long-term care functioning, hence the reflection on the directions of these transformations is essential to properly formulate public policy practices.

Disability in Older People and Socio-Economic Deprivation in Italy: Effects on the Care Burden and System Resources

The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivariate and multivariate analyses, from bivariate correlation, through multiple linear regression to principal component factor analysis, were used to reduce the number of the variables and compute the indicators. The multivariate analysis underlines how ADL disability impacts on a household’s poverty, confirming the existence of statistical correlation between them. Moreover, the study identifies and measures two answer capability models to cope with household poverty. The answer capability of the formal system is the main tool for reducing poverty due to one family member’s ADL disability. Integration and collaboration between the formal system and family capabilities remains the main solution.

SOCIAL SUPPORT OF A FAMILY-TYPE ORPHANAGE

The article reveals the social support of a family-type orphanage, which is a type of social work that involves the implementation of centers of social services for young people in the system of long-term care through the provision of comprehensive social services by social workers involved, if necessary, professionals, parents -teachers in order to protect and realize the rights of children who are in their upbringing. The purpose of the article is to reveal the features of social support of a family-type orphanage. Research methods apllied: generalization, concretization, synthesis, theoretical analysis of sources. The author describes the content of stages of development of a family-type orphanage and features of interaction between a social worker and a family and a social institution of a family-type orphanage, which are to help the client understand his real problems and distinguish them from problems created by him; help to make a decision on this problem and address the person to a specialist to solve the problem by appropriate methods. This allows to formulate the tasks of a social worker of the center of social services for youth and to identify problems of social support of the family − the team, rehabilitation, socio-therapeutic, which specifies the content of their activities, consisting of a list of services (advisory, informational, socio-pedagogical, psychological, socio-economic, legal, socio-medical). In our opinion, such work contributes to the restoration of the family’s independence in solving its problems through learning to solve and prevent these problems, reduce the impact of the problem on family life, prevent its crisis and disintegration, eliminate the consumer approach to society and creating conditions for normal family life. The results of the study are a substantiation of the content, tasks and main functions of social support of family-type orphanages, which is a form of state support for the family in the interests of the child. Prospects for further research in this direction, we see in the disclosure of the functions of a social worker in preparing the child to leave the orphanage and into independent living.