Eldercare Provision Research Articles

Elderly Care Provision under National Policy on Older Persons 2013: A Cross-Sectional Study in Dhaka City, Bangladesh

Bangladesh is undergoing a notable demographic transition, characterized by a substantial rise in the proportion of elderly individuals within its population. This demographic transition presents a range of economic, social and cultural issues that necessitate prompt attention and intervention. The aim of this study was to examine the current state of elderly care services and facilities available for older adults in urban landscape by taking into account the ‘National Policy on Older Persons 2013.’ This study was conducted in Dhaka city by employing a cross-sectional study design. The study population covers elderly people aged 60+ years, living in Dhaka City for more than five years continuously and are able to speak well with someone. The study was based on a sample of 240 and the respondents were chosen using convenient sampling technique. The data were collected through face-to-face interview using structured questionnaire and they were analyzed utilizing descriptive statistics. This study found that the existing elderly care services and available opportunities are below the satisfactory level for most of the older adults of the city, even though the ‘National Policy on Older Persons 2013’ was adopted a decade ago. The elderly people in Dhaka city encountered a number of difficulties considering their physical health, psychological and social well-being. In the case of availability of the affordable and quality healthcare services for older adults in their community, 30.4% of the respondents said that the availability, accessibility and affordability of quality healthcare services are very poor, followed by 24.6% below average and 26.3% at the average level. Nearly 75% of the study people said that they had ever experienced unfair treatment for being aged. Indeed, they receive care and support in an inconsistent, disorganized and incoherent manner. The study clearly revealed that there is a need to prioritize person-centered care as well as integrated care system for the effective management of the ageing population in Bangladesh. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 118−134

Can better elderly care lead to a better quality of life? Evidence from China’s government purchasing of elderly care services policy

ABSTRACT We employed a difference-in-differences (DID) model to examine the impact of government purchasing policy for elderly care services on the quality of life of functionally limited middle-aged and elderly individuals. Our analysis reveals a significant enhancement in life satisfaction among this demographic, primarily attributed to improved care needs met and increased companionship from their children. We also observed a more pronounced impact among individuals without spouses and those residing in rural areas. This research provides valuable insights for policymakers seeking to strengthen elderly care provision and promote the well-being of middle-aged and elderly individuals.

Stretching the social protection system beyond capacity: tensions between governance capacity and conceptualisations of elder care in nursing homes in Indonesia

PurposeAgeing is a global concern that poses many challenges for governments, particularly in relation to the pressing issue of how to provide adequate social protection for the increasing number of elderly. Alongside rapid social and demographic transformation, Indonesia is especially challenged by the increasing number of elderly in need of formal care that is stretching the capacities of government and necessitates improvements in the social protection system. This study examines governance capacity in nursing homes and offers recommendations for improving the social protection system.Design/methodology/approachThe research presents a qualitative case study of government aged care centres in East Java and the experiences of residents and staff of three centres managed by the Provincial Social Service of East Java. The case study is based on ethnographic fieldwork, semi-structured interviews with 32 informants comprising directors, managers, staff and elderly residents of nursing homes.FindingsThe research finds that while social protection is in place, governance capacities at the provincial and local level are thinly stretched. The research highlights the tensions between existent governance capacities – in terms of mobility, decision-making, implementation and established local structures of governance and management – and the inability to meet the increasing demands for government elder care services and resources amidst broader societal transformations such as shifts in cultural framing of familial care of elderly. The findings point to the importance of understanding the dynamic relationship between governance capacity and the shifting terrains of elderly care due to societal transformation.Originality/valueThe research brings attention to the pivotal role that governance capacity plays in shaping the experiences and challenges of local government level elder care provision and the growing need for elder care in the face of an ageing population and shifts in kinship and family elder care arrangements. Elder care is not simply about addressing basic needs but also the quality and dignity of elderly and this is not easy to address where social protection systems are stretched beyond capacity. Recommendations are provided for enhancing government policy and expanding the scope for building cross-sectorial partnerships.

A typology of family caregiving for older immigrants: perspectives from care receivers and care providers

PurposeAs populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on family-provided care for older immigrants, examining how older immigrants and care providers experience and construct family caregiving.Design/methodology/approachBased on interviews with care recipients, family care providers, municipal staff and representatives for migrant organisations in Sweden, this study presents a typology of family caregiving for older immigrants.FindingsThe authors found three caregiving types, namely, solely family-provided care and a combination of family care and public care (predominantly one or the other). The decision to select family-provided or publicly-funded care depends on personal and institutional factors.Originality/valueThe paper makes three empirical contributions to the literature on care provision for older immigrants. Firstly, this study provides insights into the structural and personal factors that shape care-giving arrangements for older immigrants. Secondly, this study examines the perspectives of care recipients and care providers on family-provided care. Care expectations differ between both groups and sometimes result in intergenerational disagreement. Thirdly, in terms of institutional support, this study finds that the Swedish state’s notion of individual needs does not match the needs of immigrant elderly and their caregivers. The paper places the care types in a broader discussion about eldercare provision in the Swedish welfare state, which has experienced a decline in publicly funded care services and an increase in family caregiving in the past 30 years. In addition, it addresses questions of dignified ageing from a minority perspective.

Do Socially Assistive Robots Help in Caring for Elderly Patients with Frailty or Mild Cognitive Impairment?

The burgeoning elderly population, set to double by 2050 worldwide, will place immense demand on provision of elderly care. The mismatch in supply and demand of social care, made worse by the recent Covid-19 pandemic, has heightened the search for viable adjuncts to social care. The purpose of this dissertation is to explore the possible role of socially assistive robots (SAR) in care of elderly patients with frailty or mild cognitive impairment. In the past decade, SAR has emerged as a possible contender for assisted care. Through interviews with frontline NHS clinical stakeholders, review of research articles and visit to the Robot House research facility in the University of Hertfordshire, this project has identified the barriers, limitations to SARs and ethical challenges that needs addressing before the mainstream implementation of SARs to assist in care of the elderly. It is imperative to establish SARs’ safety profile and effectiveness through end-user inclusive, robustly designed, randomized clinical trials addressing the contextual factors of SAR implementation. Particular care and attention should be devoted to ensuring that future studies are enrolled with adequate numbers of participants to achieve statistically significant outcomes of SAR safety and acceptability. With paucity of social care workers and an ever-increasing population of older age adults, SARs will have a potential role to play in supporting the independence and dignity of elderly people in their own environment. SARs offer hope amidst the current social care despair, and further research is key to their eventual success in aged care, which may be years away from reality.

Unpaid eldercare and its impact on the US labor supply

Globally, the dependency ratio is rising due to increase in aging population. Individuals, especially women are challenged when choosing between participating in the labor market and providing care. Using 2011-2017 American Time Use Survey data for a subsample of individuals aged 25- 61 years, we examine the effect of frequent eldercare provision on labor force participation in the US using bivariate probit instrumental variable approach. Our findings suggest that unpaid eldercare performed frequently reduces labor force participation. Female frequent providers are likely to have lower labor force participation compared to their male counterparts. Robustness and sensitivity checks confirm these findings.

Intergenerational Esthetic Co-Creation Program for Promotion of Community Creative Aging

The world is facing rapid global aging. Global countries are concerned about the development of aging societies and related topics ranging from successful, healthy, and active aging in the past to the current creative aging (CA) perspective. However, in-depth research on applying esthetics to promote community CA in Taiwan is lacking. To address this deficiency, the Hushan community in Douliu City, Yunlin County was selected as the research area, and the CA perspective was adopted to promote community CA through multi-stage intergenerational esthetic co-creation (IEC) workshops. A model for applying IEC workshops to promote CA was constructed. Using the action research approach, community CA enabled the elderly to identify with their inherent values, opening new possibilities for the provision of elderly social care. This study explored the psychological impacts of implementing IEC workshops on the elderly, analyzed their interactions with peers and youth, helped the elderly review their lives, analyzed relevant data to construct a practical model for applying IEC workshops to promote CA, and provided the data collected during the multi-stage applications of CA and an IEC model for promoting CA as a reference for future researchers, thereby opening new possibilities for sustainable care in aging societies.

Forgotten and Invisible Laborers: Domestic Workers in Singapore and Taiwan

This paper is about legal yet unjust systems of domestic servitude; the oppressive circumstances that ‘foreign maids’ the world over face as unappreciated, unrecognized, and undervalued workers in the invisible domestic space. Regardless of political culture and regime - liberal democracies to authoritarian governance – ‘maids’ are excluded from normal labor standards. The author explains and discusses the legal blind spots, loopholes, and oversight of labor clauses for foreign domestic workers (FDWs) in the East Asian states of Singapore and Taiwan. This paper aims to spark critical conversations about the public/private divide, also the feasibility of enacting home-based legislation for private household workers. It uses the reviewed literature – relevant research studies, government websites, and news sources – and interview findings to advance its main claims. Between May 2021 and July 2022, the author conducted online semi-structured interviews on WhatsApp/Zoom with 61 people who were directly or indirectly involved in eldercare provision: FDWs, domestic employers, recruitment agency managers, unpaid family caregivers, and NGO workers. The author’s analysis shows that FDWs, called ‘maids’ in the local parlance, face a myriad of shocking abuses by sending/receiving governments, unscrupulous recruitment agencies, and host employers who view them as private property (owned) rather than human beings with needs. This paper argues that FDWs deserve to be respected and included in formal labor laws like the rest of the workforce, to better safeguard their physical safety, mental wellbeing, and personal dignity

Elderly Care Provision and the Impact on Caregiver Health in China

AbstractWith the fast pace of population aging, industrialization, and urbanization in China, the main source of elderly care is changing. Using China Health and Retirement Longitudinal Survey data, we investigate the elderly care provision situation and find that spouses are currently the most important elderly care providers in China. We use a model to depict the trade‐off between a caregiver's own health and the care quality obtained by the care recipient. The model predicts that under some conditions, the caregivers will provide care at the cost of their health. Employing a stratified propensity score matching method, we find that spouses' caregivers are more likely to have depression, physical pain, and hypertension than noncaregivers. The negative effects are larger for caregivers with a high level of care intensity or less support from other resources. Female spousal caregivers tend to suffer more from depression and physical pain than male spousal caregivers. Our findings suggest that policies toward “healthy aging” should target not only the disabled elderly but also their spousal caregivers who are also elderly people.

Social Innovation in Home-Based Eldercare: Strengths and Shortcomings of Integrating Migrant Care Workers into Long-Term Care in Tuscany.

Italy is one of the main receiving countries of migrant care workers in Europe. Its migrant-in-the-family model has developed since the 1990s, and, today, home-based eldercare is unimaginable without the work of the almost one million care workers employed in private households, of whom over 75% are migrants. Despite forming one of the most important pillars of eldercare provision in the country, the employment of migrant care workers is not addressed in national policy. However, regional policymaking is far from inactive in the face of growing gaps in care as regions and municipalities play a crucial role in regulating, organising, and providing eldercare. With a focus on comprehensive solutions, cross-sector collaborations, and interactive learning processes, social innovation becomes an important element in reforming eldercare in the context of institutional inertia, fragmentation, and permanent austerity. In what ways are regions using social innovation to respond to challenges in eldercare provision and integrate migrant care workers? This study is based on interviews with experts from the region of Tuscany, which is running the project Pronto Badante (emergency care worker). The results suggest several advantages of local interventions breaking with the institutional silo mentality, as well as ongoing challenges regarding the impact and sustainability of these interventions.

A Conceptual Analysis: The Inclusion of Elder-Care Funding in Contemporary Waqf Revival in Nigeria

The urgent need for eldercare funding follows an alarming increase in the population of elderly persons aged 65+ within the last two decades, implying the need for countries to prioritize funding in terms of policy and budget. However, most developing countries like Nigeria are lacking in this regard making the search for optional methods that could ensure funding and provision of functional elderly care more evident. Waqf counts as an avenue for social support especially the waqif of religion and philanthropy. Hence, it is a need for a study of the waqf model. The analysis hinged on the structural functionalist theory as presented by Talcott Parsons, (1951). In the current academic discourse on the need to revive waqf, the central argument of this research agrees that the waqf model needs revival but also an orientation towards addressing the excesses generated by population aging across Muslim countries. From the studies reviewed, it is clear that political practices affect the waqf. In addition, a poor application and execution of funds, mismanagement, misappropriation, corruption, and the poor attitude of the Ulama in reviving the age-long institution among others. The paper concludes that the functional role of the waqf in funding areas of social justice makes the waqf a key institution that can address the challenges of eldercare as posed by the aging of the population across Muslim countries. It recommends eldercare funding in the waqf revival debate in addition to addressing the numerous problems affecting the waqf institution for a successful revival towards addressing contemporary issues in Muslim communities in Nigeria.

Under the Press(ure)? The Role of Media in Organisation and Provision of Municipal Elderly Care

What is the role of media(tisation) in organisation and provision of elderly care? By looking at how planning, organising and execution of elderly care is understood in two Swedish municipalities this paper seeks to contribute to discussions of the ways in which values, preferences and working practices of news media play out in shaping conditions for provision of municipal welfare services. Our findings suggest that we can see the role of media values and preferences as embedded – although in different ways and to varying extent – in three distinct but inter-related processes that influence how actors connected to organisation and provision of municipal welfare services understand and relate to each other. These are: 1) setting the aims, aspirations and priorities in the provision of welfare services (i.e., the what); 2) translating these aims, aspirations and priorities into necessary means, resources and activities (i.e., the how); and 3) explaining and justifying the what and the how to different constituencies (i.e., the why). The paper concludes that commonly held values and beliefs about media reinforce the ongoing changes in the governing regime of elderly care in a direction where the role of municipal administrative bodies is more explicitly articulated, especially in terms of accountability and responsibility.

Impact of elderly care on “sandwiched-generation” women in Turkey

AbstractThe aging population and, along with it, increasing long-term care needs create pressure globally on the social and health care spending of governments under the constraint of shrinking tax bases. The common tendency of governments is to minimize the cost by transferring the elderly care burden to families. However, care provision comes with penalties for caretakers in the form of potential income losses and a rising, unpaid workload that requires a gender-based assessment. These impacts intensify with additional demographic trends that impose new challenges. Increasing longevity accompanied by decreasing fertility and delays in having children in Turkey have contributed to the growth of the “sandwiched generation” which encounters the care needs of their elderly as they care for their children. This study investigates whether and how caring responsibilities can be associated with the caregivers’ economic participation in Turkey, where the retreat from institutional provisioning of elderly care services is concealed with a neoconservative family-oriented rhetoric. Using the 2014–2015 Time Use Statistics compiled by TurkStat, we analyze the relationship between informal elderly care provision and employment hours, taking into account the potential impact of providing elderly care on labor force participation, focusing on sandwiched- generation women.

Geriatric Care in Pakistan: Current Realities and Way Forward

Worldwide, the geriatric population rate is 690 million which is alarmingly high and calls for an increasing need for preventive and curative services. In Pakistan, the elderly population is 11.3 million and is expected to increase to 43.3 million by 2050. With the increasing aging population there is an urgent need to improve standards and provision of elderly care in the country. Few geriatric healthcare organizations exist with weak infrastructure resulting in negligence and poor care of the elderly. Older adults have one or more chronic illnesses and complications that contribute to out-of-pocket payments in 73% of the population. Moreover, due to rapidly changing family value systems and sociocultural values, the elderly population is faced with additional challenges such as elder abuse, loneliness, and social isolation. The shrinking of family structure, industrialization, poverty, and prevalence of chronic illnesses among older adults put a massive burden on the family caregivers. Using SWOT and PESTLE analysis, the paper identifies several gaps and discusses various challenges contributing to the access, implementation, and provision of adequate geriatric care services in Pakistan. The paper proposes several strategies including quality home health screening, evidenced based informed care, and training of healthcare professionals to enhance the provision of compassionate and ethical geriatric services to improve the quality of life of elderly and their caregivers in Pakistan.

Professional Women and Elder Care in Contemporary Japan: Anxiety and the Move Toward Technocare

The elder population in Japan is increasing drastically, causing a number of issues that have not yet surfaced in most Western countries. Demographic data from Japan reveal that the Japanese have the longest lifespan globally, resulting in the world’s highest population of older adults. Concurrently, the country has a rapidly declining birth rate. As the population ages, the workforce is shrinking and leaving a high number of elders with fewer caregivers to meet their needs. At present, the Japanese government is developing robotic care solutions to overcome the elder care labor shortage and implementing a new agenda to introduce social robots into the field. This article discusses professional women in Japan and their burden of caring for aging relatives and how introducing robotic care devices might reduce current anxieties regarding the provision of elder care. It analyzes the elder care strategies of 12 white-collar professional women in their forties and fifties and examines the extent to which gendered, expected at-home caregiving affects their professional commitments and associated anxieties. The findings below provide crucial insight into the most effective strategies that can be used by Japanese women to balance their careers with responsibilities to care for older relatives, particularly when it is impossible to predict the intensity of caregiving in the future.

Promoting ageing in place in Hong Kong: neighbourhood social environment and depression among older adults

ABSTRACT Neighbourhood plays an increasingly prominent role in the provision of elder care in light of population ageing. Many governments worldwide have committed to improving neighbourhoods to promote ageing in place. This article investigates the association between neighbourhood social conditions and depression among the elderly Hong Kong population ages 60 and older with a focus on neighbourhood elderly services, a modifiable factor with policy implications. Using two waves of data from the Hong Kong Panel Study of Social Dynamics (HKPSSD), the ordinary least squares (OLS) regression estimation reveals that neighbourhood centres aiming to encourage social interaction among the elderly are significantly related to reduced symptoms of depression. The beneficial effects of such facilities are greater among older individuals living in low socioeconomic (SES) neighbourhoods. These results suggest that neighbourhood-based services are effective in enhancing healthy ageing in an ultra-dense Chinese metropolis, and policies should put priority to address social service and facility issues in disadvantaged neighbourhoods.

Who Has Benefited from Nursing Home Expansion in Japan?: The Effects of Government Supply-Side Intervention in the Elderly Care Market

This study analyzes the relation between the labor force participation of caregivers and the provision of informal in-home elderly care. In Japan, the national government both regulates the market entry of nursing home suppliers and intervenes in the supply side of the eldercare market. Using exogenous variations in this supply side intervention, our analysis finds that the Japanese policy of expanding nursing homes has increased the labor force participation of female workers with low opportunity costs in the labor market while simultaneously reducing their provision of informal care. As the per capita expense of nursing home care is higher than the wage income of most non-regular female workers who tend to provide the bulk of informal in-home care, one may reasonably conclude that the capacity of public nursing homes in Japan has expanded excessively, putting unnecessary pressure both on the Japanese budget and the personal provision of eldercare services.

Care Triangle or Care Diamond? The Case of Childcare and Eldercare in Serbia

Overall changes in political, social and economic spheres in Serbia, along with ongoing demographic processes, have affected various policies and all aspects of people’s lives, including system(s) of care. While care became an important analytical concept and category of social policy analysis internationally, it has not been systematically applied in the analysis of the Serbian welfare state. Incorporation of care in welfare state analysis is much needed as its organisation in the national context reveals a lot about the nature of the welfare state, changes in its socio-institutional arrangements and, most importantly, the effects of provision. This article thus aims to outline the evolution of childcare and eldercare policies in Serbia over the last decade, employing the concept of the care diamond developed by Shahra Razavi, which allows examining the “architecture” through which the care is provided: families/ households, markets, the state and the voluntary sector. By analysing the prevalent care policy “architecture” for children and the elderly in Serbia and the roles of different sectors in that respect, as well as by identifying similarities and differences in the provision of childcare and eldercare in the national context, the article exposes developments and current state in childcare and eldercare provision in Serbia. The analysis indicates the profound role of the informal sphere in both care systems in Serbia, childcare and eldercare. Some differences between the two care domains could also be noted. These relate to the configuration of welfare sectors involved in care provision, revealing the modified shape of the care diamond in the case of childcare. That is, while all four sectors are involved in providing care in the case of eldercare forming an eldercare diamond, this is not the case with childcare. In the latter case, the voluntary, nonprofit sector does not exist as a care provider in Serbia, with childcare “architecture” having a shape of a care triangle. In light of this evidence, the role of families and the voluntary, nonprofit sector should be taken into account in future planning and funding of policies as well as in their implementation. Key words: care, childcare, eldercare, care diamond, policy, provision, Serbia

Juggling paid work and elderly care provision in Japan: Does a flexible work environment help family caregivers cope?

Using unique data from a Japanese survey, this paper examines whether flexible work arrangements targeted specifically at workers with caregiving responsibilities under the Child Care and Family Care Leave Act help family caregivers reconcile paid work with care provision. The regression results suggest that access to caregiver leave, which allows family caregivers to take a continuous leave of up to 93 days, is negatively and significantly associated with the probability of leaving one's job within one year of the onset of demand for parental care. This alleviating effect of access to caregiver leave remains robust even in the longer term and in a specification where we take into account the possible endogeneity of care provision to the labor supply decision. The findings of this paper thus suggest that the caregiver leave introduced pursuant to the Act in Japan helps meet the need of family caregivers to take a certain period of time off from work to make the necessary arrangements for accommodating the sudden and unexpected demand for elderly care in their daily lives.

Sector Bias and the Credibility of Performance Information: An Experimental Study of Elder Care Provision

AbstractReporting government performance to the public is key tool in improving accountability. Some evidence, however, has shown that individuals’ anti‐public sector biases may distort performance information about public organizations. Using an experimental vignette on U.S. nursing homes, this study fills four gaps in the literature: (1) the need to include nonprofit organizations rather than just public and for‐profit, (2) consideration of the credibility of the source of performance information, (3) the use of simple commonly used performance metrics, and (4) the willingness to use services as a performance dimension. We find the public has a general but modest anti‐for‐profit sector bias in nursing home care with nonprofits perceived the most positively. Sector biases generally disappear when clear performance data are presented. The credibility of the source matters, and respondents' willingness to use organizational services is more sensitive to both sector bias and performance ratings than are performance measures.Practitioner Points In the field of long‐term care, individuals have no anti‐public sector bias, and they have more favorable views of nonprofit organizations than for‐profit organizations. Perceived sector bias disappears when simple and unambiguous performance information is introduced. The source of performance information matters: individuals perceive the information from government and nonprofit sources as more credible than that from for‐profit sources. A high degree of credibility amplifies the effect of performance information in shaping individuals’ evaluations of public services.