Long-term Care System Research Articles

Measures to support informal care for the older adults in Kazakhstan: a review of the current status.

The demand for informal caregivers to support the older adults has grown worldwide in recent decades. However, informal caregivers themselves require support. This article aims to examine existing support measures for caregivers of the older adults in the Republic of Kazakhstan. Relevant articles and grey literature were identified through manual searches on Google and Google Scholar, as well as electronic searches using indexed databases like PubMed, Web of Science, and Scopus. Moreover, the reference lists of identified sources and government ministry websites were meticulously scrutinized. This review highlights the scarcity of research on caregiver support measures in Kazakhstan, supported by the lack of peer-reviewed articles on this subject. A comprehensive analysis of the literature shows that in Kazakhstan's legislative framework, "caregivers" exclusively refers to individuals providing care for a first-degree disability. The responsibility of caring for older adults parents lies with able-bodied children. However, there is a lack of registration and assessment procedures to evaluate the burden and quality of life of caregivers. As a result, the medical and social support provided to caregivers is standardized, failing to adequately address their unique needs and requirements. The analysis of current support measures for informal caregivers highlights the need to develop support mechanisms and recognize individuals providing informal care as key figures in the long-term care system.

Influence of Sociodemographic, Organizational, and Social Factors on Turnover Consideration Among Eldercare Workers: A Quantitative Survey.

Staff turnover in long-term care (LTC) is considered one of the main causes of staff shortages and a key problem for LTC systems in the developed world. Factors affecting staff turnover in LTC facilities are poorly understood due to a fragmented approach. The aim of this study was to use multivariate analysis to identify the factors at the macro-, meso-, and micro-level that influence LTC workers' turnover in Slovenia, a typical Central and Eastern European country. A correlational cross-sectional survey design with a self-reported online questionnaire was used among Slovenian LTC workers (N = 452). The results show that more than half of LTC workers intend to quit their jobs and leave the LTC sector. LTC workers who intend to leave are generally younger, have worked in the LTC sector for a shorter period, are mainly employed in the public sector, especially in nursing homes, and earn less. The connection between the intention to leave and the factors at the macro-, meso-, and micro-level is very high. Over 75% of the variance of intention to leave was explained by the linear influence of sociodemographic characteristics, social recognition, and work environment. Urgent measures for improving the work environment are needed.

Projected Savings to Canadian Provincial Budgets from Reduced Long-Term Care Home Utilization Due to a Disease-Modifying Alzheimer’s Treatment

BackgroundA disease-modifying Alzheimer’s treatment could provide budgetary savings to Canadian provinces from a reduction in long-term care home use, yet we do not know the magnitude of those potential savings.ObjectiveWe project savings to each Canadian province’s budget from 2023 to 2043.DesignAnnual savings are projected using a Markov model. We account for reduction in long-term care home use and in use of Alternative Level of Care (ALC) beds, which are hospital beds occupied by care home-eligible patients on the wait list for admission.ResultsA treatment that delays disease progression by 40% is projected to avoid 142,507 long-term care home and ALC years, resulting in $17.2 billion cumulative savings across all Canadian provinces, a 21% relative reduction among treatment eligible patients. Average per capita savings were $1,132, ranging from $734 (Alberta) to $2,895 (Prince Edward Island). Cumulative savings could increase to $22.7 billion with enhanced triage of patients in primary care stages and to $25.6 billion if all capacity constraints for diagnosis and treatment were removed.ConclusionA disease-modifying treatment could create budgetary savings from lower long-term care home use, offsetting part of the treatment cost. With the increasing demand for long-term care home beds and the high rates of patients being held in hospitals while wait-listed, such a treatment could additionally provide relief to the overburdened long-term care system in Canada.

COVID-19 and Nursing Homes in Decentralized Spain: How Governance and Public Policies Influence Working Conditions and Organizational Responses to the Crisis

How did long-term care (LTC) policies and the prevailing governance model affect the working conditions of nursing home workers in Spain during the COVID-19 pandemic? Here, we rely on qualitative analysis of semi-structured interviews and document analysis to answer the research question. The results suggest that lack of coordination between health and social services, underfunding of the LTC system, and the absence of legislative initiatives have harmed caregivers’ labor and employment conditions and the effectiveness of managing the crisis. These findings are relevant as they expose the implications of the territorial structure of welfare and sectoral public policies in managing a crisis.

When health trumps money: Economic incentives and health equity in the public provision of nursing homes in Norway

The allocation of public care services should be determined by individual needs, but can be influenced by economic factors. This paper examines the impact of economic incentives on the allocation of public nursing home care in the Norwegian long-term care system. In Norway, municipalities and city districts have economic incentives for choosing nursing home care for high-income individuals in need of care and home-based care in sheltered housing for low-income individuals. The study uses a theoretical model and empirical data from the municipality of Oslo to determine if nursing home spots are allocated based on income, which would be financially advantageous for the city districts. We do not find evidence that the economic incentives of the care provider play a role in the allocation of nursing homes. Thus, in this setting, needs seem to be the dominant factor for allocation of nursing home care, while economic incentives seem to play no significant role. The clear legal mandate to provide services based on needs only is likely an important factor in this.

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

Integrated Long-Term Care 'Neighbourhoods' to Support Older Populations: Evolving Strategies in Japan and England.

Western countries are currently facing the public health challenge of a rapidly aging population and the associated challenge of providing long-term care services to meet its needs with a reduced working age population. As people age, they will increasingly require both health and social care services to maintain their quality of life and these will need to be integrated to provide cost-effective long-term care. The World Health Organization recommended in 2020 that all countries should have integrated long-term care strategies to better support their older populations. Japan, with the most rapidly ageing society in the world, started to address this challenge in the 1990s. In 2017, it introduced a national policy for integrated long-term health and social care services at a local geographical level for older people. England has recently embarked on its first plan aiming for the integration of services for older people. In this article, we compare these approaches to the integration of long-term care systems, including the strengths of each. The paper also considers the effects of historical, cultural and organizational factors and the emerging role of technology. Finally, we identify critical lessons that can inform strategy development in other countries, and highlight the need to provide more international comparisons.

The multiplier effect from the development of a long-term care system for elderly citizens

Lately, the demand for long-term care for the elderly as well as the requirements to its quality have been increasing worldwide. The annual growth in the volume of state investment in the system of long-term care for the elderly generates multiplier effects for the development of certain types of activities in the services sector. The article aims to devise a method for calculating these effects. The methodological basis of the study is the Keynesian multiplier and institutional theory. Statistical and economic methods are applied. The paper performs calculations using the own method based on the Keynesian approach and including a system of linear equations. The data comes from twelve pilot social welfare institutions of the Stavropol krai (Russia). The authors formulate the own definitions to the concepts “multiplier effect in the long-term care system” and “multiplier of the development of the long-term care system (for services)”. According to the results of testing the suggested method, the annual increase in state investment funds allocated for the long-term care system leads to an increase in the expenditures of pilot institutions on various types of services (transport, utilities, education, communications, catering, cultural events, health resort treatment). The findings expand theoretical and practical knowledge about the peculiarities of determining the multiplier effect.

Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people

BackgroundFrom 2020 to 2050, China’s population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer’s disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country.MethodsUsing official and population-level statistics, we summarise China’s demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China’s improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: ‘what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?’. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China’s second long-term care insurance pilot phase in 2020.ResultsRapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home.ConclusionsChina has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

The work status of nurses in long-term care institutions in elderly care: A qualitative descriptive study.

To understand the work status of nurses in long-term care institutions in China for elderly care to provide a reference for further formulating management strategies and promoting the development of long-term care teams. Using qualitative descriptive research methods, 31 nurses from three long-term care institutions were selected through purposive sampling for in-depth interviews, and a three-week participatory observation was conducted on the daily work of nurses in the above three long-term care institutions. Content analysis was used to analyse data. In our sample, nurses in long-term care institutions had insufficient manpower, generally had low academic qualifications, and lacked professional ability. Their work enthusiasm and initiative need to be further improved. Long-term care nurses were moderately paid, and their salary satisfaction was lower than in other trades. At the same time, the social understanding of the long-term care industry was insufficient, and the social identity of nurses in long-term care institutions was low. The development of long-term care requires the joint efforts of nurses, medical institutions, and society. By improving the system, cultivating talents and building a harmonious atmosphere, we aim to enhance the work enthusiasm of long-term care nurses and promote the stable and orderly development of the long-term care team. Nurses in long-term care institutions are at the core of the ageing age and play a vital role in coping with the ageing problem, meeting long-term care needs, improving the quality of life of old people and reducing the cost of long-term care. The training and management of nurses in long-term care institutions and the construction of the entire long-term care system should be based on China's national conditions and actual needs.

The impact of different care dependencies on people’s willingness to provide informal care: a discrete choice experiment in Germany

BackgroundInformal care provided by family members, friends, or neighbors is a major pillar in the German long-term care system. As the number of care-dependent older adults grow, ensuring their future care still relies on the willingness of family members, friends, or neighbors to assume the role of an informal caregiver. This study aimed to investigate the impact on people’s willingness to provide informal care to a close relative with predominately cognitive compared to physical impairments.MethodsAn online survey was distributed to the general population in Germany, which resulted in 260 participants. A discrete choice experiment was created to elicit and quantify people’s preferences. A conditional logit model was used to investigate preferences and marginal willingness-to-accept values were estimated for one hour of informal caregiving.ResultsIncreased care time per day (hours) and expected duration of caregiving were negatively valued by the participants and reduced willingness to care. Descriptions of the two care dependencies had a significant impact on participants’ decisions. Having to provide care to a close relative with cognitive impairments was slightly preferred over caring for a relative with physical impairments.ConclusionsOur study results show the impact of different factors on the willingness to provide informal care to a close relative. How far the preference weights as well as the high willingness-to-accept values for an hour of caregiving can be explained by the sociodemographic structure of our cohort needs to be investigated by further research. Participants slightly preferred caring for a close relative with cognitive impairments, which might be explained by fear or discomfort with providing personal care to a relative with physical impairments or feelings of sympathy and pity towards people with dementia. Future qualitative research designs can help understand these motivations.

Exploring Legal Issues Related to the Application of Artificial Intelligence in Long-Term Care Systems

Exploring Legal Issues Related to the Application of Artificial Intelligence in Long-Term Care Systems

PROMJENA RELATIVNE EFIKASNOSTI SUSTAVA DUGOTRAJNE SKRBI U ODABRANIM ZEMLJAMA OECD-A

The population is ageing, which has many social and economic implications, and one of them is an increase in demand for institutional long-term care for the elderly. Therefore, the aim of this paper is to analyse the change and to detect whether there are differences between twelve selected OECD countries in the period 2014-2019 in regard to the values of total factor productivity of long-term care system for the population aged 65 and over these countries. The Malmquist – DEA performance measure, under the assumption of the variable returns to scale (BCC model) and by using the input-oriented model, has been used to obtain the patterns of productivity change. The number of long-term workers and the number of beds in residential long-term care facilities are selected as input variables, while the number of long-term care recipients has been used as an output variable. According to obtained results, the total factor productivity in selected OECD countries increased by 1.023% in the analysed period. The increase is mainly a consequence of a 1.018% increase in technical efficiency, which emphasises an increase in managerial relative efficiency. Results obtained for Turkey indicate the highest productivity increase, accompanied by both a rise in technical efficiency and in technological change. Additionally, an increase in technical change that reflects a catch-up effect and a modest increase in technological change, indicating a lack of innovation altogether, resulted in an average productivity increase of 1.02% over the analysed period.

Formation of a mechanism for regulating the long-term care system for senior citizens in Stavropol Krai of the Russian Federation

The article is devoted to the issue of developing the interaction of participants in the system of long-term care for senior citizens. The solution of this problem will improve the quality and level of provision of social care services and will help to meet the existing interests and individual needs of the recipients of social services. The purpose of the article is to develop a mechanism for regulating the system of longterm care for older people using financial, personnel, organizational, managerial, information and technological components in the Stavropol Krai of the Russian Federation. The authors used such research methods as a systematic approach, analysis and systematization of information, methods of processing and displaying the information received. The article analyzes the existing definitions of the “mechanism”, “regulatory mechanism” concepts. Based on the analysis of definitions, considering industry specifics, the authors’ definition of the mechanism for regulating the longterm care system is formulated. Based on the results of the article, the authors concluded that the formed mechanism is able to ensure coordinated and interdepartmental interaction between all participants in the long-term care system at the regional and municipal levels, as well as attracting additional financial, human, organizational resources to provide social care services of proper quality, which will fully satisfy the need for them among the recipients of services.

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.

'Where do we come from and where are we going?' A study about the transformation of knowledge related to long-term care.

The care crisis manifests the tensions and profound changes which are taking place in contemporary long-term care systems, leading to new care views and modalities in society. Through 26 interviews conducted with caregivers, family members and elderly people with care needs, this study aims to make visible the transformation in the conceptions of care in the Basque Country. First, the results show the displacement of familiarist ideas and values. Second, we describe the daily management of the social and moral tensions associated with outsourcing and the meaning of care work. Third, the findings indicate the emergence of new perspectives on the modalities of care. The contribution of cognitive polyphasia towards analysing the management and integration of new knowledge associated with care in a specific socio-cultural context is discussed. Finally, we consider the applicability of our findings in terms of relevant solutions for care management and innovation in this field.

The intergenerational transmission of filial norms and children's provision of long-term care to parents

Abstract In the light of an increasing future demand for long-term care services in ageing societies, families' provision for current and future long-term care needs has been subject to debate. Within this context, there is little discussion about parents' incentives to socialise their children to their own traits to achieve a desired child behaviour. Our study contributes to the literature by analysing to what extent parents transmit filial norms to their children and whether this transmission process affects children's care-giving behaviour if a parent needs long-term care. Using data from the German Family Panel, we initially analyse the transmission of filial norms from mothers and fathers to their children. Second, we examine the importance of filial norms that prevail in the child's local environment. Third, we assess whether an intergenerational transmission of norms transmits into child behaviour if a parent needs long-term care. We estimate linear regression models and account for child and parent characteristics as well as for the living environment. The results show that children have stronger filial norms when both parents report stronger filial norms. But, children also tend to be influenced by average norms in their local environment. Furthermore, children are more likely to provide support to a parent in need when their filial norms are stronger. We conclude that children's filial norms are at least partially shaped via a process of socialisation and that these norms transmit into children's care-giving behaviour if a parent needs long-term care. It is, therefore, important that filial norms that prevail in a society are in accordance with the institutional long-term care system that prevails within that country.

The influence of strong social ties on the choice of long-term care model for middle-aged and older adults in China.

With the acceleration of population aging in China, the care of middle-aged and older adults has become the focus of social attention. As China is an "acquaintance society," strong social relations play an important role in residents' access to information and resource allocation, which has an impact on the choice of long-term care models for middle-aged and older adults. Therefore, based on the 19,728 samples from the 2018 CHARLS Phase I data, an empirical analysis was conducted using a logistic dichotomous model, which showed that both kinship (p < 0.01) and friendship (p < 0.01) among social relationships positively influenced the choice of social care models for middle-aged and older adults. The analysis of the heterogeneity showed that the choice of long-term care models was significantly influenced by strong social relationships in the central and western regions and rural areas (p < 0.01). On the basis of this, the transmission mechanism of strong social relationships was further analyzed in conjunction with the further construction of the SIRS Contagion Model, which was used to describe the information transmission process. The results showed that residents who attached importance to strong social ties were more likely to incur medical transfer expenditure, thus further increasing their own demand for the formal care model. The policy implications of this study are to promote the coordinated development of long-term formal care and strong social relations, to further promote the socialization of the formal care model while relying on traditional family care, and to build a multi-level and diversified long-term care system for middle-aged and older adults.

Female perspective: the burden of Alzheimer's disease and other dementias in China from 1990 to 2019 and prediction of their prevalence up to 2044.

Dementia is more prevalent in women than in men across the world, and sex differences are reflected in the burden of dementia borne by women and men. However, a few studies have specifically analyzed the disease burden of dementia in Chinese women. This article aims to raise awareness of Chinese females with dementia (CFWD), outline an effective response to future trends in China from a female perspective, and provide a reference for the scientific formulation of dementia prevention and treatment policies in China. In this article, epidemiological data on dementia in Chinese women were obtained from the Global Burden of Disease Study 2019, and three risk factors, namely, smoking, a high body mass index, and a high fasting plasma glucose, were selected for the analysis. This article also predicted the burden of dementia in Chinese women in the next 25 years. The prevalence of dementia, mortality, and disability-adjusted life year rates increased with age in CFWD in 2019. All three risk factors provided by the Global Burden of Disease Study 2019 showed positive correlations for the effect of disability-adjusted life years (DALYs) rates on CFWD. Among them, a high body mass index had the greatest effect (8%) and smoking had the smallest effect (6.4%). Over the next 25 years, the number of CFWD and its prevalence are expected to be on the rise, while mortality is expected to remain relatively stable and decline slightly, but deaths from dementia will continue to increase. The situation arising due to the spread of dementia among Chinese women in the future is going to become a serious issue. To reduce the burden of dementia, the Chinese government should prioritize its prevention and treatment. A multi-dimensional, long-term care system involving families, community, and hospitals should also be established and supported.

Innovative management of the social sphere in the context of digitalization

The paper investigates the implementation of digital solutions and technologies in the social services for senior citizens in terms of the national project “Demography”. Current changes, according to the author’s position, form a new and problematic area for the management of social processes at the stages of planning, forecasting, control, and exchange of information. The development of information systems and electronic services is only one aspect of the multifactorial nature of the current situation. The main task is to solve the problem of interdepartmental fragmentation of participants in the system of long-term care for senior citizens and regulatory legal acts. Therefore, modern tendencies of studying and introduction of the positive experience of regions, search and systematization of information on effective methods of working with the population were analyzed, and examples of successful practices of innovative management were given. In addition, information products for different types of organizations were analyzed, and the modern system of interdepartmental interaction between healthcare and social service organizations in the provision of social services and medical care for senior citizens was assessed. Moreover, major problematic issues of interdepartmental interaction between healthcare and social service organizations in the provision of social services and medical care for senior citizens and the prospects for the effective development of resources of social service providers in the implementation of strategic sectoral development were identified. Consequently, recommendations on improving the efficiency of interdepartmental interaction in the system of social services and ways of exchanging information were offered. Particular attention was focused on the factors that inhibit innovation processes in the implementation of digital solutions and technologies in the activities of social services. In conclusion, the guidelines for the formation and development of innovative potential in the system of social services were specified.