The use of community-based social services by elderly people at risk of institutionalization: an evaluation

How Can the Modern Chinese Family Retirement Function Be Separated and Sustainable?

In the context of hybrid changes taking place in population and family structures, it is widely perceived that the function of the family as a place where older people retire has weakened. Family support has lost its vitality and has been replaced by public support. However, since the elderly are inseparably connected to their family, it is relevant to rethink and analyze how modern families’ pension functions can be sustainable. Based on structural functionalism and the family modernization theory, we construct an analytical framework to understand how the family ageing function operates separately. Fieldwork was carried out in Nantong, a place where the population has drastically aged. We documented different types of households to explain the changes and differences in modern family ageing. The results show that it is not simply a general weakening, but that a differentiated development pattern has separated the family functions and that there is a functional alternative path to compensate for sustainable development. That is, the economic function is strengthened and compensates for the weakened service function. Based on our research, we argue that families and the government should share the responsibility of meeting the diversified and specialized needs of older people in families where economic functions have strengthened and service functions have weakened. In families where both sets of functions have weakened, the government needs to overtake those functions. Today, family retirement function has been revitalized and redeveloped.

Legal Aspects of Social Infrastructure for Housing and Care for the Elderly—The Case of Slovenia

On 17 June 2021, the Government of the Republic of Slovenia adopted a Bill on Long-term Care. This legislative activity also raised the question of the existence and effectiveness of a legal environment to promote social infrastructure development for housing and care of older adults. Social infrastructures include the facilities in which long-term care services are provided. Therefore, the new legislative proposal also raised the issue of the regulation of this social infrastructure and the housing and care solutions as a part of the social infrastructure since they benefit individuals and communities. Furthermore, in line with the growing trend towards deinstitutionalisation, the legal environments should enhance alternative housing solutions for the elderly. The purpose of this article is to describe the foundations of the social infrastructure for older adults and examine the legal basis for its provision. The research belongs to legal geography studies, which means that the substance of laws and materialisation in space are considered. We identified two primary spatial–legal barriers to overcome, which are (a) the separate treatment of the housing and health aspects and (b) the absence of the guarantee schemes for the construction of housing-with-care solutions. The results would be helpful for the optimal organisation of integrated care, which individual research groups in Slovenia are studying.

Factors Associated with Willingness to Choose the Way for Old-Age Care: A Population-Based Cross-sectional Study in Chongqing, China

The objective of this study is to investigate the factors associated with the willingness for old-aged care and the demands for health care among elders, which might provide a reference for the establishment of health care strategies. A cross-sectional study was conducted via questionnaires among 1553 randomly selected residents aged 65 or older from Chongqing, China during 2016. Data of demographics, and demands for old-age care and health care services were collected. Descriptive analysis was used to examine the characteristics of the respondents. A chi-squared test and multiple logistic regression were performed to explore the relevant factors associated with the preference of old-age care among older people in Chongqing. We found that 85.4% of the respondents were willing to select home-based care: family old age care (55.9%), and its combination form for old-age care: family old age care plus community old age care (29.5%) old age care. Multivariable logistic regression analysis showed that willingness to choose family old age care for old-age care was associated with lower monthly income, more children, worse commercial insurance, better health status, and shorter distance to their children. Most older adults had the demands for health-related services, including regular check-up, regular health seminars, establishment of health files. Hospital was the most acceptable provider for care services, and there was a preference for long-term care and emergency call among the elders. The majority of older Chinese prefer the family old age care and its combination form with community old age care for old-age care, and demand for a variety of health-related services. Home- and community-based care with sound and perfect medical and health mechanism should be the main pattern of old-age care system in China.

Seniors' campus continuums: local solutions for broad spectrum seniors care

BACKGROUND

As demand and desire to "age-in-place" grows within an aging population, and new areas of need emerge, governments nationally and internationally are focusing effort and attention on innovative and integrative approaches to health and well-being. Seniors' Campus Continuums are models of care that seek to broaden access to an array of services and housing options to meet growing health and social needs of aging populations. The objective of this study is to increase understanding of this model and factors that influence their evolution, development, ongoing functioning and capacity to integrate care for older adults wishing to age in their own home and community.

METHODS

This research uses a comparative case study approach across six-bounded cases offering four geographically co-located components (mixed housing options, internal and external community supports, and a long-term care home) in various contexts across Ontario, Canada. Onsite in-person and phone interviews with senior campus staff (N = 30), and campus partners (N = 11), enhanced by direct observation at campuses explored historical and current efforts to offer health, housing and social care continuums for older adults.

RESULTS

Analysis highlighted eight key factors. Enabling factors include i. rich historical legacies of helping people in need; ii. organizational vision and readiness to capitalize on windows of opportunity; iii. leveraging organizational structure and capacity; iv. intentional physical and social design; v. broad services mix, amenities and innovative partnerships. Impeding factors include vi. policy hurdles and rigidities; vii. human resources shortages and inequities; and viii. funding limitations. A number of benefits afforded by campuses at different levels were also observed.

CONCLUSION

Findings from this research highlight opportunities to optimize campus potential on many levels. At an individual level, campuses increase local access to a coordinated range of health and social care services, supports and housing options. At an organizational level, campuses offer enhanced collaboration opportunities across providers and partners to improve consistency and coordination of care, and improved access to shared resources, expertise and infrastructure. At a system level, campuses can address a diversity of health, social, financial, and housing needs to help seniors avoid premature or inappropriate use of higher intensity care settings.

The Stability and Change of Loneliness Across the Life Span: A Meta-Analysis of Longitudinal Studies

Individuals experience loneliness when they perceive a deficiency in the quality or quantity of their social relationships. In the present meta-analysis, we compiled data from 75 longitudinal studies conducted in Asia, Australia, Europe, and North America (N = 83, 679) to examine the rank-order and mean-level development of loneliness across the life span. Data were analyzed using two- and three-level meta-analyses and generalized additive mixed models. The results indicate that the rank order of loneliness is as stable as the rank order of personality traits and follows an inverted U-shaped trajectory across the life span. Regarding mean-level development, loneliness was found to decrease throughout childhood and to remain essentially stable from adolescence to oldest old age. Thus, in contrast to other personality characteristics, changes in loneliness are not generally related to age. Implications for theory are discussed.

Senior citizens’ requirements of services provided by community-based care facilities: a China study

Purpose

This study aims to identify senior citizens’ requirements related to “embedded retirement facilities (ERFs)”, which are small-scale, multi-functional and community-based care facilities for senior citizens in mainland China, and to discuss whether senior citizens’ perceptions are influenced by their backgrounds.

Design/methodology/approach

A questionnaire type of research was administrated to gain senior citizens’ rankings of services that should be provided by ERFs. Non-parametric statistical models were applied to analyse the collected data.

Findings

Results reveal that health care services for senior citizens are considered the most important. Requirements regarding rehabilitation and entertainment and daily life assistance are ranked second and third, respectively. Culture-related activities are the least important. Differences in the senior citizens’ background also influence their choices.

Research limitations/implications

This research is based on a questionnaire survey completed in northeast China. Opinions from other areas of mainland China will be collected in the future study. Furthermore, the key items identified in this research, which was completed by participants from the built environment discipline, can be further elaborated by combining interdisciplinary feedback.

Practical implications

This study explores services that are supposedly provided by ERFs. Findings will provide useful perceptions from senior citizens and will enable decision makers to prioritise services for senior citizens.

Social implications

Although senior citizens are the end users of ERFs, their needs are easily overlooked. This study calls attention to their needs from ERFs, and the results are likely to serve as references for stakeholders in building improved facilities.

Originality/value

ERFs have been provided in mainland China to cater to senior citizens’ needs since 2014. However, few studies have identified senior citizens’ requirements for provided services. The survey-based results of this work will serve as references for various stakeholders in making enhanced decisions.

Factors associated with willingness to enter long-term care facilities among older adults in Chengdu, China

OBJECTIVE

To describe Chinese older adults' willingness to enter long-term care facilities and to examine individual factors associated with the willingness of using this growing model of long-term care in China.

METHODS

A cross-sectional study involving a random sample of 670 adults aged 60+ in the Hezuo community in Chengdu, China in 2016. Respondents were interviewed by trained staff on socio-demographics, health status, quality of life, social support, and willingness to enter long-term care facilities.

RESULTS

Only 11.9% of the respondents were willing to enter long-term care facilities for meeting their medical and social service needs. Multivariable logistic regression analysis showed that willingness to enter long-term care facilities was associated with higher household income (OR = 4.55, 95% CI:1.72-12.00), insurance of Urban Resident Basic Medical Insurance (OR = 4.80, 95% CI:1.17-19.67) and unemployment (OR = 0.48, 95% CI:0.24-0.99). Among those who were willing to enter long-term care facilities, an overwhelming majority (81.2%) would prefer going to a facility within 30-minute walking distance from their current residence, 82.5% indicated the need of nursing care, and 90.0% expected a partnership between the long-term care facility and a large hospital.

CONCLUSIONS

A minority of older Chinese were willing to receive long-term care delivered at a facility within walking distance from their current residence. Recent policy aimed at increasing the supply of long-term care facilities may not be consistent with consumer preference for home and community-based care. Balancing investment between home and community-based care, and establishing long-term care insurance remain the top priorities for long-term care research and policy development in China.

Family and community support among older Chilean adults: the importance of heterogeneous social support sources for quality of life

Family and community social networks act as social resources that promote well-being at advanced ages. In this study, we analyze the association between social support received from personal social networks (social support from various family members and friends) and community social networks (social support from neighbors and the neighborhood, age, ethnic, or religious group peers and formal social support networks) and quality of life (QoL) for a sample of older Chilean persons (n = 777). The results confirm that social support from family (partner, children, and extended family) and friends, integration in the community (neighbors) and social support from informal systems (social groups) are associated with QoL. Moreover, the model including both types of support explains 25.8% of variance in QoL. The results and their possible implications are discussed.

Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing

BACKGROUND

The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.

METHODS

We used the database "Health and Social Support of Elderly Population in Community". Questionnaires were issued in 2013, covering 3 districts in Beijing. A group of 1036 people over 60 years in age were included in the study. The respondents' profile variables were organized in Andersen's Model and community healthcare resource factors were added. A multinomial logistic model was applied to analyze the factors associated with the desired aging care models.

RESULTS

Cohabiting with children and relying on care from family was still the primary desired aging care model for seniors (78 %), followed by living in institutions (14.8 %) and living at home independently while relying on community resources (7.2 %). The regression result indicated that predisposing, enabling and community factors were significantly associated with the aging care model preference. Specifically, compared with those who preferred to cohabit with children, those having higher education, fewer available family and friend helpers, and shorter distance to healthcare center were more likely to prefer to live independently and rely on community support. And compared with choosing to live in institutions, those having fewer available family and friend helpers and those living alone were more likely to prefer to live independently and rely on community. Need factors (health and disability condition) were not significantly associated with desired aging care models, indicating that desired aging care models were passive choices resulted from the balancing of family and social caring resources.

CONCLUSIONS

In Beijing, China, aging care arrangement preference is the result of balancing family care resources, economic and social status, and the accessibility of community resources. Community facilities and services supporting elderly were found to be insufficient. For China's future health system, efforts should be made to improve community capacity to provide integrated services to senior citizens.

The association between the utilization of long-term care services and mortality in elderly Koreans

It is necessary to confirm the effect of long-term care insurance (LTCI) by identifying changes in mortality, whether benefits are used or not, as well as the effects of in-home and institutional services on mortality. The goal of this study was to identify the association between service use and the mortality rate in elderly Koreans. We used Cox proportional hazard regression models and the Kaplan-Meier survival curve method to estimate the hazard ratio and survival probability for death while adjusting for covariates. We detected a 27.8% mortality rate at the 40-month follow-up period. Male gender, advanced age and activities of daily living were risk factors for mortality. In all models, the hazard ratio of participant death of those using long-term care services was significantly lower than for those who did not use these services. Among the service users, the hazard ratio for participant death of institutional service users was significantly higher than it was for in-home service users. This study also identified the impact of the transition from in-home services to institutional services. A primary goal of LTCI is to promote health and life stabilization in the elderly. To both delay and prevent institutionalization, it is necessary to develop assistive devices and effective in-home services and ensure access of these for elderly patients.

Environmental Predictors of Unmet Home-and Community-Based Service Needs of Older Adults

Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults’ eventual need for health services and HCBS.

Disabled older people's use of health and social care services and their unmet care needs in six European countries

BACKGROUND

The national health and social care systems in Europe remain poorly integrated with regard to the care needs of older persons. The present study examined the range of health and social care services used by older people and their unmet care needs, across six European countries.

METHODS

Family carers of older people were recruited in six countries via a standard protocol. Those providing care for disabled older people (n = 2629) provided data on the older person's service use over a 6-month period, and their current unmet care needs. An inventory of 21 services common to all six countries was developed. Analyses considered the relationship between older people's service use and unmet care needs across countries.

RESULTS

Older people in Greece, Italy and Poland used mostly health-oriented services, used fewer services overall and also demonstrated a higher level of unmet care needs when compared with the other countries. Older people in the United Kingdom, Germany and Sweden used a more balanced profile of socio-medical services. A negative relationship was found between the number of different services used and the number of different areas of unmet care needs across countries.

CONCLUSIONS

Unmet care needs in older people are particularly high in European countries where social service use is low, and where there is a lack of balance in the use of health and social care services. An expansion of social care services in these countries might be the most effective strategy for reducing unmet needs in disabled older people.

Evaluating the Effectiveness of the Trumbull Advocacy and Protective Network: A Formative Evaluation

The Trumbull Advocacy and Protective Network (TAPN) in Ohio is a county network of agencies in social services, government, medicine, law enforcement, and housing that coordinates and integrates services and programs for seniors with extraordinary needs. The purpose of this study was to assess the strengths and weaknesses of TAPN and make recommendations for improving its effectiveness. Seventeen TAPN member agencies participated in this formative evaluation in Phase 1, whereas 19 participated in Phase 2. The fact that mean scale scores for the TAPN Accomplishment Scale increased significantly over time was revealed by t tests. The most important changes were in addressing the special needs of older adults being served by more than one agency, advocating for the efficient and effective allocation of resources, enabling agencies to better serve their clients, and offering a “single focus location” for advocacy. Important future activities and functions of TAPN were identified, and the lessons learned were described.