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Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.

Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.

The study aims to devise a comprehensive evaluation model (CEM) for evaluating spatial equity in the layout of elderly service facilities (ESFs) to address the inequity in the layout of ESFs within city center communities characterized by limited land resources and a dense elderly population.

The CEM incorporates a suite of analytical tools, including accessibility assessment, Lorenz curve and Gini coefficient evaluations and spatial autocorrelation analysis. Utilizing this model, the study scrutinized the distributional equity of three distinct categories of ESFs in the city center of Xi’an and proposed targeted optimization strategies.

The findings reveal that (1) there are disparities in ESFs’ accessibility among different categories and communities, manifesting a distinct center (high) and periphery (low) distribution pattern; (2) there exists inequality in ESFs distribution, with nearly 50% of older adults accessing only 18% of elderly services, and these inequalities are more pronounced in urban areas with lower accessibility, and (3) approximately 14.7% of communities experience a supply-demand disequilibrium, with demand surpassing supply as a predominant issue in the ongoing development of ESFs.

The CEM formulated in this study offers policymakers, urban planners and service providers a scientific foundation and guidance for decision-making or policy amendment by promptly assessing and pinpointing areas of spatial inequity in ESFs and identifying deficiencies in their development.

Demand for long-term care services increases with population aging. This study aims to develop a conceptual model of elderly customers’ health-care experiences to explore the antecedents, mechanisms and outcomes of social participation in long-term care service organizations.

Using a two-phase data collection approach, this study collects data from 238 elderly customers in a long-term care service organization. The final data are analyzed through structural equation modeling.

The results show that care management efforts (i.e. customer education, perceived organization support, role modeling, perceived other customer support and diversity of activity) influence elderly customers’ psychological states (i.e. self-efficacy and sense of community), leading to increased social participation. In addition, high levels of social participation evoke positive service satisfaction and quality of life, both of which alleviate switching intention.

This study is one of the first conclusive service studies focused on the role of elderly customers’ social participation in their long-term care experience. The findings contribute to health-care service marketing and transformative service research, and expand understanding of elderly customers’ health-care experience, especially in long-term care service settings.

The purpose of this paper is to investigate eldercare issues in China through exploring what was discussed about eldercare in a Chinese online community for older adults (OCOA).

Netnography was used to explore eldercare-related online discussion in a Chinese OCOA – LaoYouBang. After a two-month-long online observation, 275 microblogs and 594 comments were collected and analysed qualitatively and quantitatively.

The main findings include as follows: the users involved in an online discussion about eldercare were consist of four categories, namely, elderly user, non-elderly user, advertiser and community administrator. Non-elderly user include the elderly’s caregivers and families, young and middle-aged people concerning about eldercare. From 2012 to 2017, eldercare issues gradually became refined and differentiated in China and elderly users’ contribution proportion and activeness increased yearly. According to the results of thematic analysis, users’ information needs for eldercare included opinion, news, practice, emotion, knowledge and others. In China, some changes have taken place in the public’s conceptions of eldercare, embodied in the changes in the public’s attention, attitudes and cognition. Changes in user structure and communication patterns in OCOA have also been noted. OCOA plays an important role in eldercare information dissemination and social support exchange and helps to meet the eldercare challenges.

This study explored an online community for older adults. This is the first netnography study in the information field on Chinese OCOA. This paper provides new perspectives to explore eldercare issues and OCOA in other regions and cultures and it also provides some suggestions to improve OCOA.

This article analyses community care services (CCS) in terms of availability, awareness, accessibility, and acceptance (the Four A’s approach), untangles the deep-seated factors underlying the CCS and provides some short-term, medium-term, and long-term recommendations.

A literature review was conducted, including relevant government reports, consultation papers, Legislative Council papers and articles from academic journals from 1980 to the present.

The Four A’s approach shows that applicants to both centre-based services and home-based services endure lengthy waiting times because of the limited number of CCS. Furthermore, the awareness of day respite services is approximately 50 percent, which lags behind other CCS. Accessibility is contingent on a cross-district day respite service system and a lack of consistency between the quota and the proportion of older adults in the districts. Finally, the level of service provided by CCS is unsatisfactory due to inflexible service provision. Reviewing the brief history of long-term care services (LTC) reveals the deep-seated factors at the core of their heavy reliance on the subvention model, in contrast to the adoption of the ‘mixed economy of care’ by residential care services (RCS). An imbalance in budget allocation to RCS and CCS is also revealed.

Although the principle of ‘ageing in place’ was introduced in 1977, the institutionalisation rate (6.8 percent) of older adults remains unexpectedly high in Hong Kong, even surpassing its Asian counterparts, whereas the usage rate of CCS hovers around 0.8 percent. Thus, how to implement policy concerning LTC services for older adults must be re-evaluated.

This qualitative study aims to explore the experiences of Taiwan’s community-based long-term care service stations.

Semi-structured interviews were conducted with eight managers selected from stations located in the counties with the highest proportion of elderly people.

The results are as follows: the main services offered by the stations include health promotion activities, congregate meal programs, respite care and making house calls; government subsidies constitute a major proportion of the service stations’ funds, followed by user payments and external donations; the adversities encountered include frequent policy revisions, the dwellers’ reluctance to participate in the activities, manpower shortages and subpar service quality; and the effects of the stations on the community include achieving aging in place, providing more options for life after retirement, mitigating caregivers’ burden, expanding the elderly’s social networks and strengthening their health literacy.

The results of this research can understand the benefits and difficulties of Tier C service centers in Taiwan. Also, the practical experiences provide some suggestions for policies and training. Future studies can focus on establishing systematized training programs and standardizing the service personnel’s competence.

Hong Kong implements a policy for the aging population involving the core themes of “aging in place as the core,” “institutional care as backup” and “continuum of care.” Encouraging elders to live independently at home is a top priority, and elders who are not able to live at home independently are provided with various residential care services, namely Hostels for the Elderly, Homes for the Aged, Care and Attention (C&A) Homes for the Elderly and Nursing Homes (NHs). The purpose of this paper is to analyze the adoption of the publicly funded model of providing residential care services of elderly in Hong Kong.

The paper analyzes the current conundrum encountered by elders in residential care services and makes recommendations. A comprehensive literature review was conducted covering relevant government reports, academics' journal papers and nongovernmental organizations’ reports concerning residential care service of elderly from 1965 to present.

Subsidized residential care homes for the elderly (RCHEs) clearly outperform private RCHEs in terms of space and staff provisions, but the supply of subsidized RCHEs cannot meet the demand. Hence, between 2007 and 2018, the average waiting time was 33 months for NHs and that for C&A homes was 23 months. Several viable measures to meet the demand are purchasing Enhanced Bought Place Schemes (EBPSs) from private RCHEs, subsidizing elders who opt for living in private RCHEs by providing them with Comprehensive Social Security Assistance (CSSA) and residential care service voucher (RCSV) and subsidizing elderly applicants who opt for living in RCHEs in Guangdong. However, these viable measures are problematic because of the inadequate quality of EBPSs and private RCHEs, which is attributed to the costing arrangement of public and private RCHEs that were established in the colonial period. The brief history of RCHEs also indicates a deviation from the original policy aim, namely aging in place, which was introduced in the Green Paper on Services for the Elderly in 1977.

The supply and quality of community and home care services should be thoroughly examined; effective community and home care services can prevent and even delay unnecessary institutionalization. Another complementary solution is to devise a long-term plan for residential care services. To address disparities in quality standards in different RCHEs, adopting the combination of punitive and compliance models such as conducting frequent inspections and implementing an accreditation system for private RCHEs is imperative.

Although the principle of “aging in place” originated in 1977, the institutionalization rate 6.8% of elders was unexpectedly high in Hong Kong and even surpassed the Asian counterparts. It necessities to rethink how to implement policy concerning long-term care services of elders.

Shanghai is currently faced with a rapid increase in the ageing population and demand for elderly homes. Continuing care retirement community (CCRC) has been emerging as a high-end alternative to offer specialised accommodation to the elderly in major cities. Since the first development in 2008, the industry is now still at the infancy stage. This study aims to examine the investment barriers hindering the supply and demand of CCRCs with an aim to recommend practical and senior housing policy measures to facilitate CCRC developments.

Multiple-case study method was used to confirm whether the literature findings on investment barriers apply to the context of Shanghai. Four representative CCRC development cases in Shanghai were examined, in which qualitative data were collected from interviews with experienced CCRC development managers and quantitative data from a questionnaire survey of the CCRC residents.

Operation management experience, financial risks and government support policy were found to be the main supply barriers. Chinese traditional family-oriented culture and affordability were not the main demand barriers of CCRCs in Shanghai. Poor quality of services and living environment were identified as the main barriers suppressing the demand for CCRC.

Although common trends and views can be drawn from the representative cases in Shanghai to provide valid results, further research should be conducted on other major cities in China so that the results can be widely applied.

Successful CCRC investment strategy should focus on partnering with experienced professional eldercare management companies, provisions of high-quality medical professionals and trained care personnel and delivery of flexible care service, along with intensive capital flows for land, construction and operating costs.

Additional senior housing policy support should be established to promote the CCRC supply to address the ageing needs, particularly granting lands for CCRC developments at Tiers 1 and 2 major cities where the land cost is high.

This research’s practical and policy measures can be applied to enable and promote CCRC developments in Shanghai, thus benefitting both housing investors and the government. The findings also form a baseline for CCRC developments in other major cities.

This chapter will review the evaluations of the newly developed elderly care system in Japan, Long Term Care Insurance, and its social implications with the focus on demographic change.

By reviewing literature, this chapter will examine how demographic and social change over the years has impacted the features of caregivers. Then, how this policy change has demedicalized the aging process will be described. Finally, this chapter will evaluate whether this insurance has shifted the responsibility for elderly care from the family to society as the governmental slogan advertised.

The new insurance has offered more options in different services and established a new norm of self-reliance and determination for one’s own aging however it is doubtful if this new insurance has shifted the responsibility from family to society.

Applying the implications of policy reforms for elderly care in Japan to the United States, one can assume the traditional U.S. norms and values can facilitate effective utilization of the elderly care system. However, since each nation faces different problems with its specific condition, continuous studies and observations on the relationship between elderly care, immigration issues, and demographic changes will be necessary in order to offer more specific suggestions for each aging nation.

As Japan’s new insurance scheme for the elderly has been studied by many aging nations, recommendations for more comprehensive plans are suggested including building a community-based support system into the Long Term Care Insurance scheme to prevent social isolation and respond to emergency situations for the elderly.

To review the voluntary operations of Counseling Services for the Elderly, which has operated since 1972 under the National Insurance Institute of the State of Israel.

The paper considers the elderly population and its characteristics and the gradual development of the volunteering counseling services. The characteristics of the volunteers and their motivation in this work are also discussed. The training that volunteers undergo is constantly being updated and upgraded, and details are provided that cover home visits, consultations and special projects.

Currently, Counseling Services for the Elderly operates 4,278 volunteers in 21 branches across the country, supporting thousands of the elderly on a relatively low budget of less than $3 million for 2003.

The paper presents a unique voluntary service that is fully integrated into national welfare for the elderly. The service meets the objectives of assistance to the elderly while helping to maintain and develop the quality of life of the volunteer.