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The purpose of this study is to develop new type of reverse mortgage contract. How to provide adequate services and housing for an increasing number of people that are dependent on the help of others is a crucial question in the European Union (EU). The housing stock in Europe is not fit to support a shift from institutional care to the home-based independent living. Some 90% of houses in the UK and 70%–80% in Germany are not adequately built, as they contain accessibility barriers for people with emerging functional impairments. The available reverse mortgage contracts do not allow for relocation to their own adapted facilities. How to finance the adaptation from housing equity is discussed.

The authors have extended the existing loan reverse mortgage model. Actuarial methods based on the equivalence of the actuarial present values and the multiple decrement approach are used to evaluate premiums for flexible longevity and lifetime long-term care (LTC) insurance for financing adequate facilities.

The adequate, age-friendly housing provision that is appropriate to support the independence and autonomy of seniors with declining functional capacities can lower the cost of health care and improve the well-being of older adults. For financing the development of this kind of facilities for seniors, the authors developed the reverse mortgage scheme with embedded longevity and LTC insurance as a possible financial instrument for better LTC services and housing with care in assisted-living facilities. This kind of facilities should be available for the rapid growth of older cohorts.

The numerical example is based on rather crude numbers, because of lack of data, as the developed reverse mortgage product with LTC insurance is a novelty. Intensity of care and probabilities of care in certain category of care will change after the introduction of this product.

The model results indicate that it is possible to successfully tie an insurance product to the insured and not to the object.

The introduction of this insurance option will allow many older adult with low pension benefits and a substantial home equity to safely opt for a reverse mortgage and benefit from better social care.

While currently available reverse mortgage contracts lapse when the homeowner moves to assisted-living facilities in any EU Member State, in the paper a new method is developed where multiple adjustments of housing to the functional capacities with relocation is possible, under the same insurance and reverse mortgage contract. The case of Slovenia is presented as a numerical example. These insurance products, as a novelty, are portable, so the homeowner can move in own specialised housing unit in assisted-living facilities and keep the existing reverse mortgage contract with no additional costs, which is not possible in the current insurance products. With some small modifications, the method is useful for any EU Member State.

The purpose of this paper is to study and compare knowledge and skills in basic care for the dependent elderly of health volunteers before and after the increase in ability program participation.

Quasi experimental research includes one group pretest-posttest design. The research was conducted from January to March 2018. The samples were 30 health volunteers in Nakorn Pathom Province selected by purposive sampling. They were all female, aged 20–50 years, with minimal education level of early secondary school and were current or former health volunteers. The increase ability program consisted of lecture and skill practice by demonstration and individual replay demonstration. The program duration was 30 h with 19 h of skill practice and 2 days of site visit to the dependent elderly’ homes. The tool for collecting data was a questionnaire for the evaluation of knowledge and skills in basic care for the dependent elderly. The data were analyzed by means, standard deviation and paired t-test.

After the increase in ability program participation, the health volunteers had very good level of knowledge in basic care for the dependent elderly with statistical significance (p<0.01) and had most correct skills in basic care for the dependent elderly with a score of 9 from 11 items.

Knowledge and skills in basic care for the dependent elderly of the health volunteers increased to a very good level after program participation. Thailand should provide periodic and continuous training program to increase health volunteers’ knowledge and skills in basic elderly care to provide care for the elderly with most benefits.

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 paper aims to explore how historical context influences the content and selection of rhetorical legitimation strategies. Using case study method, this paper will focus on how insurance companies and labor tried to defend their legitimacy in the context of enactment of Medicare in the USA. What factors influenced the strategic (rhetorical) decisions made by insurance companies and labor unions in their institutional work?

The study is empirically grounded in archival research, involving an analysis of over 9,000 pages of congressional hearings on Medicare covering the period 1958–1965.

The authors show that rhetorical legitimation strategies depend significantly on the specific historical circumstances in which those strategies are used. The historical context lent credibility to certain arguments and organizations are forced to decide either to challenge widely held assumptions or take advantage of them. The authors show that organizations face strong incentives to pursue the latter option. Here, both the insurance companies and labor unions tried to show that their positions were consistent with classical liberal ideology, because of high respect of classical liberal principles among different stakeholders (policymakers, voters, etc.).

It is uncertain how much the results of the study could be generalized. More information about the organizations whose use of rhetorics the authors studied could have strengthened our conclusions.

The practical relevancy of the revised paper is that the authors should not expect hegemony challenging rhetorics from organizations, which try to influence legislators (and perhaps the larger public). Perhaps (based on the findings), this kind of rhetorics is not even very effective.

The paper helps to understand better how organizations try to advance their interests and gain acceptance among the stakeholders.

In this paper, the authors show how historical context in practice influence rhetorical arguments organizations select in public debates when their goal is to influence the decision-making of their audience. In particular, the authors show how dominant ideology (or ideologies) limit the options organizations face when they are choosing their strategies and arguments. In terms of the selection of rhetorical justification strategies, the most pressing question is not the “real” broad based support of certain ideologies. Insurance company and labor union representatives clearly believed that they must emphasize liberal values (or liberal ideology) if they wanted to gain legitimacy for their positions. In existing literature, it is often assumed that historical context influence the selection of rhetorical strategies but how this in fact happens is not usually specified. The paper shows how interpretations of historical contexts (including the ideological context) in practice influence the rhetorical strategies organizations choose.

The purpose of this study is to examine the effectiveness of the Thai nursing student competency enhancement program applied through project-based learning (PjBL) in caring for the elderly in the community.

This quasi-experimental one-group pre-post-test design was used to compare mean scores on gerontological nursing competency scales comprising four dimensions including holistic health promotion, empirical evidence, empowerment and quality care and ethical and moral competencies. A total of 95 participants were randomly selected from a list of registered attendees. A five-week PjBL approach for a community nursing practicum was designed and comprised of an introduction to the project, components of research methodology, group projects and group presentations. A gerontological nursing competencies questionnaire was used with participants, and data were analyzed using descriptive statistics. Two-way ANOVA and a paired t-test were used to compare pre-post mean scores of competencies.

A total of 95 students participated in the PjBL and the majority of participants were female (92.6%). The results revealed post–PjBL mean scores of gerontological nursing competencies were higher than the premean score (p value < 0.05) except the empirical evidence competencies which showed no statistical difference.

Since the results show the effectiveness of the student nursing competency enhancement program through PjBL when caring for the elderly in the community, it is important for health care instructors to apply PjBL, especially in community nursing. Improving empirical competency evidence among nursing students is still required and necessary.

The purpose of this study is to explore the expectations and experiences regarding a robotic shower, from a dual user perspective.

This was an explorative qualitative study in which elderly and personnel were interviewed before the robotic shower was installed and again after four or five months of usage.

The elderly participants found the robotic shower empowering. The personnel’s experiences encompassed their own work conditions, as well as the user value for the elderly. A shared experience for both user groups was a more independent shower situation for the elderly.

Low user frequency among the elderly may have affected the results; more frequent use may lead to different user experiences. Understanding whether and to what extent long-term use affects user experience is important for future adoption and implementation.

Implementation of digital assistive technology (DAT) should focus on the user value of the DAT for all possible user groups, as the different users may experience different values over time. In addition, approaching adoption and acceptance issues of DAT from a learned helplessness perspective may help users find value in the DAT and the independence these aim to provide, helping users maintain or increase quality of life.

This study presents a dual user experience of a DAT in an intimate care situation and shows the importance of including both elderly and personnel to fully understand the value of DATs.

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.

The purpose of this paper is to examine the accessible tourism market potential, alongside the implications of operating in the accessible tourism market and an assessment of major travel and leisure company involvement. The research focused on providing a market value forecast using historic data from 2005 and extrapolating this to 2025. An examination of the reasons for and against major travel and leisure company involvement in the accessible tourism market was accompanied by an analysis of managerial perceptions.

The exploration of travel patterns of disabled tourists, in particular spend per head per holiday, was used to measure the value of the demand side of accessible tourism. Semi-structured interviews were carried out with employees of major travel and leisure companies in managerial positions.

The study indicates that the accessible tourism market is a distinct sector, possessing the capacity for extensive future growth, and thus presents major travel providers with a potentially substantial and lucrative market, generating potential revenues of €88.6 billion by 2025.

Due to a lack of existing data an assumption had to be made on the evolution of travel spend per head per holiday. However, the formula used, using GDP/Capita growth, is a recognised way of forecasting this kind of data in the travel and leisure industry.

This is the first paper to provide an examination of the reasons for and against major travel and leisure company involvement in the accessible tourism market, as well providing a forecast of the market value up to 2025.

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.

The purpose of this paper is to contribute to the analysis and grasp of accessible tourism, from its present into a medium-term future. It provides a socio-anthropological approach.

This paper uses the scenarios-planning analysis framework proposing four scenarios arising from the interaction of aforementioned driving forces. The author also use a trilemma to both form and evaluate scenarios. The criteria for the trilemma were (stakeholders, cooperation and prejudice).

The strength of combining a new set of driving forces, namely, empathy, apathy, certainty in economic profits and fear of economic losses, which would enable to draw four plausible scenarios into the future of accessible tourism within a scenarios-planning framework. The significance is to provide “food for thought” to address the future through a range of different concepts.

The main limitation is the difficulty to obtain honest answers about why the lack of development of accessible tourism.

Participant observation on both groups and individuals in vacation atmosphere. Also, in-depth interviews to different stakeholder representatives.

To try to explain to the stakeholders their wasted economic benefits and, at the same time, the opportunity of getting social prestige.

The main value is about considering the interplay of social concepts as empathy, apathy, “aesthetic prejudice” and fear of losses or faith in profits.