Provision Of Long-term Care Services Research Articles

Functional disability and receipt of informal care among Chinese adults living alone with cognitive impairment

BackgroundAdults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was associated with a higher burden of functional disability but lack of informal care. Methods982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours. ResultsAdults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = −127.7 h per month, standard error = 25.83, P < 0.001), compared to the adults living with others and with normal cognition. ConclusionsThis study highlights the high burden of functional disability but low coverage of informal care among Chinese adults living alone with cognitive impairment and calls for more resources to be allocated to this vulnerable subpopulation to improve the functional health and to increase the provision of long-term care services.

Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study.

The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.

Home Care Services: Experience of Shkoder's Nurses During COVID-19.

Nursing home care refers to the provision of long-term care services to individuals who are unable to live independently and require assistance with activities of daily living such as bathing, dressing, eating, and medication management. To explore the experience of nursing home care in Shkoder during COVID - 19 and to explore the key challenges and concerns associated with nursing home care during the quarantine period. A qualitative phenomenal approach study was conducted. Data were collected through one in one semi-constructed interviews. In this study were included 30 nurses who offered their service at home of patients during pandemic. Only the nurses who have a bachelor's degree in nursing and have at least 1 year of experience in providing home care were included in the interview. Those who refused and people who did not offer this service at home were excluded. Out of 37 nurses, 30 agreed to be part of this study. All these people have been invited for an interview via WhatsApp. Then we went to their place of work where the interviews were conducted in a separate room at their place of work. All audio recorded interviews were transcribed into type written text and qualitatively analyzed using an inductive thematic analysis approach. Inductive thematic analysis is a method for identifying, analyzing and reporting patterns or themes independently from existing theoretical frameworks or categories. The period time of this study was January - February 2023. The nurses in Shkodra encountered various challenges while providing home care services during the Covid-19 pandemic. Shkodra's nurses have exemplified resilience and dedication as they navigate the complexities of providing home care services during the ongoing Covid-19 pandemic.

Development of a management model for the provision of long-term care services for elderly and disabled citizens on an extraterritorial basis

Universal globalization dictates the need for new forms and methods of social work. The system of long-term care for elderly citizens and the disabled also requires updating. Basically, long-term care is based on regional regulation. The regions independently determine the list of “care” services, their volume, frequency and criteria of need. This gives rise to some kind of discrimination of some elderly citizens against others in terms of the volume and list of social services. In addition, the regional or decentralized principle of building a long-term care system «binds» elderly citizen in need of it to their place of residence, restricts their constitutional right to movement and freedom to choose their place of residence. The study analyzes the current state of regulation of the long-term care system and formulates proposals for the transition to the extraterritorial principle.

The Effect of Business Operating Systems on Nursing Home Termination.

Objectives: Nursing home terminations have increased worldwide due to rising costs, staffing shortages, and the coronavirus disease pandemic. However, little is known about the impact that business operating systems have on nursing home termination. Methods: This study used the National Long-term Care database, which comprised 7,842 operating nursing homes in January 2018. Nursing home termination was identified when nursing homes discontinued provision of long-term care services to all residents between January 2018 and December 2020. Business operating systems that were reimbursed by the LTC insurance system were the exposure of interest. The logistic regression model for nursing home termination included a series of organizational, internal, and external factors as covariates. Results: From 2018 to 2020, 83 (1.1%) nursing homes were terminated. The proportion of reimbursed nursing homes varied greatly depending on the type of business operating systems. Implementing physical function training and improving working conditions were significantly associated with a lower risk of nursing home termination. Conclusion: Financial incentives to several business operating systems are an effective way to build a sustainable environment for nursing homes to continue to exist.

Relationship between unmet needs for assistance and healthy aging among disabled older adults in China.

BackgroundAlthough there is a growing consensus around the world that long-term care services and supports are important to help the aged population with disabilities achieve healthy aging, a misallocation of care resources and inefficiency in care delivery still exist in China. The absence or inadequate provision of long-term care services and supports among older adults with disabilities results in a range of adverse health consequences. However, the negative influence of unmet needs for assistance on healthy aging, based on functional perspectives including physiological, psychological, and societal domains, has been underestimated. This study aimed to measure healthy aging based on a person-centered approach and examine the relationship between unmet needs for assistance and healthy aging among older adults with disabilities in China.MethodsBased on the data from the Chinese Longitudinal Healthy Longevity Survey 2018, we used the latent profile analysis with three indicators to uncover distinctive types of older adults experiencing distinct levels of healthy aging, and applied the ordered logit regression to analyze the correlation between unmet needs for assistance and different levels of healthy aging. To further address the endogeneity bias, the robust test was conducted by the two-stage least-squares instrumental variable estimation and the conditional mixed process instrumental variable estimation.ResultsThree ordered latent classes were identified: a low level of healthy aging (42.83%), a middle level of healthy aging (47.27%), and a high level of healthy aging (9.90%). Disabled older adults with unmet needs had a lower probability of achieving the higher level of healthy aging (OR = 0.57, SE = 0.04, CI = 0.48–0.66, p < 0.001).ConclusionsThis study highlights the need to increase awareness among gerontological practitioners with respect to long-term care services and supports for disabled older adults as a potential for enhancing their healthy aging, and that unmet needs could be a basis for risk assessment and a means for determining the efficacy of long-term care interventions on maintaining health.

Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study.

BackgroundWelfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care.ObjectiveWe aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care.MethodsQuantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis.ResultsA total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach.ConclusionsMany municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources.

Difficulties and Policy Recommendations Related to the Deployment of Long-Term Care Resources in Taiwan`s Indigenous Areas

Changes in the demographic structure in Taiwan have increased the need for long-term care (LTC). Person-centered and community-based care is being advocated. The need to address the specific LTC needs of Taiwan`s indigenous peoples has been a part of national LTC policy since National Long-term Care Plan 2.0 was adopted in 2015. The provision of LTC services and the deployment of related resources in indigenous areas generally lag behind Taiwan`s other areas. Potential reasons for this disparity include lack of in-charge, dedicated units; exclusive use of normative service models in indigenous areas; and conflict between talent cultivation and rooted development. Future policy should focus more on providing cultural care in indigenous areas and on offering more flexible and diversified development possibilities. The implementation of these policies may promote the development of LTC and the successful deployment of LTC resources in Taiwan`s indigenous regions.

State Variation in Long-Term Care Availability, Regulation, and Cost and Suicide Mortality Among Older Adults in the United States: 2010–2015

ObjectivesResidential long-term care (LTC) facilities may be key settings for the prevention of suicide among older adults; however, little is known about the relationship between statewide policies determining characteristics of LTC facilities and suicide mortality. The primary goal of this study was to evaluate the association between state policies regarding availability, regulation, and cost of LTC and suicide mortality among adults aged 55 and older in the United States over a 5-year period. DesignLongitudinal ecological study. Setting and ParticipantsLTC residents from 16 states reporting mortality data to the National Violent Death Reporting System (NVDRS) from 2010 to 2015. MethodsWe linked suicide data from the NVDRS and data sources on LTC services and regulations for 16 states. We applied a natural language-processing algorithm to identify suicide deaths related to LTC. We used fixed effect regression models to assess whether state variation in LTC characteristics is related to variation in the rate of suicide (both overall and related to LTC) among older adults. ResultsThere were 25,040 suicides among those aged 55 and older reported to the NVDRS during the study period; 382 suicides were determined to be associated with LTC in some manner. After adjusting for state-level characteristics, greater average nursing home capacity was significantly associated with increase in the cumulative incidence of suicide related to LTC (β = 0.087, SE = 0.026, P < .01), but not overall suicide incidence. Neither cost nor regulation measures were significantly associated with state-level LTC-related suicide incidence. Conclusions and ImplicationsState-level variations in LTC facility capacity are related to variation in LTC-related suicide incidence among older adults. Given the challenges of preventing suicide among older adults through facility- or individual-level interventions, policies governing the features and provision of LTC services may therefore serve as a means for public health suicide prevention.

Views from Below: Inspectors’ Coping with Hybrid Accountabilities

Regulation of long-term care service provision is a case of hybrid accountabilities. How do inspectors who are responsible for the implementation of regulations handle the uncertainties arising from hybrid accountabilities? While the prevailing scholarly consensus is that hybridity creates tensions that have a negative impact on the quality of regulation, this article shows that different accountabilities can reinforce each other. However, situations in which inspectors can develop a positive stance toward hybridity and integrate competing logics are rare. Hybrid professionalism among inspectors requires training, education, and resources as well as a joint regulatory culture with inspectees—preconditions that are hardly present in recent institutional settings of long-term care regulation.

Changing long-term care provision at the local level in times of austerity – a qualitative study

ABSTRACTIn the first decade of the century, long-term care (LTC) policies for dependent older people in Italy were improved with respect to both the availability of public funds and the quality of services. At the turn of the decade, however, cost-containment and austerity measures were imposed as an overall priority for the public sector and this goal also affected the LTC sector. This article explores the effects produced by cost-containment policies, which widened the gap between care needs and available public funding, on the provision of LTC services at the local level in Italy during the economic crisis. The study is based on 34 semi-structured interviews with services managers employed in Italy's publicly funded LTC system. Data were analysed with the framework analysis method and six cross-cutting thematic categories were identified that depict, according to the interviewees, the main transformations that occurred in the provision of LTC at the local level as a consequence of cost-containment policies. ‘Uncertainty’ refers to the inability to predict what direction the LTC system is going to take in the foreseeable future. ‘Short-termism’ illustrates the pressure to focus excessively on day-to-day service delivery at the expense of a medium- to long-term view of their future. ‘Endangering quality’ describes the risk of not being able to maintain the level of quality of care achieved so far. ‘Allocative tensions’ refers to the tensions due to the increasing requirement to ration the provision of public LTC services. ‘Unequal re-familiarisation’ represents the very different impacts of the trend of re-familiarisation depending on families’ financial situation. ‘Inappropriate care’ depicts the rising number of older people receiving public care interventions that are not appropriate to meet their needs.

A Qualitative Study on Use of Welfare Technology in the Long-term Care Service Provision

A Qualitative Study on Use of Welfare Technology in the Long-term Care Service Provision

Cost Trends in Long Term Care in Japan and Sweden over the Period 2000 to 2010

Japan and Sweden have similar ambitions and both similarities and differences when it comes to provide long term care (LTC) for their old age citizens. The study compares cost increase for LTC in Japan and Sweden in the time period 2000–2010 by decomposing the changes in costs into changes in the size of the old age population (65 years and above) , the distribution on level of dependency /disability by age-group and gender, the volume of provided LTC services in relation to level of dependency/disability and the unit costs for provided services. The analysis of needs of LTC services is based upon nationally representative sample surveys population studies completed in each country: Nihon University Japanese Longitudial Study of Aging and the Swedish Survey of Living Conditions with 19. 602 and 9.433 observations respectively. Data on LTC services provision by level of dependency/ disability is taken from nine Japanese municipalities collected by assessments in the LTCI-system and from surveys in eight Swedish municipalities. It is shown by the analysis that the rapid cost increase in Japan in the period 2000–2010, 108 %, has mainly been driven by the increase in the old age population. However, another important factor in the period 2000–2005 has been increased provision of LTC services given level of dependency. In Sweden the cost increase depending on population increase has been countered by decreasing levels of disability by age-groupand gender. Services provision given needs of LTC has not increased very much. As a result the cost increase in the time period 2000–2010 has been much lower, +6 %.

‘Everyday Advocates’ for Inclusive Care? Perspectives on Enhancing the Provision of Long-Term Care Services for Older Lesbian, Gay and Bisexual Adults in Wales: Table 1

This paper centres on a neglected area of social work with older people-the social inclusion of older lesbian, gay and bisexual (LGB) adults in long-term care environments. The translation of equality law into the delivery of adult care services is a challenging endeavour for organisations, even more so in the morally contested terrain of sexual well-being. In this paper, we report findings from a mixed-methods study into the provision of long-term care for older adults who identify as LGB. Herein we present findings from a survey of care workers and managers (n = 121) and from focus groups with equality and LGB stakeholder represent atives (n = 20) in Wales. Focusing on the current knowledge and understanding of staff, we suggest that affirmative beliefs and practices with sexual minorities are evidentamongst care workers and managers;however, theinclusion of LGB residents needs to be advanced systemically at structural, cultural and individual levels of provision. There is a need for enhancing awareness of the legacy of enduring discrimination for older LGB people, for cultural acceptance in care environments of older people's sexual desires and relationships, and for a more explicit implementation of equality legislation. Social workers in adult care can advance this agenda.

Enabling carers to care

Addressing challenges in long-term care will require a comprehensive approach covering both policies for informal carers as well as policies addressing the formal provision of long-term care services and its financing.

Organization and Supply of Long‐term Care Services for the Elderly: A Bird's‐eye View of Old and New EU Member States

AbstractThis article provides an overview of the organization of formal long‐term care (LTC) systems for the elderly in ten old and 11 new EU member states (MS). Generally, we find that the main responsibility for regulating LTC services is centralized in half of these countries, whereas in the remaining countries, this responsibility is typically shared between authorities at the central level and those at the regional or local levels in both institutional and home‐based care. Responsibilities for planning LTC capacities are jointly met by central and non‐central authorities in most countries. Access to publicly financed services is rarely means tested, and most countries have implemented legal entitlements conditional on needs. In virtually all countries, access to institutional care is subject to cost sharing, which also applies to home‐based care in most countries. The relative importance of institutional LTC relative to home‐based LTC services differs significantly across Europe. Although old MS appear to be experiencing some degree of convergence, institutional capacity levels still span a wide range. Considerable diversity may also be observed in the national public–private mix in the provision of LTC services. Lastly, free choice between public and private providers exists in the vast majority of these countries. This overview provides vital insights into the differences and similarities in the organization of LTC systems across Europe, especially between old and new MS, while also contributing valuable insight into previously neglected topics, thus broadening the knowledge base of international experience for mutual learning.

Outsourcing Elderly Care to Migrant Workers: The Impact of Gender and Class on the Experience of Male Employers.

This article, based on semi-structured interviews, addresses masculinity in the international division of reproductive labour through an analysis of the impact of gender and class on the outsourcing of elderly care services to migrant care workers. In the Italian context, characterised by a limited provision of long-term care services and by cash-for-care benefits, the strategies of men as employers of migrant care workers are shaped by class and gender. The outsourcing of care to migrant workers reproduces hegemonic masculinity in so far as male employers are able to withdraw from the ‘dirty work’. At the same time, men engage with tasks which are, in principle, kept at a distance. The employers’ family status, combined with their class background, are crucial factors in shaping the heterogeneity of men’s experiences as employers and managers of care labour, and the ways in which they make sense of their masculinity.

Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers.

In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure.

Long-Term Care Insurance and Health Care Financing of the Korean National Health Insurance Program

This paper is to evaluate how the new element of public health insurance for long-term care services, the Long-Term Care Insurance (LTCI), financially affects the preexisting National Health Insurance (NHI) program. We focus on examining the effects of the LTCI benefit payment on the NHI expenditure and service use of the elderly members. Using longitudinal data of 245 municipalities of South Korea for the period of 2008-2010, we conduct the fixed-effects panel estimation and find the statistically significant positive association of the LTCI spending with the NHI benefit payment for the elderly: additional 7,263 million KRW spending in the NHI program for one percent increase in the LTCI spending on the elderly. Findings further show that the intensity of the NHI service use among the elderly is positively associated with the LTCI benefit payment. It suggests that coordinated management across acute care service delivery and long-term care service provision is warranted to achieve cost effectiveness of the NHI program with the support of the LTCI program.

Local Networks in the Provision of Long-term Care Services in Serbia – a View from the South-East of Europe

This paper is focused on social support networks in providing long-term care services for elderly along a centre-periphery divide in Serbia. Long-term care is fragmented at Republic and local levels between the social assistance and health care, residential and community based services, state and private service providers with consequential (negative) effects on coverage, quality and sustainability of services. Against this background, available literature points to numerous advantages of networking. The analysis, which is substantiated by four semi-structured expert interviews, reveals the dominance of ego-centred networks over the thematic ones at the local level which are rudimentary existent. Improvement of networking requires the mobilisation of all stakeholders and the identification and allocation of leadership and moderation tasks. Lokale Netzwerke in der Bereitstellung von Langzeitpflege in Serbien – ein Blick vom Südosten Europas Die vorliegende Analyse konzentriert sich auf die Betrachtung von sozialen Netzwerken bei der Bereitstellung von Langzeitpflege für ältere Menschen entlang einem Zentrums-Peripherie-Gefälle in Serbien. Das Feld der Altenpflege in Serbien ist sehr stark fragmentiert zwischen Sozialhilfe und Gesundheitssystem, zwischen stationären und ambulanten Dienstleistungen sowie zwischen den unterschiedlichen involvierten Akteuren. Hieraus resultieren (negative) Effekte im Hinblick auf Reichweite, Qualität und Nachhaltigkeit von Dienstleistungen. Bezogen auf diese Problemstellung verweist die Literatur auf die Vorteile von Netzwerken und Vernetzung. Die hier durchgeführte Analyse, für die u. a. vier semi-strukturierte Experteninterviews durchgeführt wurden, untermauert die Dominanz von ego-zentrierten Netzwerken in der Versorgung von pflegebedürftigen älteren Menschen in Serbien. Thematische Netzwerke sind hingegen auf der lokalen Ebene nur rudimentär vorhanden sind. Eine bessere Vernetzung erfordert sowohl die Mobilisierung der Akteure als auch die Identifikation und Zuweisung von Führungs- und Moderationsaufgaben.