Search results

The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the complexity of the health- and elderly care systems provides challenges in improving system efficiency. Hence, the system-level understanding of the main obstacles to integration care needs further exploration. In order to better integrate health- and elderly care, the study needs to identify the actual misalignments underpinning the issue. This study provides the theoretical foundations for resource misalignments and provides empirical examples of these.

Semi-structured interviews with multiple stakeholders on various hierarchical levels were carried out to create a more complete view of the system and resources deployed in health- and elderly care. The application of user-centered design methods and co-creation with employees have also been crucial to the outcomes of the study.

Results show that health- and elderly care is a large-scale complex system. The overlapping and mutually reinforcing misalignments are: (1) regulation and policy differences, (2) stakeholder quantity and variation, (3) external control of health- and elderly care, (3) decreasing collaboration and (4) communication channels and IT development.

This qualitative study builds on institutional theory and resource integration theory and contributes with empirical descriptions of misalignments in the health- and elderly care system. These descriptions will serve as points of departure for systems design to improve the efficiency and effectiveness of health- and elderly care.

Recruiting and retaining staff to work with elderly people in social care is a global issue. The quality of leadership is considered important because it influences employees’ job satisfaction, job turnover and health. This paper aims to identify leadership that employees in residential elderly care facilities in Sweden consider as contributing towards a healthy work environment.

The authors interviewed 14 persons employed in facilities organized in different ways. The data from these interviews was analysed using qualitative content analysis..

The results showed that the employees felt that their health partly depended on the attributes that leaders possessed, what leaders do and how leaders do it. This study confirms that leadership influences the perception of a healthy workplace. It also shows that questions about leadership are complex.

Research about factors that increase health risks is wide-ranging; however, research that examines factors that promote health, especially how leadership influences employees’ well-being, is not as comprehensive.

National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality).

Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM).

The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance.

Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level.

The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.

Research was conducted to investigate whether, and how, political accountability might stabilise when agents are faced with profound changes in external structures such as competition laws and austerity policies.

We performed a field study from 2007 to 2015 in a regional hub in Finland and worked with data from document analysis, interviews and meeting observations. We have used embedded research design, where we apply methodological bracketing as well as composite sequence analysis for field research.

Accountability declined when irresistible external structures were the dominant influence on the unreflective actions of agents-in-focus. With time, however, the agents started acting critically by drawing on structures that could facilitate strategic actions to stabilise political accountability.

The field research and interpretation of the data were limited to the organisation analysed; however, the theoretical arguments allow for analytical generalisations.

The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible change in external structures.

The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible changes in external structures.

The study locates political accountability in the context of strong structuration theory and discusses how it is redefined by external structures.

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.

The purpose of this paper is to examine the health sector reform toward 2040 of Japan as a super-aged society.

This paper discusses the current healthcare policies adopted in Japan and projects the challenges in future as a super-aged society.

Through Japanese experiences, it is considered that Community-based Integrated Care System is useful, which takes into account the perspective of health care users. Being a super-aged society, it is essential for Japan to have more consensus by further removing obstacles, and paying attention to the change of paradigm and the purpose of care.

Based on the case of Japan, this paper serves as a reference for other East Asian countries, which would sooner or later encounter the similar situation of becoming super-aged societies in the 21^st century.

The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.

This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations.

This research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors.

Policymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare.

This paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”.

Malaysia is considered to be a relatively young country as compared to other older countries such as Japan, China and Australia in terms of the ageing population. However, until 2035, Malaysia will be in the ageing group countries as 15% of the entire population will be above 60 years of age. This situation is quite alarming as more and more ageing care centres will be required to fulfill the ongoing demands of the ageing population. The elderly care centres in Malaysia are categorised as public (sponsored by the government), private, and charity based that comes under religious centres. Currently, there are about 365 registered elderly care centres working in the main states of Malaysia, including Sabah and Sarawak, two states of the East Malaysia. Due to the importance of ageing population issues, the present study is conducted to explore the demographics facet of Malaysian’s elderly care centres. The main reason behind that lies on the fact that many of these centres are still labelled as being not well equipped and lacking behind in trained staff, equipment and also suffering from severe financial constraints but some still capable of working on a sustainability basis.

Qualitative Research Strategy has been adopted, and 28 centres throughout Malaysia are included in this study. About 18 Operators from different centres and 15 caregivers were interviewed to get the holistic view of ageing care and facilities in their respective centres.

The results highlight that the majority of centres are not receiving any financial help from the government, and few centres are doing small business such as supplying consumable medical and non-medical items and providing renting and rehabilitation centres facilities to sustain. The caregivers are facing issues such as excess workload, less salary, peer conflicts and non-cooperative centre leadership.

The present study may help to provide useful information to the policymakers, which enables them to formulate the strategies for ageing care centres in Malaysia. As this study provides insight of components that have an impact on the overall wellbeing of elderly care centres, hence, it could help the care services providers to act as a rising star for Malaysian’s social life comfort.

The purpose of this paper is to estimate the changes of dental caries status among Thai adults and elderly under the different policy options using system dynamics modeling.

A multi-sector system dynamics model was developed to capture the dynamic interrelationship between dental caries status changes and oral health behavior – including self-care, dental care utilization and sugar consumption. Data used to populate the model was obtained from the Thai national oral health survey in 2000, 2006, 2012 and Thailand Official Statistics Registration. Three policy scenarios were experimented in the model: health promotion policy, dental personnel policy and affordable dental care service policy.

Dental caries experiences among Thai adults and elderly were projected to increase from now to 2040, as the elderly population increases. Among all policies experimented herein, the combined policies of health promotion, increased affordability and capacity of dental health service were found to produce the highest improvement in dental caries status with 3.7 percent reduction of population with high decayed, missing and filled teeth (DMFT) and 5.2 percent increase in population with very low DMFT.

This study is the first comprehensive simulation model that attempts to explore the dynamic interrelationship among dental caries experiences and behavioral factors that impact on oral health outcomes. In addition, the simulation model herein offers a framework for policy experimentation that provides policymakers with additional insights to inform health policy planning.

The purpose of this paper is to investigate aspects related to difficulty to retain nursing assistants at nursing homes in Sweden related to perceived work environment characteristics.

To reveal aspects related to difficulty to retain nursing assistants, the paper uses the BIKVA model, sense of coherence and New Public Management (NPM). In total, three focus groups with nursing assistants at three nursing homes are interviewed with corresponding individual interviews with their senior managers and users. The purpose is to analyze the situation from the affected group of nursing assistants. The focus of this study is how nursing assistants discuss related to recruit and retain nursing assistants at nursing homes and elderly care and the response from senior management related to those aspects.

The main conclusions are that nursing assistants consider their job as meaningful, but limited latitude and direct involvement in managing their daily tasks in a continuous communication with management affect negatively. Furthermore and combined with wage levels, aspects related to scheduling, working hours, shift work, split shifts and understaffing generate a burdensome and stressful environment affecting the possibility to retain staff in a negative direction.

The research uses a new approach utilizing the BIKVA model, sense of coherence and NPM. The study shows that central in retaining nursing assistants at nursing homes relates to aspects such as wages, staffing, shift work and split shifts and continuous communication between nursing assistants and management.