Social Long-term Care Research Articles

Long-term social care reforms unlikely before 2028, warns Labour

Long-term social care reforms unlikely before 2028, warns Labour

Care Relationships Between Support Staff and Adults With a Learning Disability in Long-Term Social Care Residential Settings in the United Kingdom: A Systematic Literature Review

Context: Research exploring care relationships between support staff (e.g., support workers) and adults with a learning disability in long-term social care residential settings in the United Kingdom is relatively neglected. This has potential theoretical and care practice implications. Objectives: This study sought to synthesise relevant literature, expand knowledge, and identify directions for future research. We investigated five questions about care relationships and what makes them positive, exploring definitions of care relationships, relational practices and processes, barriers and facilitators to good care relationships, the impact of relationships, and restoration of disrupted relationships. Methods: Following protocol registration in PROSPERO, a systematic literature review was conducted in June–July 2021. The review was informed by official guidelines and focused on the United Kingdom, covering 41 years of relevant work. Twelve databases and five websites were searched, and experts were contacted. Forty-five reports were included and synthesised using the narrative synthesis framework. Findings: Definitions of care relationships revolved around friendship, equality, professionalism, and power. Practices and processes underlying positive relationships included knowing the person, setting boundaries, and shifting power dynamics. Barriers to positive care relationships included staff interactional patterns, attributions, and staff dilemmas, whilst facilitators included receiving training and using communication tools. Good care relationships were key to effective support and ways to restore disrupted relationships included receiving input from systemic therapy. Limitations: Literature was limited for certain review questions and more extensive for others. Only a few reports addressed care relationships as such with the rest focusing on communication or interactions. Time constraints prevented us from including more kinds of reports. The voice of residents was limited. Implications: We hope that this review contributes to and expands knowledge around care relationships and shapes directions for future research. Findings can be used by support staff, service managers, residents, trainers, advocates, regulators, and researchers.

Zur Beitragssatzentwicklung in der Sozialen Pflegeversicherung – Wie wirkt ein Einfriermodell mit degressiver Leistungsdynamisierung?

Abstract An increasing contribution rate in social long-term care insurance is likely to be unavoidable in the future. To achieve the possibility of contribution rate stability, we consider the idea of a freezing model with partial degressive benefit dynamization. Using a projection model to calculate the potential future development of the contribution rate, we analyze the dampening effects of this proposal. In terms of contribution rate stability and sustainable financing in social long-term care insurance, the considered approach is able to make a significant contribution. Conclusively, it represents a compromise between subsidiarity and solidarity by transferring more responsibility to younger generations and continuing to guarantee social support to older generations.

From the Perspective of Internal Control, Research on the Government Responsibility for the Construction of Long Term Care Insurance System in China

Under the pressure of aging, aging of the aged, disability, empty nesting and so on, the demand for long-term care services for the elderly in China has risen sharply. To explore and establish a social long-term care insurance system is conducive to meeting the needs of the elderly for long-term care services. This paper demonstrates the necessity of government responsibility in the social long-term care insurance system, discusses the advantages and disadvantages of different government responsibility modes and the choice of government responsibility modes, and analyzes in depth the implementation of government responsibility. Specific contents.

Assessment of satisfaction with quality of stationery long-term social care system: the Stavropol Territory case

Assessment of satisfaction with quality of stationery long-term social care system: the Stavropol Territory case

Socialinių paslaugų poreikio vertinimas iš pasiūlos perspektyvos: Panevėžio miesto savivaldybės atvejis

The paper presents the results of assessing the need for social services in Panevėžys City Municipality from the providers’ perspective. It is noted that the city has ambitions to become the most important gateway to the northeast of Lithuania. However, at the same time, it is one of the regions in Lithuania most affected by demographic changes. As the population age structure changes, so are the needs of the established population structure. The growing number of older people is also shifting the priorities for allocating society’s resources in the areas of economics, politics, social solidarity, health care, and social ecology, which implies the need to ensure the volume, composition, and quality of social services. The results of a survey of the population on the quality and demand for social services in the municipality, initiated by the municipality of Panevėžys, characterised the state of social services as not fulfilling expectations. In the context of the development of services, this study aims to assess the situation in the social services field from the providers’ point of view. The objectives of the study are focused on revealing the attitudes of social service providers towards the quality of services provided and the need for new services. The methods of data collection were interviews, and descriptive content analysis was used for processing. As a result of the research, the position on the supply of social services in Panevėžys City Municipality was divided. On the one hand, it was acknowledged that over the last 3 years, changes were observed in the city regarding the scope and structure of social services, although, in many cases, determined by changes in the external environment. In this sense, the growing role of the municipality as a change initiator was also mentioned. On the other hand, the shortage of specialists in certain areas, the workload, emotional burnout, lack of motivation of the staff, inefficient administration of social services and lack of interinstitutional cooperation and coordination have been identified as fundamental issues to be tackled, which are linked to the quality of the services that are being called into question. The study has shown a particular need to extend the scope of home care to social care and social care to daycare, intensifying short- and long-term social care. There is no clear need to expand the scope of social institutions. In terms of supply, the declared approach is to differentiate between institutions based on their capacity to ensure quality, considering the volume of activities, competencies, resources, and potential if there is a need for new social services in the city. The need for new social service providers has emerged.

Quality of Services Provided by Social Care Centres for the Elderly in Latvia: Challenges and Possible Solutions

Latvia faces the challenges of an ageing society, which increases the demand for long-term social care services at municipal level. The aim of the work was to address the problematic issue related to the quality assurance and control of the care service for people of retirement age and the improvement of this quality control process in SCCs in Latvian municipalities. In addition, an analysis of the administrative data of social care homes in Latvia was carried out. The authors have concluded that currently, the arrival at an objective assessment of SCC service quality is impossible. The content of this work allows to argue that quality indicators (QI) should be integrated within SCC quality assessment, thus providing several advantages in terms of service planning and quality assessment, and the use of data for high quantity research.

Usefulness of Administrative Data in Assessing the Service Quality and Technical Efficiency of Social Care Centres

Latvia, like other countries worldwide, faces the challenges of an ageing society, with an increasing proportion of elderly population group and the demand for long-term social care services at local level. The Latvian Social Protection and Labour Market Policy Guidelines for 2021–2027 include actions on the improvement of the quality monitoring and efficiency assessment system of social services. In this article, the authors evaluate the quality of 67 social care centres (SCC) in the period from 2011 to 2017, and technical efficiency (TE) of 64 SCCs in 2017 by using publicly available administrative data of SCCs. The aim of the work is to find out whether administrative data can be used in the evaluation of the quality of care at SCC and TE of SCC. The authors conclude that the analysis of administrative data does not allow one to determine the quality of SCC because administrative data do not contain predictors of the care process. The administrative data of SCC can be used in the evaluation of TE of SCC, where, depending on the applied method, set goals, and objectives, the obtained results can be used to determine the effectiveness of local government SCCs and to improve economic activity. Based on the content of the work, the authors point out the need to introduce unified quality indicators (QI) of the care process at SCCs of Latvia. This would ensure opportunities for control of the quality of care at SCCs, transparency of the care process, and quality assessment. In addition, QI can be used as a component in evaluating the efficiency of SCCs. The authors acknowledge that further research related to the assessment of SCC quality and efficiency in Latvia is needed.

CHANGES IN PATTERNS OF FORMAL AND INFORMAL HELP AND UNMET NEEDS AMONG KOREAN OLDER ADULTS

Abstract Despite the consistent expansion of social long-term care insurance (LTCI), informal care by family members is still dominant in Korea. This study aims to examine how older adults in need utilized formal and informal sources of help and how patterns of help and unmet needs changed over time, since LTCI has been introduced in 2008. Community-dwelling older adults (65+) from the Korean Longitudinal Study of Ageing (N = 2,501) reported their I/ADL limitations and who helped them—if they are in need in 2010 and 2018. We grouped older adults’ sources of care into (a) no help, (b) informal help only, and (c) any formal help, and examined the patterns by wave and gender. Among older adults with I/ADL limitations, formal help use increased between waves (1% to 12%), suggesting the impact of LTCI expansion. Changes in the patterns of help and unmet need differed by gender. The proportion of older men with no help dramatically decreased (41% to 27%); more men received informal or formal help in 2018. In contrast, the proportion of older women who did not receive any help remained similar (33% to 34%); thus, although more women received formal help, less women relied on informal help in 2018. Within the context of LTCI expansion, older men may mobilize support from their family further, which contributes to lowered unmet needs. However, older women’s unmet need did not decrease, while reduced use of informal help. These findings highlight the importance of considering gendered long-term care resources in Korea.

Met or unmet need for long-term care: Formal and informal care in southern Europe

Southern European countries share many common traits but there are differences among them that can justify different levels of need and of unmet need for social long-term care (LTC). In our study, we quantify met and unmet need for LTC for older people, in the four southern European countries – Portugal, Spain, Italy, and Greece – and we analyse their determinants, using multinomial logits and data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). We analyse the association between several demographic and socio-economic factors and the chances of having needs, and of receiving or not different types of care. Although most of the effects of the explanatory variables are valid in all the countries, some factors are more important in some countries than in others. Portugal stands out as the country where people aged fifty or older have more care needs and, as a result, a higher risk of having people with unmet social care needs, compared to the other countries. Also, there is evidence that Portuguese women are especially penalized. In Greece and Portugal, people with the same characteristics have a higher probability of receiving exclusively informal care. Curiously, despite its suboptimal LTC system, the Greek reliance on informal care leads to superior performance in terms of unmet needs of people with ADL limitations. Italy and Spain show similar traits, particularly concerning the probabilities of having care needs and experiencing unmet needs. However, in Spain, receiving exclusively informal care is much less probable. Our findings suggest caution in the treatment of southern European countries as a uniform cluster and the need to take the differences into consideration when defining a policy to promote disability-free ageing or to guarantee that support is provided when needed.

The social long-term care insurance model: comparing actor configurations across countries and time

AbstractTo date, social long-term care insurance (SLTCI) systems have been introduced in six countries globally: the Netherlands, Israel, Germany, Japan, Luxembourg and South Korea. Applying an actor-centred, multi-dimensional framework and fuzzy-set analysis, the present article investigates the typical characteristics and variations of these SLTCI schemes at introduction and today. In short, we find that the SLTCI model features dominant social contribution financing, a mix of for- and non-profit providers, and state regulation. In light of the relevance of corporate self-regulation often associated with social insurance systems, the dominance of state regulation is unexpected. The analysis also reveals considerable variance between cases, most notably concerning the extent of private individual actors’ involvement. While geographical proximity of countries does not explain differences between SLTCI systems, “temporal clusters” seem to partly drive the variation of SLTCI actor configurations.

Asymmetric information, strategic transfers, and the design of long-term care policies

Abstract We study the optimal design of social long-term care (LTC) insurance when the utility of informal caregivers is taken into account. Informal care is exchange-based. Children’s cost of providing care is continuously distributed over some interval and is not observable. Parents choose a rule specifying transfers conditional on the level of informal care. We study first uniform provision of LTC and then a nonlinear policy depending on family transfers. In both cases, informal care increases with the children’s welfare weight. Our theoretical analysis is completed by calibrated numerical solutions. Uniform public care should represent up to 40% of total care but its share decreases to about 30% as the weight of children increases. In the nonlinear case, public care increases with the children’s cost of providing care at a faster rate when children’s weight in social welfare is higher. It represents 100% of total care for families with high-cost children.

The long life-time shadow of bullying: cost-effectiveness of KiVa to reduce bullying in primary schools

BackgroundThe ‘long shadow’ of childhood bullying can extend beyond immediate adverse mental health and educational outcomes well into adulthood, with associated long-term health and social care costs. Reducing bullying is therefore a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in schools in Finland and is currently being tested in the UK through the large-scale Stand Together trial. MethodsThe Stand Together trial is a two-arm, pragmatic multicentre cluster randomised controlled trial (RCT) to test the effectiveness and cost-effectiveness of KiVa in reducing bullying in UK primary schools compared to usual practice over one academic year. The trial is targeting approximately 13,000 7- to 11-year-olds in 116 primary schools across England and Wales, including North Wales, the West Midlands, South East- and South West England. Usual practice is defined as the delivery of the Personal and Social Education (PSE) curriculum in Wales and the Personal, Social, Health and Economic (PSHE) Education in England. To assess cost-effectiveness, we are conducting a cost-utility analysis and wider cost-consequence analysis from a school and societal perspective. Pupil self-reported health-related quality of life (CHU9D) is the primary outcome to enable the calculation of quality-adjusted life years (QALYs) in an Incremental Cost Effectiveness Ratio (ICER). The cost-consequence analysis will consider other outcomes such as pupil self-reported bullying-victimisation, pupil absence and bullying-related service use, teacher wellbeing and the frequency of parent-school meetings regarding bullying. Cost calculations will include the time and resources required to implement KiVa in schools versus usual practice, including the cost of resources and training. We will undertake sensitivity analysis to explore the impact of assumptions about dose of intervention, adherence, and costs of delivery. Our analyses will provide the first large-scale RCT-based evidence of the cost-effectiveness of KiVa in UK primary schools.

Well-being losses by providing informal care to elderly people: Evidence from 310 caregivers in Shanghai, China.

A series of policies aimed toward rational resource allocation of long‐term care have being actively discussed since the launch of the social long‐term care insurance in Shanghai, and it is important to take a societal perspective for informed decision‐making. This study aims to explore factors that are associated with well‐being of informal caregivers in Shanghai, and to provide empirical evidence of application of an established well‐being valuation method to monetise informal caregivers' well‐being losses in a developing country. 310 informal caregivers of applicants for social long‐term care insurance in Shanghai were interviewed. Univariate and multivariate analyses were conducted to explore the associated factors with life satisfaction of the caregivers. The monetary values of an additional hour of caregiving with and without specification of care tasks were estimated by the well‐being valuation method. Life satisfaction was consistently associated with monthly income, health status, and caring hours of the caregivers. The money needed to compensate one additional hour of caring per week was 12.58 CNY (0.3% of the monthly income), and 96.95 CNY (2.0% of the monthly income) for activities of daily living (ADL) tasks. Income, health status, and caregiving are significantly associated with well‐being of informal caregivers. Caregivers in relatively poor health condition and/or involved in more ADL tasks should be particularly considered in supporting policies in Shanghai.

Measuring Childlessness Among Middle-Aged and Older Americans

Existing literature on childlessness among middle-aged and older Americans is sparse, and measuring childlessness is not straightforward for those with complex family histories. To address this knowledge gap, we examined data on 19,929 respondents age ≥50 from the 2016 Health and Retirement Study. All analyses accounted for complex sample design to generate nationally representative estimates. The proportion of respondents without children differed significantly depending on how “childless” was defined: 1) 14.9% (95% confidence interval [CI]: 13.9-15.9%) having no biological children, versus 2) 10.4% (95% CI: 9.5-11.3%) having no children/step-children that were living and in-contact. When measured based on absence of biological children, the prevalence of childlessness was higher in younger cohorts (17.7%, 13.2%, and 9.0% for age 50-64, 65-74, and ≥75 years, respectively, p<0.001) and among more educated individuals (17.4%, 12.3%, and 9.6% for more than high school, high school, and less than high school education, respectively, p<0.001). The prevalence of childlessness was also higher among men (16.7%) than women (13.2%) (p<0.001) and among non-Hispanic whites (16.0%) than Hispanics (9.8%) (p<0.001). Similar patterns, but lower prevalence, were observed when measuring childlessness based on absence of children/step-children that were living and in-contact. Although non-Hispanic whites (16.0%) were more likely than non-Hispanic blacks (13.0%) to have no biological children (p=0.007), a similar proportion of them had no children/step-children that were living and in-contact (10.8% versus 10.6%, p=0.06). Given fertility decline and growing family complexity, these findings help inform the structure of social support and long-term care needs of middle-aged and older Americans.

Social Care Insurance: A Review of Psychological Influences on Uptake.

There is not currently a developed market for long-term social care insurance in England. Policymakers are interested in what behavioral influences should be considered in the design of insurance products for long-term social care to increase uptake. This review describes the behavioral factors that might be barriers or facilitators of uptake and could be considered in future policy solutions. Behavioral factors include psychological capabilities (knowledge and understanding), which are important given that public knowledge on this topic is poor. Psychological motivations (reflective or automatic biases) may also influence consumers' decision-making. Cultural factors such as language barriers and family norms for caring are considered. Overall, the authors demonstrate processes by which the uptake of long-term social care insurance can be encouraged, pertinent to policymakers.

Person-centred care in Northern Ireland: learning from the experiences of adult social care users

PurposeThe move towards a “person-centred” or “personalised” system of adult social care has been at the heart of policy debates in Great Britain. However, policy developments in Northern Ireland are more limited than in other parts of the UK, and less attention has been paid to reforming adult social care. The purpose of this paper is to examine the views and experiences of adult social care users who receive care at home, to explore if and how a person-centred approach might work for older adults in Northern Ireland.Design/methodology/approachUsing a qualitative approach, semi-structured interviews were carried out with 12 people aged over 70 years who receive social care provision at home.FindingsThe empirical findings show that social care users experienced limited involvement in their care planning process, reflecting a predominantly service-led approach. The importance of care worker continuity and consistency was crucial for all participants, particularly for maintaining discreet routines and promoting personal dignity. However many experienced different care workers which presented challenges caused by the inconsistency of carers.Research limitations/implicationsThe majority of participants in the study were women, despite attempts to achieve greater gender diversity. It was also difficult to recruit a range of ethnic groups for the study. It would be important for future studies to include these groups and to ensure their voices are represented in further work in this area. Nonetheless, the findings offer valuable insight into the views of adult social care users and can form a useful basis for future studies.Originality/valueThe findings provide a more nuanced understanding of what people want and expect in social care to generate future policy debates and discussions in planning long-term adult social care provision in Northern Ireland. It also provides important and timely contribution to this area, where there is currently limited research and information available.

Continuity of care and health care cost among community‐dwelling older adult veterans living with dementia

To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N=102073). Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.

Willingness-to-pay and willingness-to-accept of informal caregivers of dependent elderly people in Shanghai, China

BackgroundIn order to make optimal long-term care-related decisions, it is important to take a societal perspective. Shanghai is one of the pilot cities of social long-term care insurance in China. However, little knowledge exists about the economic value of the informal care provided to dependent elderly people in China. This paper aims to evaluate the economic value of informal caregiving in Shanghai using the contingent valuation method by their least-preferred care tasks, and identify the associated factors of willingness-to-pay (WTP) and willingness-to-accept (WTA) of the informal caregivers.MethodsThis study employed the contingent valuation method to elicit 371 informal caregivers’ WTP and WTA for 1 hour of reduction or increase of least-preferred caring tasks in Shanghai. Univariate and multivariate analyses were conducted to explore the associated factors with the WTP and WTA values.ResultsThe average WTP and WTA were 25.31 CNY and 38.66 CNY, respectively. The associated factors with WTP include caregiver’s income and caregiver’s relationship to the recipient. Care recipient’s age, income, least-preferred task by the caregiver, and subscales of Caregiver Reaction Assessment were found to be associated with WTA. The non-responsiveness rates were 26.1 and 33.2% for WTP and WTA questions, respectively.ConclusionsThe findings of the current study demonstrated that decision-makers and researchers should take the economic valuation results of informal care into account to make more informed and effective long-term care-related policies and analyses.

Historical and medical aspects of the organization of medical and social services for the elderly and senile people in Russia in the late XX — early XXI centuries

When analyzing the historical and medical aspects of the organization of medical and social services for the elderly and senile people in Russia in the late XX — early XXI centuries not only obvious achievements in this sphere, but also a number of problems requiring solution were identified. The primary role in the delivery of medical care to geriatric patients is assigned to the primary health care sector. However the work of the geriatric service in the format of a single system for the provision of long-term medical and social care based on the continuity of patient management between differ- ent levels of the health care system and between the health and social protection services is not well organized. There is no clear coordination and interaction between health care and social protection institutions, functions of which include providing care to older citizens, and it significantly reduces the effectiveness of the provision of both medical and social services.