Policy Design and Consumer Direction: Cross-country Comparisons on Consumer-directed Care Programs

Objectives The consumer-directed care (CDC) program aims to maximize health outcomes by offering older adults more control, choice, and flexibility over the care services they received. However, countries may operate CDC programs in different ways based on heterogenous sociostructural systems. We proposed a comparative framework to evaluate three dimensions of CDC—control and direct services, variety of service options, and information and support—and analyzed how countries varied in their policy design to achieve consumer direction. Methods Using cross-national document analysis, we analyzed eleven CDC programs from seven selected countries (Netherlands, United States (US), United Kingdom (UK), Germany, China, Australia, and Spain) with five CDC care regimes. A total of fourteen indicators capturing three dimensions of CDC programs was developed. We further used these indicators to evaluate and compare similarities and differences of policy features across countries using descriptive statistics and graphical approaches. Results CDC programs in the Netherlands, Arkansas, and the UK ranked at the top in consumer direction. All countries except Germany employed a “service-based” principle in determination of service type. Training care workers was in the most widespread use to assure quality of care. Merely the UK and Germany integrated CDC and conventional agency care without restrictions. Representative with relevant support was only available in the UK and Netherlands. Discussion and Implication: CDC models involve multi-faced aspects, rather than dichotomies and discrete entities. Implications include the need for a systematic reflection with our developed framework and enriching variety of service options to promote consumer direction.

The Life Satisfaction of Informal Caregivers in Europe: Regime Type, Intersectionality, and Stress Process Factors

This research assessed the role of welfare state/family care regimes, intersecting social locations and stress process factors in influencing the life satisfaction of informal caregivers of care recipients with age-related needs or disabilities within a European international context. Empirical analyses were conducted with a sample of informal caregivers residing in Denmark, Sweden, France, Germany, Italy, Greece and the United Kingdom (n=6,007). Ordinary least squares and ordered logit regression models revealed that welfare state/family care regime, intersecting social locations, and stress process factors were independently associated with the life satisfaction of informal caregivers. Furthermore, there was some evidence to suggest that social location and stress process factors intervened in some of the relationships between regime type and life satisfaction. There was also some evidence that stress process factors intervened in the relationships between social location factors and life satisfaction. Overall, the results provide support for integrating welfare state/family care regime type and intersectionality factors into the stress process model as applied to the context of informal caregiving. The results also have policy and practice implications with regards to which social location and stress process factors explain specific disparities in life satisfaction between informal caregivers residing in different welfare state/family care regimes.

Disabled Women, Care Regimes, and Institutionalised Homophobia: a Case Study From Poland

Introduction The intersection of non-heterosexuality, gender, and disability became a prolific field of research among both queer, crip, and disability studies scholars, though focusing mainly on Western regions. In the paper discusses how women narrate their experiences in relation to ableist and heteronormative regimes in the context of Central and Eastern Europe (CEE). The case study of Poland, a country characterized by institutionalization, lack of individualized disability support, and state homophobia contributes to a growing body of research on non-western sexuality and disability studies. Methods We conducted interviews with 11 non-heterosexual disabled women living in Poland. Results By tackling care regimes, our analysis explores women’s experiences in the context of discursive confusions resulting from being at the intersection of often-contradictory local narrations on gender, disability, and sexuality. We identified three intertwined processes to understand how care regimes work in Poland: (1) the separateness between queer and disabled policies and discourses, (2) the coopting/obscuring of homosexual relations between women by category of care, and (3) familiarisation of care and its consequences for non-heterosexuality. Policy Implication We suggest that social support systems must better address the needs of non-heterosexual women with disabilities which are profoundly impacted by structural, political, and cultural constraints and possibilities.

Othering in Media Representations of Elderly Care: Using the Social Justice Framework to Make Sense of Public Discourses on Migrants and Culture

Population ageing and international migration are two of the major societal trends challenging European elderly care regimes at present. Virtually no research has addressed how public discourses about the implications of these trends for elderly care are shaped in different countries. This article addresses this knowledge gap, examining how Swedish daily newspaper (SvD and DN) reporting on elderly care between 1995 and 2017 (N=370) depicts the impact of increased ethno-cultural diversity on this sector. Through content analysis, this article brings attention to the representations of migrants and culture that this reporting has deployed, and the rhetorical practices that the reporting has relied on (i.e. genre stratification, hegemonisation, homogenisation, normative referencing and idealisation/ diminishment). The article exposes how the ‘Othering’ of migrants is accomplished in Sweden’s daily newspaper reporting on elderly care, and problematizes the ethea of inclusiveness and equality of care with which we have come to associate this welfare sector.

Peripartum Covid-19 Pneumonia with Severe ARDS – A Case Report

Introduction SARS-CoV-2 is a novel coronavirus that was first isolated in Wuhan, China, and resulted in a rapidly spreading pandemic worldwide. Currently there is only limited evidence on the effect of COVID-19 on pregnant women. Case Here we present one of the first serious COVID-19 cases in pregnancy at term with subsequent delivery. Postpartum the mother required antibiotic and symptomatic treatment. She experienced acute worsening of symptoms and developed acute respiratory failure requiring endotracheal intubation and subsequently extracorporeal membrane oxygenation. Conclusion COVID-19 affects all medical disciplines, requiring interdisciplinary approaches and development of patient care regimes. Obstetricians should be aware and be prepared for the special needs of pregnant women with potential prenatal and postnatal issues. Ideally pregnant COVID-19 patients should be cared for at a tertiary perinatal center with experienced perinatologists and neonatologists.

Gender inequality, the welfare state, disability, and distorted commodification of care in Turkey

Reforming care regimes to cover the care deficit and enhancing the marketization of care to promote individualism and gender equality have been on the European agenda since the 1990s. However, both implementation and results have been path-dependent. This study first underlines some specificities in the Turkish case—namely, the limited welfare state, a large shadow economy, gender roles, patriarchal backlash, Islamization, and neoliberalism, all of which receive little treatment in the welfare state literature. It then analyzes how these specificities interact in the construction of the care regime in Turkey, conceptualizing the outcome as distorted commodification of care—namely, the continuing ambiguity of care services despite these activities producing precarity and positional suffering for caregivers and recipients. Finally, the study provides concrete examples from the less studied topic of long-term disability care. It presents a perspective on Turkey that foregrounds the connections between gendered care imagery and case-specific qualities of the commodification of care shaped by the long-standing shadow economy, the outsourcing of disability services to for-profit private companies, and the introduction of the cash-for-care policy. The study analyzes the outcomes of distorted commodification of care under these conditions in Turkey vis-à-vis visibility, valuation of work, working conditions, and gender inequality.