Responsibility For Long-term Care Research Articles

From Institutions to Families? The Changing Allocation of Responsibility for Cognitively Disabled Children in Dutch Postwar Long-Term Care Policies

Who is responsible for health care? Neoliberal policies since the 1970s seem to place this responsibility increasingly on the individual, in a process that is called responsibilization. The recent literature on neoliberalism, however, has questioned the preference of free-market liberalism for individual responsibility and shows how neoliberals often made common cause with communitarian conservatives on social policies. Melinda Cooper, for instance, has argued in her book Family Values that free-market liberals and social conservatives in the US both identified the family as a ‘wholesale alternative to the 20-century welfare state’. This article investigates whether this coalition of neoliberals and social conservatives, who agree on the importance of familial solidarity in addition to market freedom, has also played a role in the making of Dutch health care policies. By tracing how responsibility for long-term care has been allocated in the postwar Netherlands in the specific case of children with (cognitive) disabilities, the author will show how ‘the family’ has increasingly been embraced by policymakers as the main responsible party. This is remarkable because the Dutch postwar welfare state sought to loosen family ties in favour of individual arrangements. However, attempts by different stakeholders to deinstitutionalize Dutch health care during the 1990s unintentionally moved the state's responsibility for long-term care not so much onto individuals as onto families.

Stakeholder collaboration in long-term care of older people in Lithuania.

Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.

Responsibility for Long-Term Care of Breast Cancer Survivors

Responsibility for Long-Term Care of Breast Cancer Survivors

The family role in the context of long-term care.

Current long-term care policy and practices are built on the premise that family is and should be the primary party responsible for impaired older persons. This article presents evidence that this premise and the resulting policies and practices are (a) built on myth; (b) fueled by gender, income, and ethnic inequalities; and (c) largely responsible for the creation of a service system that has inadequate capacity to meet current and future needs. An alternative paradigm, which places primary responsibility for long-term care needs on the individual, is proposed here and implications for new policy direction are outlined. The projected benefits of this shift in paradigm will be the development of a more viable and more equitable long-term care system that has the capacity to provide high quality care to meet the expanding need.

International long-term care reform: A demographic, economic, and policy overview

Advanced industrial countries around the world are making or contemplating major reforms of their systems for financing and organizing long-term care for the elderly. The paper describes major reform efforts including: the pursuit of cost efficiencies from further differentiation of the acute and long-term care delivery systems, promotion of home and community-based care alternatives to traditional institutions, and 'systems integration' involving consolidation of responsibility for long-term care at one level of government. The paper concludes by discussing the special relevance to the longterm care reform debate in the U.S. of recent British and German decisions to, respectively, decentralize versus centralize responsibility for long-term care.