scholarly journals Gender equality and the governance of long-term care policy: new comparative models and paradigms

2020 ◽  
pp. 1-18
Author(s):  
Kirstein Rummery
Keyword(s):  
Welfare State ◽  
Gender Equality ◽  
Long Term Care ◽  
Care Policy ◽  
Term Care ◽  
New Models ◽  
Care Policies ◽  
And Gender ◽  
The Way

Abstract There is a long-established link between care policies and gender equality outcomes, and much modelling of welfare state typologies look at care provision as a distinguishing feature. However, to date, little research has been done which has systematically and critically examined those links by examining the policies and the way they operate, how and why they affect gender equality, and the governance of care policies in a comparative way. This paper draws on evidence from a recently completed comparative study looking at long-term care and gender equality. A CQA (Comparative Qualitative Analysis) approach was used to identify case studies, and further analysis carried out which focussed on: overall, how the policies and the way they operated to achieve gender equality; the governance and design of policies that led to good gender equality outcomes; the level of policy making; the role of the state, the family, the community and the nonstatutory civic sector in designing and delivering effective policies; and how context specific the ideas, actors and institutions supporting the policies were. Instead of using existing welfare typologies that were not driven by gender equality as the defining outcome variable, the author takes an inductive approach to policy analysis to compare policy outcomes according to gender equity outcomes. She devises two new models of long-term care policy: the Universal Model and the Partnership Model, both of which lead to improved gender equality in different ways. This paper concludes by noting the need to move beyond existing welfare state typologies in examining gender equality outcomes, which will result in new models as depicted here.

scholarly journals Long-Term Care and Gender Equality: Fuzzy-Set Ideal Types of Care Regimes in Europe

2020 ◽  
Vol 8 (4) ◽  
pp. 92-102 ◽  
Author(s):  
Attila Bartha ◽  
Violetta Zentai
Keyword(s):  
Gender Equality ◽  
Fuzzy Set ◽  
Long Term Care ◽  
Ideal Type ◽  
Term Care ◽  
Ideal Types ◽  
Intergenerational Ties ◽  
And Gender ◽  
Care Regimes

Recent changes in the organization of long-term care have had controversial effects on gender inequality in Europe. In response to the challenges of ageing populations, almost all countries have adopted reform measures to secure the increasing resource needs for care, to ensure care services by different providers, to regulate the quality of services, and overall to recalibrate the work-life balance for men and women. These reforms are embedded in different family ideals of intergenerational ties and dependencies, divisions of responsibilities between state, market, family, and community actors, and backed by wider societal support to families to care for their elderly and disabled members. This article disentangles the different components of the notion of ‘(de)familialization’ which has become a crucial concept of care scholarship. We use a fuzzy-set ideal type analysis to investigate care policies and work-family reconciliation policies shaping long-term care regimes. We are making steps to reveal aggregate gender equality impacts of intermingling policy dynamics and also to relate the analysis to migrant care work effects. The results are explained in a four-pronged ideal type scheme to which European countries belong. While only Nordic and some West European continental countries are close to the double earner, supported carer ideal type, positive outliers prove that transformative gender relations in care can be construed not only in the richest and most generous welfare countries in Europe.

Re-conceptualising the relationship between de-familialisation and familialisation and the implications for gender equality – the case of long-term care policies for older people

2018 ◽  
Vol 40 (4) ◽  
pp. 869-895 ◽  
Author(s):  
Thurid Eggers ◽  
Christopher Grages ◽  
Birgit Pfau-Effinger ◽  
Ralf Och
Keyword(s):  
Older People ◽  
Gender Equality ◽  
Social Protection ◽  
Long Term Care ◽  
Welfare States ◽  
Theoretical Assumption ◽  
Term Care ◽  
And Gender ◽  
The Relationship

AbstractThis article explores how far the concepts of de-familialisation/familialisation are adequate to the classification of long-term care (LTC) policies for older people. In the theoretical debate over LTC policies, de-familialising and familialising policies are often treated as opposites. We propose re-conceptualising the relation between de-familialisation and familialisation, arguing that they represent substantially different types of policy that, in theory, can vary relatively autonomously. In order to evaluate this theoretical assumption, this article investigates the relation between the generosity level of LTC policies on extra-familial care, and the generosity level of LTC policies on paid family care, introducing a new multi-dimensional approach to measuring the generosity of LTC policy for older persons. It also explores the consequences of this for gender equality. The empirical study is based on a cross-national comparison of LTC policies in five European welfare states which show significant differences in their welfare state tradition. Data used are from document analysis of care policy law, the Mutual Information System on Social Protection, the European Quality of Life Survey and the Organisation for Economic Co-operation and Development. The findings support the argument that de-familialising and familialising LTC policies can vary relatively independently of each other in theory. It turns out that we get a better understanding of the relationship between LTC policy and gender equality if we analyse the role of different combinations of extra-familial and familial LTC policies for gender equality. The paper brings new insights into the ways welfare states act in regard to their LTC policies. It helps to clarify how the concept of de-familialisation/familialisation can be understood, and what this means for the relationship between LTC policies and gender equality.

scholarly journals Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 39-39
Author(s):  
Katie Aubrecht ◽  
Ivy Bourgeault ◽  
Tamara Daly
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Social Divisions ◽  
Care Workers ◽  
Power Differentials ◽  
Care Relationships ◽  
And Gender ◽  
Relations Of Power ◽  
Status Of Care

Abstract Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

scholarly journals Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Hiroto Yoshida ◽  
Yuriko Kihara
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Elderly Age ◽  
Term Care ◽  
Intentional Weight Loss ◽  
Long Term Care Insurance ◽  
And Gender ◽  
The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

scholarly journals The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 185-185
Author(s):  
Rachel McPherson ◽  
Barbara Resnick ◽  
Elizabeth Galik
Keyword(s):  
Racial Differences ◽  
Long Term Care ◽  
Analysis Of Covariance ◽  
Positive Interactions ◽  
Term Care ◽  
Race And Gender ◽  
Significant Difference ◽  
And Gender

Abstract Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

Aging, health expenditure, proximity to death, and income in Finland

2008 ◽  
Vol 3 (2) ◽  
pp. 165-195 ◽  
Author(s):  
UNTO HÄKKINEN ◽  
PEKKA MARTIKAINEN ◽  
ANJA NORO ◽  
ELINA NIHTILÄ ◽  
MIKKO PELTOLA
Keyword(s):  
Health Care ◽  
Health Expenditure ◽  
Long Term Care ◽  
Health Care Expenditure ◽  
Term Care ◽  
Age And Gender ◽  
And Gender ◽  
Proximity To Death ◽  
Naive Model

AbstractThis study revisits the debate on the ‘red herring’, i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a naïve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naïve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

Future Costs of Long-term Care in Japan and Sweden

2017 ◽  
Vol 48 (1) ◽  
pp. 128-147 ◽  
Author(s):  
Mårten Lagergren ◽  
Noriko Kurube ◽  
Yasuhiko Saito
Keyword(s):  
Long Term Care ◽  
Population Change ◽  
Population Aging ◽  
Population Data ◽  
Epidemiological Data ◽  
The Other ◽  
Age Group ◽  
Term Care ◽  
And Gender

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

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