Search results

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.

This paper aims to provide an overview of the inequalities between three countries – England, The Netherlands and Taiwan – in relation to the welfare and long‐term care of older people. It compares the positive and negative distinctions between the respective countries and their systems.

This paper discusses and analyses data from public sources and literature and measures the similarities and differences between demographic and social issues, the cultural and political differences shaping policy objectives, economic constraints and long‐term care services.

All three countries face similar pressure in long‐term care provision of ageing populations, funding limitations and shrinking numbers of carers. None of the countries studied completely conforms to Esping‐Andersen's ideal types; instead they seem to constitute hybrids. The care system in the Dutch social democratic‐conservative welfare regime seems to provide wider support for older people who need care, the English liberal‐social democratic welfare regime comes second and Taiwanese conservative‐liberal welfare regime comes third. Overall, some converse trends of the long‐term care systems indicate a narrowing of the gap in responsibility between state, family and individuals in the East and the West.

The paper contributes suggestions to further research in the area of elements and structures of care systems support and the failure to provide ongoing quality of long‐term care and reflects on the implications for the global market of care‐workers and the extensive use of migrant workers in the field.

The paper provides a detailed consideration of the wide‐ranging issues that impact on older people's care provision in England, The Netherlands and Taiwan.

To describe, analyze, and compare two long-term care (LTC) systems for elders in Germany and Israel.

Secondary analyses of data on LTC beneficiaries, structure of service provision and content analyses of policy documents in a comparative perspective based on the Esping-Andersen welfare state typologies.

Descriptive background of demographic attributes in the two countries; discussion of LTC development laws which in Israel focuses on “aging in place” concept, where in-kind services are geared only to community-dwelling frail elders while in Germany it’s for community and institutionalized elders. Analyses of various service types provided their use, resources invested, and benefits incurred for frail elders and their family caregivers.

The advantages and shortcomings of the two systems were analyzed with recommendations for future developments. Such comparisons across nations can inform social policy debates in Germany and Israel as to how to prepare for population aging. The originality of such comparison can shed light on issues for LTC service development in other countries.

Although marketing does not play a large role in the Canadian health‐care system, acute care facilities have been conducting patient satisfaction surveys as a quality measurement tool for a number of years. More recently those in the long‐term care system have expressed an interest in this concept. This study set out to determine if long‐term care facilities in the Ministry of Health, Ontario Central West Region, conduct consumer satisfaction surveys. If they do, the study asked how the information is utilized and, if they do not, why not. This paper will highlight issues of service quality, health‐care quality and health‐care consumer satisfaction. This study is focused on long‐term care; however, the majority of the available research and information pertains to the acute care system. Although the principles of quality measurement and consumer satisfaction are the same for acute and long‐term care, our findings will identify the unique ways in which these principles apply to the long‐term care system.

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.

This paper offers a personal perspective on the author's experience working with issues relating to the long-term management of nuclear contaminated sites, from the programmatic to the site-specific. Long-term care is and will be far more challenging than remediation activities; thus, the dynamics of long-term care require different approaches to problem solving. The need for nonlinear thinking will challenge management that has traditionally relied on linear approaches. Integrated risk management potentially offers some powerful and flexible tools for identifying and managing uncertainties. Managing uncertainties involves not only traditional budget, schedule, cost, and worker safety issues, but also other influences that are not easily quantifiable, including regulatory, cultural, social, political, legal, and “quality” issues. Understanding and incorporating changes in social context is critical to the planning and implementation processes of long-term care; the Department of Energy (DOE) must utilize processes that have consistency over time and that involve the public throughout the process. Management in the long term must reflect an understanding of how human systems function and how they couple with technological systems. DOE's relative success with its Uranium Mill Tailings Remedial Action Program exhibits some of these components. Many are now recognizing these components as key needs for any long-term care program for long-lived hazards.

Health care organizations’ decision-making for the future relies on anticipating changes. Reliable predictions are becoming increasingly difficult, creating anxiety and requires long-term adaptive planning to cope with unforeseen circumstances. The purpose of this study is to gain insights into the awareness of uncertainties that decision makers in healthcare have, particularly when making long-term investments.

This is a qualitative study with an explorative purpose. The data were collected through semi-structured and open interviews with board members of long-term care organizations.

The study revealed that respondents are most uncertain about the future financing of their real estate system. Another concern revealed is about the shortage of care professionals combined with an increasing demand for future care. Despite most decision makers do recognize uncertainties during the decision-making process, decision makers hardly address the level of these uncertainties. Although this study did find that some decision makers are aware of deep uncertainties, in terms of “unknown unknowns,” they have no actual approaches for dealing with such situations.

Decision makers at healthcare organizations are uncertain as to their ability to anticipate technological, economic, social and political developments, as well as predict future healthcare system transformations. Some decision makers are aware of deep uncertainties, in terms of “unknown unknowns” and “unidentified unknowns,” but they lack an actual approach to deal with such situations. This study examines how strategies adapt to unforeseen developments or how to deal with deep uncertainties in healthcare as complex adaptive system.

Spain departed from the Southern European tradition of residual long-term care services with the 2006 reform. The paper aims to present the main traits of the reform and its implementation, explores the reasons that may explain why the reform happened and to which extent and why it fell short of expectations.

The article draws on available literature on the reform and on administrative data to present a complex and nuanced view of the reform process and its limits.

The reform was actually a measure to enhance and rationalize a preexisting process of social care services development, rather than the creation of a completely new care system. A rapid increase in female labor market participation since the 1990s and the looming demands of a late baby-boom and the subsequent fertility crash appear to be two key factors that explain both the previous development and its bolstering by the reform. The budgetary constraints of the Great Recession and governance problems, linked to a complex and sometimes dysfunctional multilevel governance arrangement, help to understand why the reform bogged down. Nevertheless, the overall balance is more nuanced, and significantly more services are provided 12 years after the reform.

While many assessments of the reform have been negative, putting it into a larger context of social care development, the 2006 Dependency Act has contributed to a significant increase in expenditure and coverage. The impact of budgetary restrictions has been important, but other factors, such as governance arrangements, may explain more of the problems of the implementation.

This paper aims to maintain the high service quality of the long-term care service providers by establishing a knowledge-based system so as to enhance the service quality of nursing homes and the performance of its nursing staff continually.

An intelligent case-based knowledge management system (ICKMS) is developed with the integration of two artificial intelligence techniques, i.e. fuzzy logic and case-based reasoning (CBR). In the system, fuzzy logic is adopted to assess the performance through the analysis of the long-term care services provided, nurse performance and elderly satisfaction, whereas CBR is used to formulate a customized re-training program for quality improvement. A case study is conducted to validate the feasibility of the proposed system.

The empirical findings indicate that the ICKMS helps in identification of those nursing staff who cannot meet the essential service standard. Through the customized re-training program, the performance of the nursing staff can be greatly enhanced, whereas the medical errors and complaints can be considerably reduced. Furthermore, the proposed methodology provides a cost-saving approach in the administrative work.

The findings and results of the study facilitate decision-making using the ICKMS for the long-term service providers to improve their performance and service quality by providing a customized re-training program to the nursing staff.

This study contributes to establishing a knowledge-based system for the long-term service providers for maintaining the high service quality in the health-care industry.

The purpose of this paper is to find the key innovative principles for evaluating the long-term care (LTC) cloud system by exploring contradictory and complex points in its development.

The theory of inventive problem solving (TRIZ) and the decision-making trial and evaluation laboratory (DEMATEL) approaches are integrated to resolve complex contradictions in the system. The heuristic reasoning of TRIZ is applied to obtain innovation principles for an LTC cloud mining system. However, the importance and feasibility of these innovative principles require further assessment. In this study, DEMATEL is employed to clarify the complex relationships among the principles and evaluate their key influences.

This paper identifies six primary contradictions and derives 25 innovative principles for the resolution of these conflicts. Further analysis confirms three key innovative principles. First, the government should consider the overall planning of the cloud system platform, followed by the participation of other medical and LTC institutions. Second, the information capability of LTC institutions should be unified by recording the pathology data of care recipients to create an information exchange system. Third, LTC institutions should act in cooperation with medical institutions to provide professional medical capabilities.

The contributions of this paper are two-fold. First, this study provides an integrated methodology integrating the TRIZ and DEMATEL approaches to resolve LTC problems. Second, this research identifies the key innovative principles for developing an LTC cloud system in Taiwan.