Decentralisation and privatisation of long-term care in UK and USA

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study

PURPOSE

Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes.

METHODS

The main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson's Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster.

RESULTS

The variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of "poor" couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability.

CONCLUSION

The results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way

The corona pandemic challenges countries worldwide in many different ways. Due to its magnitude and impact on global health, this health crisis exposes several shortcomings in their health systems and emphasizes their shortcomings and deficiencies. These deficiencies have quickly affected the most frail citizens, such as older people. The first wave of the COVID19 pandemic in Belgium has quickly shown that nursing homes were not prepared for these kinds of crises. The nature, speed and extent gave rise to an accelerated and more extensive collaboration between various nursing homes and Ghent University Hospital. Before this crisis, the level of integrated care between nursing homes and hospitals was mostly limited. But setting up a strong collaboration model and integrated care between nursing homes and hospitals enables the nursing homes to manage this specific and complex care in their own environment.

Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.

Caregiver Involvement Following Institutionalization:

Family members face a variety of challenges when placing a cognitively impaired relative in a nursing home. However, few studies have determined how stressors and psychological well-being prior to placement influence the institutionalization experience for caregivers. In this article, the authors hypothesize that stress and negative mental health before institutionalization will have a significant effect on variables that reflect caregivers’postplacement involvement, including satisfaction with the nursing home environment, weekly visits, and problems with staff. Primary caregivers ( N = 185) were assessed prior to and after the institutionalization of a cognitively impaired elderly relative. A multivariate regression found that several preplacement stressors (behavior problems, activities of daily living dependencies, role captivity), depression, and socioemotional support were predictive of nursing home involvement. As these results suggest, the stress process has important implications for caregivers throughout the nursing home transition.

Lifting the ‘Violence Veil’: Examining Working Conditions in Long-term Care Facilities Using Iterative Mixed Methods

Le présent document se concentre sur les méthodes mixtes nous avons utilisé pour comprendre conditions de travail de leur travailleurs dans les établissements de soins de longue durée. Nous avons mené une enquête auprès des syndiqués travailleurs de santé en Ontario (n= 917), et une autre enquête dans trois provinces (n= 948) et quatre pays Scandinaves (n= 1625). Neuf groupes de discussion avec les Canadiens ont eu lieu; les répondants ont été présentés avec des questions du sondage et aussi descriptive des résultats statistiques et ont été demandé: “Est-ce le reflet de votre expérience?” Les contraintes de temps pour les travailleurs et la fréquence des expériences des travailleurs de la violence physique et attentions sexuelles non désirées sont signalés. Nous discutons comment de le façon dont nous utilisé des méthodes qualitatives et quantitatives étè itératif. Nous avons trouvé pas seulement la cohérence des données mais aussi la divergence des données qui montrent comment une culture de la violence dans les établissements de soins de longue durée est acceptée par les travailleurs comme d’habitude. Comment le constat de la violence structurelle vu le jour et la signification profonde, le contexte et les idées qui proviennent de la combinaison de nos méthodes itératives sont discutées.

Older people's willingness to use home care nursing services

AIM

This paper reports a study exploring willingness to use home care nursing services among older people and discussing the implications for long-term and home care nursing policies.

BACKGROUND

The proportion of older people is increasing in all societies across the world. Correspondingly, Korean society has experienced a rapid growth in its population of older people, and this is expected to increase from 7.2% in 2000 to 14.4% in 2019. The government is in the process of developing publicly-financed long-term care for older people, and home care nursing services are expected to be provided as an element of this care. Methods. A cross-sectional study design was used, employing data from a nationally representative interview survey with 1834 respondents conducted during May and July, 2001. Univariate and logistic regression analyses were conducted.

RESULTS

Willingness to use home care nursing services differed according to whether co-payment was required. About half the respondents answered that they would not use the services; 43% expressed a willingness to use them without co-payment; and 5% were very willing to use them even with co-payment. People with lower incomes showed greater willingness to use the services with no co-payment, while the high income group showed the greatest willingness under co-payment. Sex, living with adult children, living area, activities of daily living, and chronic conditions were associated with willingness. Older people who had known about or used home care nursing services previously showed greater willingness.

CONCLUSIONS

Co-payment guidelines for minimizing unmet needs are required, especially for older people with low incomes. A positive evaluation from those who knew about or had used such services is expected to contribute to the use of home care nursing services by older people.

Financing care for aging women in the U.S.: international perspectives

The aging of the U.S. population presents challenges in financing care and meeting the health and long-term care needs of older Americans. Women, who constitute a majority of the older adult population and a disproportionate share of those with low incomes, chronic conditions and long-term care needs, have much at stake in the future direction of health programs for aging Americans. This paper examines the status of older women in 12 industrialized nations to assess how the U.S. compares to other countries in terms of its aging female population. We find that women across the 12 industrialized countries have a longer life expectancy than men at ages 65 and 80, underscoring the universality of aging as a "women's issue". With respect to age composition, the U.S. lags behind many industrialized nations in the share of its elderly female population; by 2030, the proportion of women aged 65 and older, and 80 and older, will be lower in the U.S. than in any of the industrialized nations compared in this paper. Against this backdrop, the paper examines the characteristics of older adult women in the U.S., considers the role of Medicare in meeting the needs of aging women, and identifies gaps in coverage, primarily prescription drug and long-term care, that disproportionately affect older women. The paper concludes by considering how other nations provide and finance prescription drug and long-term care services for older adults, suggesting useful models for the U.S. to consider as it struggles to meet the demands of its aging population.

How the World Trade Organisation is shaping domestic policies in health care

High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.

What determines the need for nursing home admission in a universally insured population?

OBJECTIVES

People in lower socio-economic groups are more likely to experience disability and cognitive impairments at earlier ages than those in higher status groups. As a result, the need for nursing home care would be expected to be greater among older people of lower socio-economic status. This study examines the effects of income and education on the probability of nursing home entry in a universally insured elderly population.

METHODS

Using a prospective observational study design, a range of predictors of nursing home admission was examined over a three-year period in a representative sample of 7220 residents, aged 60 years or older, in a Canadian province. Individual census records and computerized administrative records of health care utilization were linked to form a database for analysis.

RESULTS

An increased risk of institutionalization was associated with older age, male gender, unmarried status and self-reported disability. In addition, lower household income and lower attained education were independently associated with a higher risk of nursing home admission.

CONCLUSIONS

These results emphasize the independent role of socio-economic status in accentuating or accelerating the need for institutional care towards the end of life. It is important that these effects are recognized in policies that determine the finance of both nursing home care and formal community-based supportive care.