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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.

In Sweden, responsibility for the public care of the frail elderly rests with three authorities acting at different levels. At national level, the Riksdag and the Government realize policy goals through legislation and financial control measures. At regional level, 18 county councils and two regions are responsible for the provision of health and medical care. At local level, Sweden's 290 municipalities have a statutory duty to meet the social service and housing needs of the elderly. Sweden's municipalities and county council have a high level of autonomy by international standards. Activities in caring services are ultimately controlled by politicians appointed to policy-making assemblies in municipalities and county councils through general elections. The decentralization of responsibility for elderly care makes it possible for local and regional conditions to be taken into account when policies for the elderly are formulated. The national authorities – the National Board of Health and Welfare and the 20 county/region administrative boards – are responsible for supervision, follow-up, and evaluation of municipal and county council caring services.

This chapter discusses the major steps and issues related to the inclusion of public services in inequality research. Empirically, it investigates how the income distribution in countries changes when the value of publicly provided services to households is included. The authors consider five major categories of public services: education, health care, social housing, childcare and elderly care. On average across OECD countries, spending on these ‘in-kind’ benefits accounts for about 13% of GDP, slightly more than the spending on cash transfers – but with considerable cross-country variation. Broadening the income concept to account for in-kind benefits considerably increases households’ economic resources. But public services also contribute to reducing income inequality, by between one-fifth and one-third depending on the inequality measure. This chapter suggests that publicly provided services fulfil an important direct redistributive role in OECD countries.

The population is aging. The desire to remain in one’s own home through the aging process appears universal. Home health caregivers provide a vital role in allowing people to age in place. Women, and in particular immigrant women, have become the face of home health caregivers. Caregiving is generational. Paid caregiving is viewed as a natural extension of a skill set women have used most of their adult life. Home health caregivers view their work as a continuation of their roles in the family and they often frame their work as providing services that family members cannot, or will not perform. Reimbursement for these services is problematic. Assigning a monetary value to caregiving seems callous, and as a result caregivers are underpaid and undervalued. Global push–pull factors and the creation of a gray economy also contribute to a devaluation of these jobs. Caregivers themselves are poor advocates for better pay and working conditions because they believe it commodifies a kinship like experience. The future of caregiving is problematic. Poor countries will suffer greatly exporting their women; rich countries will need a tremendous number of caregivers to match their demographics and women will be overwhelmed providing care for others and themselves.

This chapter provides an overview of the social policy development and assessment in East Asia. Our study shows that social policy assessment in this region is still relying on objective indicators and interviews, even though most of the regional governments have implemented the Regulatory Impact Assessment for improving regulation quality. General approaches to measuring social value such as Cost–Benefit Analysis, Cost-Effectiveness Analysis and Social Return on Investment are not commonly used in the formulation of social policies. We compare the features of these approaches and provide suggestions about how to embed social value assessment tools into social policy and strategy development process.

Older women living in medically underserved areas (MUA) might have particular problems with access to health care. This is an in-depth report of the accessibility issues raised by six frail older women (age 82–93 years) during a longitudinal descriptive phenomenological study of the experience of home care. Three White women lived in the same rural MUA, and three Black women lived in the same urban MUA. The need for health service was understood subjectively and prospectively as the personal perception of a situation requiring relief or supply. Some women reported presenting needs for accessibility to providers, whereas others reported needs for their future accessibility to providers or services. Some intentions were likely linked to residence location, and residence in a rural MUA was relevant to the phenomenon of securing the help that I might need down the road. Feasibility was proposed as a new parameter of access. Research and practice implications were proposed.