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Help Wanted?: Providing and Paying for Long-Term Care

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... En países que cuentan con sistemas públicos de cuidados a largo plazo, estos servicios también incluyen atención en hospitales de día o ambulatorios y servicios a domicilio que van desde el apoyo para realizar actividades instrumentales como realizar las compras o cocinar, acompañamiento, suministro de medicamentos específicos o terapias, entre otras. 15,16 Por lo general, los modelos de financiamiento y accesibilidad a los sistemas de cuidados a largo plazo siguen los modelos de los sistemas de seguridad social en cada país, por lo que pueden basarse en sistemas universales con alta cobertura, hasta modelos basados en seguros de salud y menores beneficios. Finalmente, en la mayoría de los países de ingreso alto, los sistemas de cuidados a largo plazo son nacionales, pero la prestación de servicios y extensión de los beneficios quedan en responsabilidad de las autoridades locales que responden a las necesidades de ese entorno. ...
... Para abordarlo, es fundamental desarrollar un marco legal y normativo que defina claramente el alcance, actores y mecanismos de financiamiento del sistema. 15,19 Este marco debe promover la integración de los servicios de cuidados con el sistema de salud y los programas de protección social existentes, permitiendo un enfoque centrado en la persona y una mejor continuidad de la atención. 4,20 Un elemento clave es el fortalecimiento de los cuidados domiciliarios y comunitarios, que prioricen servicios que le permitan a las personas mayores envejecer en sus hogares y comunidades el mayor tiempo posible. ...
... Estos servicios, que incluyen apoyo psicosocial, capacitación y periodos de descanso, son esenciales para prevenir la sobrecarga de quien cuida o el desgaste profesional y mejorar la calidad de vida de las personas cuidadoras y el personal profesional. 15,25,26 Su incorporación en el sistema de cuidados es necesario para garantizar la sostenibilidad de los mismos en el hogar y la comunidad. ...
Article
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Si bien el debate sobre el sistema nacional de cuidados está cobrando impulso en los ámbitos académico y político, es importante señalar que las cuestiones de género y cuidado de las infancias a menudo eclipsan el componente relativo a las personas mayores, tema que necesita un análisis más profundo. Este artículo tiene por objetivo apoyar en la construcción de una agenda de cuidado que priorice a las personas mayores y presenta argumentos a favor del cuidado, entendido como un derecho, y a la par discute la carga de enfermedad como responsable de dependencia y como consecuencia de largos periodos de necesidad de cuidados. Se analiza el concepto de cuidados, su distinción con cuidados a largo plazo y cuidados paliativos y se plantea una perspectiva diferente para calcular la dependencia más allá del número de actividades de la vida diaria afectadas (AVD). Además, se presenta la situación nacional e intergeneracional de los sistemas de cuidados, específicamente de largo plazo, los cuales en México son inexistentes, y se revisan puntos clave para integrar el sistema, como son legislación y normatividad de residencias, capacitación y certificación de personas mayores e incorporación del enfoque comunitario. En un contexto de desigualdad, rezago social, necesidades de salud crecientes y un proceso de envejecimiento acelerado, es indispensable vincular el sistema de salud con el sistema social de cuidados.
... income between 1,000 and 1,999 e. This profile was consistent with previous international studies (e.g., Triantafillou et al., 2010;Colombo et al., 2011;Verbakel et al., 2017;OECD, 2021). However, some differences were noted. ...
... However, some differences were noted. Notably, the percentage of women was higher than that found in several previous studies (Triantafillou et al., 2010;Colombo et al., 2011;Verbakel et al., 2017;OECD, 2021). This finding could be attributed to cultural differences. ...
... Similarly, most of the informal caregivers in the sample used in the present study had primary education, whereas in the study by Verbakel et al. (2017), the predominant educational level was secondary education. Lastly, although different average wages make it difficult to compare monthly income levels between countries, caregivers of working age are at a higher risk of poverty in all regions except Southern Europe (Colombo et al., 2011). The profile of the care recipient was also that of a woman, with a mean age of 61.3 years; while the findings regarding the gender of the care recipient are consistent with the scientific literature, the care recipients in our study are younger than those in previous studies, where individuals over 70 or even 80 years old predominated (e.g., Otero et al., 2019;OECD, 2021). ...
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Introduction Although previous research has demonstrated that resilience can be protective against various mental health conditions such as depression, existing studies examining the relationship between resilience and depression have limitations. To our knowledge, the moderators of the relationship have not been examined. The aim of this study was to determine whether resilience acts as a protective factor against depression in informal caregivers and to examine potential moderators of the relationship between these variables. Methods In this cross-sectional study, 554 randomly selected informal caregivers participated (86.8% women, average age = 55.3 years). Major depressive episode, depressive symptomatology, resilience, positive environmental reward, negative automatic thoughts, self-efficacy, and personality were assessed. Results A total of 16.1% of informal caregivers met criteria for a depressive episode and 57.4% were at risk of developing depression. The average resilience score was 26.3 (SD = 7.6); 62.6% of participants were in the lower quartile of the resilience scale. The gender of the informal caregiver and self-efficacy acted as moderating variables in the relationship between resilience and depression. The impact of resilience on depressive symptoms was more pronounced in female informal caregivers, and increased as self-efficacy increased. Discussion Based on these findings, programs aimed at preventing depression in informal caregivers should focus on promoting resilience, especially in women, and introduce strategies to enhance self-efficacy to increase their impact.
... LTC encompasses both formal care (e.g., provided by nurses) and informal care (e.g., by family members), with the latter accounting for approximately 70% to 95% of care needs (United Nations Economic Commission for Europe, 2019). Spouses, in particular, shoulder a significant burden, delivering roughly one-third of all informal care in Western countries (Colombo et al., 2011). ...
... We included middle-aged adults (aged 50-59) in our study for several reasons. First, prior research has demonstrated that caregiving initiation often begins around age 50 (Colombo et al., 2011;Verbeek-Oudijk et al., 2014). Second, because this population remains active in the workforce, understanding their response to care demands is crucial since they face the challenge of balancing work responsibilities with spousal caregiving. ...
... Global population aging has driven a dramatic increase in the need for LTC (Colombo et al., 2011;Fu et al., 2019). Family members, particularly spouses, often become informal caregivers, shouldering this crucial responsibility in many countries (Colombo et al., 2011;Giang et al., 2023). ...
Article
Background: Population aging is escalating globally, intensifying the demand for long-term care (LTC), primarily met by informal caregivers, notably spouses. Evidence from developed countries suggests potential adverse effects on caregivers' well-being. Yet, research on this topic is scarce in developing nations. We investigate the effect of informal caregiving on older spousal caregivers' health and well-being in Vietnam, a rapidly aging country with an early stage of LTC system development. Methods: Utilizing the national survey on aging in Vietnam with propensity score matching estimations to mitigate potential endogenous problems of the decision to provide care between caregivers and non-caregivers. Results: Findings showed caregiving increased poor psychological well-being, life dissatisfaction, and functional limitations by 7.3%, 9.7%, and 8.6%, respectively. The caregiving effects are heterogenous by demographic characteristics. Conclusions: We are the first to examine spousal caregiving in Vietnam, highlighting the urgency of addressing its negative impacts and suggesting several potential policy interventions.
... Globally, by 2030, 1.4 billion people will be aged 60 or over, and by 2050, this figure is expected to rise to 4.1 billion [1]. This projected proportion of the older population has many implications for the sustainability of the jobs of workers who combine paid work with informal eldercare in their families, both for their organizations and for the wider labor market [2][3][4]. As increased longevity amplifies the need for care of older relatives by working family members [5], those employees with eldercare responsibilities will be exposed to real occupational costs [6]. ...
... Our findings confirm that work-family conflict, which is classified as secondary stressor, affects a specific outcome-exhaustion-which, in turn, increases turnover intention as a general outcome at the informal caregiver level. While a vast body of research on the work-care interface has examined the relationship between eldercare responsibilities and caregivers' labor market participation [2,26,27,32,87,91,92], only a small body of research on the impact of caregiving on employment is devoted to a detailed consideration of the ICIM. ...
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Understanding the labor market participation shift associated with an aging population and the challenges of employees who provide care to old-age relatives is essential to ensure progress toward the Sustainable Development Goals. The current study focuses on the decision of employees who combine paid work with unpaid care to relatives aged 65 and above to stay or leave their jobs. We draw on the Turnover Model and the Informal Caregivers Integrative Model (ICIM) to examine how two primary stressors—care burden and work demand—one secondary stressor—work–family conflict—and emotional exhaustion increase the turnover intentions of employees who combine paid work with eldercare to their old relatives aged 65 and over. By synthesizing these two models and using a survey with three chronological waves among 356 Israeli employees, we analyze a mediation model within a Structural Equation Modeling framework. The findings underscore the fact that work–family conflict (a secondary stressor) and the sense of exhaustion act as key mediators in the relationship between employees’ primary stressors and turnover intentions. The presence of primary stressors in themselves does not increase turnover intentions. Our findings imply that, rather than providing sporadic adaptations at work, policymakers, organizations, and human resource management systems should respond proactively to prevent the process from undermining employees’ ability to achieve equilibrium between their desire to work and care for their old-age relatives. Such a proactive stance would reduce their exhaustion and turnover intention.
... The extent to which LTC provision relies on formal or informal care varies between European countries [1,2]. Disparities also exist in the share of GDP spent on LTC services; in the share of total LTC expenditure covered by public expenditure; and in what degree LTC benefits are provided in cash or in-kind [3,4]. ...
... Providing informal care reduces earnings and the likelihood of employment of female carers [14] and increases the likelihood of mental health problems [15]. To alleviate such problems, several countries have introduced cash benefits and services to reduce the care burden and to support carers' health and quality of life (QoL) [3,16]. ...
Article
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Purpose The provision and funding of long-term care (LTC) for older people varies between European countries. Despite differences, there is limited information about the comparative performance of LTC systems in Europe. In this study, we compared quality of life (QoL) of informal carers of home care service users in Austria, England and Finland. Methods Informal carers were surveyed in Austria, England and Finland. The study data (n = 835) contained information on social care-related quality of life (SCRQoL) associated with the ASCOT-Carer measure, and characteristics of carers and care recipients from each country. We applied risk-adjustment methods using a fractional regression model to produce risk-adjusted SCRQoL scores for the comparative analysis. In a sensitivity analysis, we applied multiple imputation to missing data to validate our findings. Results We found that the mean values of the risk-adjusted SCRQoL of informal carers in England were 1.4–2.9% and 0.3–0.5% higher than in Finland and Austria, and the mean values of the risk-adjusted SCRQoL of carers in Austria were 0.8–2.7% higher than in Finland. Differences in the mean values of the country-specific risk-adjusted SCRQoL scores were small and statistically non-significant. English informal carers were less healthy and co-resided with care resipients more often than carers in Austria or Finland. Conclusion Small differences between the risk-adjusted SCRQoL scores between Austria, England and Finland are consistent with the observation that the countries provide different types of support for informal carers. Our results help local and national decision-makers in these countries to benchmark their informal care support systems.
... Även om detta medför en ökad belastning för den ordinarie sjukvården och omsorgen så tillgodoser anhöriga en stor del av vård-och omsorgsbehovet för sina närstående (Wimo et al., 2017). Som en konsekvens av att antalet äldre beräknas öka i snabbare takt än tillgängliga vårdresurser, så beräknas det framtida omsorgsbehovet inte kunna mötas (Colombo et al., 2011;Pickard, 2015). ...
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Informella omsorgsgivare är många gånger förvärvsarbetande. I denna studie undersöktes samband mellan informell omsorg, arbetsrelaterad stress och depressiva symtom. Detta samt granskning av eventuella könsskillnader var studiens syfte. Urvalet bestod av sekundära tvärsnittsdata från Svenska Longitudinella studien Om Sociala förhållanden, arbetsliv och Hälsa (SLOSH). Både anhörigomsorg och arbetsrelaterad stress var relaterade till mer depressiva symtom. För kvinnor var anhörigomsorg relaterat till ökad grad av depressiva symtom, för män enbart om de gav mer än fem timmar omsorg i veckan. Förväntningar och potentiellt bristande tid för återhämtning var några av de föreslagna förklaringarna till resultatet.
... In Germany, there are more than 4 million individuals in need of care, and this number will rise within the next 20 years [1], causing a shortage of care home facilities in many towns and cities. The continuous rise of the elderly population requires more specialized care and support services, increasing the demand for care workers in nursing homes [2]. Because of this, there is a huge shortage of these care workers in Germany, making it challenging to meet the growing demand for care services [3]. ...
... Each country may have its own strengths and weaknesses in social care and services, so it is important to carefully explore and compare the different options available. These are just some of the factors that determine the impact of social care on public budgets (Colombo, 2011). To fully understand this issue, more research and analysis of country-specific situations and policies are needed. ...
Conference Paper
A social security system must provide social security and support for all members of society, regardless of their age or financial situation. The elderly and disabled may face various health problems, physical and mental decline which may make them dependent on other people or on professional care. People with financial means lack the care they need; for example, older people who may not have family carers or who do not want to use commercial care services. In this case, an additional support system is needed to provide care for those with financial resources. A social program should be available so that these people can receive help from the state or the municipality. As life expectancy increases and older people become a larger demographic group in society, it is essential to provide adequate care and support for this group of older people. This includes medical and health care, as well as social care and emotional support. In this context, the state and society have a responsibility to provide appropriate care services and resources to ensure the dignity, comfort, and security for older people if they can afford private care. In old age, people deserve to live with dignity and quality care, regardless of their financial situation or social status. This requires care and attention by both the state and society to establish and maintain systems that guarantee that the needs of older people are met.
... The Organization for Economic Cooperation and Development (OECD) defines Long-Term Care (LTC) as a range of services provided to people who have functional limitations or chronic conditions that make it difficult for them to perform basic activities of daily living (ADLs) (such as bathing, dressing, eating, and toileting) for an extended period of time (Colombo et al. 2011). These services may be provided in various settings, such as the individual's home, a residential care facility, or a hospital, and may include assistance with personal care, medical and nursing care, rehabilitation, social support, and assistance with instrumental activities of daily living (IADLs). ...
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The European Commission’s 2015 aging report forecasts a substantial increase in public spending on Long-Term Care (LTC) for OECD countries by 2060, posing significant fiscal challenges. This study aims to assess the efficiency and productivity of the LTC sector from 2010 to 2019 and explore whether efficiency gains can alleviate these fiscal pressures. Using a non-parametric Data Envelopment Analysis (DEA) model, combined with Tobit regression, we estimate the efficiency of OECD countries and examine the role of decentralization in shaping performance outcomes. The findings reveal that, on average, countries operate at 94% efficiency, with modest productivity growth. However, technical inefficiencies persist, especially in unitary countries, while federal countries, though initially less efficient, show greater improvements over time. Despite these gains, the current efficiency levels are insufficient to counterbalance the projected increase in LTC demand. Policymakers should prioritize reforms that enhance efficiency through decentralization, promoting accountability and competition as mechanisms to sustain the LTC system in the face of demographic shifts.
... Unpaid caregiving has the most negative effect on labour supply if it is provided often, e.g. on a daily basis or over 20 hours per week. Less frequent unpaid caregiving has weaker effects on labour supply (Ciccarelli and Van Soest, 2018 [16]; Carmichael and Charles, 1998[17]). ...
... This suggests that caregiving responsibilities within families may diminish the workforce. Colombo et al. 2011), in their OECD report, observed that the significant number of women taking on caregiving roles impacts female participation in the labor market Bauer & Sousa-Poza, 2015). ...
Article
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The long-term care insurance system is a crucial social service policy for disabled and elderly individuals with dementia in the context of the unfeasible traditional family old-age care model. Through the support of the social insurance model for old-age care security, it effectively addresses and meets the actual needs of long-term care recipients. This has become a significant way to alleviate the burden of disabled and demented elderly individuals, mitigate the impacts of ageing, and create employment opportunities for family caregivers. Using the long-term care insurance pilot policy implemented in Qingdao in 2012 as a quasi-natural experiment, this paper estimates the influence of long-term care insurance on the labor market performance of the pilot city using the synthetic control method of project policy evaluation. Several robustness tests of the labor market effects of long-term care insurance are conducted, utilizing two placebo methods based on time and space, and the ranked test method. The study's findings demonstrate that the implementation of the long-term care insurance policy pilot has a constructive influence on the employment choices of workers in the labor market. Specifically, it encourages participation in the workforce and expands the scale of labor force participation in the pilot cities. Furthermore, the policy's effect strengthens over time and has a marked positive effect on average employee wages, thereby spurring labor supply growth. Through further analysis, it can be determined that the pilot cities have contributed to an average annual growth of around 1 million people in total labor force participation between 2013-2017, surpassing the potential growth rate by approximately 10.5%. Additionally, during this period, the average employee wage displays a linear upward trend with a maximum increase of over 5,000 pounds per capita per year. This suggests a substantial effect on the overall performance of the labor market due to its growth-promoting influence. In addition, the analysis of the heterogeneity of its impact mechanism demonstrates that the long-term care insurance policy aims to enhance the willingness of tertiary industry workers to work and considerably increase the likelihood of their entry into the labor market. It also improves labor income expectations of urban private and self-employed workers, resulting in a virtuous circle of enhanced labor and employment driven by the increased value of labor and the strengthened willingness to participate.
... There has been a shift in the financing and operation of healthcare services in Norway, moving from the counties to the municipalities [2][3][4]. Since then, community-based long-term care has been prioritised, resulting in a reduction in nursing home places [5]. However, despite this reduction, nursing homes still constitutes the largest institutional services in Norway, with approximately 39 000 beds [6]. ...
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Background The ageing population has increased the demand for healthcare services. In Norway, community-based long-term care are prioritised, leading to fewer nursing home places. As a result, nursing home residents are now older and have more complex needs. Nearly 92% of nursing home residents are affected by cognitive impairments accompanied by neuropsychiatric symptoms (NPS) that affect their daily activity, physical function, cognition, and behaviour. Traditionally, pharmacological therapy has been the prevailing treatment for NPS. However, emerging evidence suggests that physical activity can serve as an alternative treatment approach. Physical activity has the potential to maintain physical independence and enhance the quality of life (QoL) for the residents. Despite these benefits, institutionalisation in a nursing home often restricts activity levels of residents. This study explores facilitators and barriers to physical activity in nursing homes through the experiences of healthcare professionals and family caregivers. The goal is to enhance our understanding of how to promote and support physical activity for nursing home residents by identifying essential factors for successfully implementing daily physical activity initiatives. Methods Seven focus groups were conducted with a total of 31 participants. Participants included healthcare professionals (physiotherapists, nurses, unit- and department managers, assistant occupational therapists, and assistant nurses) and family caregivers of residents at nursing homes. Data were analysed using Braun and Clarke’s reflexive thematic analysis, underpinned by hermeneutic phenomenology. Results Three main themes related to facilitators and barriers to physical activity in nursing homes were identified: inconsistency in task prioritisation; need for improved interprofessional collaboration; and need for improved utilisation of external resources. The participants experienced task prioritisation and lack of interdisciplinary collaboration as barriers to physical activity. The involvement of external societal resources was considered as both a facilitator and a necessity for obtaining physical activity in nursing homes. Conclusions This study highlights the need for a consensus in task prioritisation, enhanced competence among healthcare professionals, and better interdisciplinary collaboration to facilitate physical activity in nursing homes. Involving external societal resources could be a strategic approach to address barriers and support physical activity initiatives. Future research should focus on developing effective strategies for interdisciplinary collaboration that prioritises and promotes physical activity in nursing homes.
... Por seu lado, os cuidados informais também têm enfrentado dificuldades devido a diversas mudanças nas estruturas e dinâmicas familiares, onde se inclui o aumento da participação das mulheres no mercado de trabalho (tradicionais cuidadoras), que em grande parte dos países se dá a tempo inteiro, levantando problemas em termos de conciliação da atividade profissional com os cuidados familiares (Gil, 2022). A este respeito, prevê-se que na maior parte dos países da OCDE o número de cuidadores informais irá diminuir no futuro (Colombo et al., 2011). ...
Article
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A oferta e utilização de tecnologias de assistência, onde se incluem os serviços de teleassistência, têm-se expandido ao longo das últimas décadas, inclusivamente junto das pessoas que se encontram nas fases mais avançadas da vida. É advogado que estas tecnologias promovem o envelhecimento no lugar/na comunidade e a qualidade de vida (QdV) dos mais velhos. Contudo, a evidência empírica ainda é escassa ou inconclusiva sobre o modo como os adultos mais velhos utilizam estas tecnologias, assim como se, e de que forma, a utilização destas tecnologias promove, efetivamente, a QdV. Este artigo pretende dar um contributo para o esclarecimento destas questões, reportando alguns resultados de um estudo qualitativo sobre a utilização e avaliação do serviço de teleassistência de um Município da região do Algarve, do qual se realizaram 21 entrevistas semiestruturadas a utilizadores com 65 ou mais anos de idade (às quais se adicionam 5 entrevistas exploratórias a informantes privilegiados). Os resultados aqui reportados chamam a atenção para a diversidade de padrões de utilização do serviço de teleassistência, particularmente para a existência de um padrão de utilização que denota a persistência na sociedade portuguesa de cidadãos que não estarão suficientemente empoderados para usar os serviços sociais de que necessitam e a que têm direito. Os resultados também oferecem evidência de que o serviço de teleassistência, na ótica dos seus utilizadores, promove, efetivamente, a qualidade das suas vidas, muito por via da segurança que proporciona, e não tanto pela companhia que providencia. São discutidas as implicações destes resultados para o conhecimento sociológico, as políticas públicas e as práticas profissionais.
... in most Western countries, there is an increased focus on the challenges and costs of providing sufficient long-term care (both home-based and institutional) in the face of ageing populations [10][11][12][13][14][15]. there is also a shift towards care that enables patients to live at home, both with and without home care. ...
Article
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Objective Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.
... The increase in life expectancy over the past few decades has been accompanied by an escalation in the number of years living with debilitating mental and physical health conditions requiring long-term care (Colombo et al., 2011). Current European estimates suggest that around 27% of people over the age of 65 report severe di culties in personal care or household activities (European Commission, 2021). ...
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Providing care in older age to family members and friends is common but this could impact the carers’ time and energy for social participation. This study explores the relationship between care and social participation in 16 European countries, considering factors like care intensity, relationship to the care recipient, gender, and socioeconomic status. The study utilised pooled data from the Survey of Health Ageing and Retirement in Europe and the English Longitudinal Study of Ageing. Multiple regression models assessed the association between care status (non-carer, carer, and former carer) and social participation measured through volunteering frequency and group membership. The models adjusted for various demographic and socioeconomic covariates. The study found that carers, especially those doing so less intensely, were more likely to volunteer and belong to groups compared to non-carers. The association between care and volunteering was stronger for carers in low support countries. The association between care and group membership was found to be stronger for carers in the highest wealth quintiles, as well as for female carers in low support countries and for male carers in low and medium support counties. The study suggests that caring is not necessarily associated with negative outcomes such as lower social participation but underscores the impact of care strain and burden resulting from high intensity of care as risk factors for reduced social participation. Furthermore, the study highlights the importance of considering the individual and contextual socioeconomic resources in understanding carers' social participation outcomes.
... If the long-term heavy care burden is not alleviated and released in a timely and effective manner, it will eventually hurt both older adults and caregivers [1,2]. Informal care refers to the provision of daily living assistance, medical care, or long-term care to individuals in need, by non-professional individuals such as family members, friends, or neighbors [3]. This type of care is typically based on close relationships, emotional bonds, and social obligations, rather than employment or professional contracts. ...
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Background Forecasting the intensity, source, and cost of informal care for older adults in China is essential to establish and enhance policy support systems for informal care within the context of East Asian traditional culture that emphasizes filial piety. This study aims to analyze the current situation and influencing factors for the informal care needs and predict the trends of informal care needs for older adults in China from 2020 to 2040. Methods Using the CHARLS database from 2015 to 2018, this study first combined a two-part model and a multinomial logit to analyze the influencing factors for the informal care needs of urban-rural older adults in China. Secondly, a multi-state Markov model was constructed to forecast the number of urban-rural older populations in each health state from 2020 to 2040. Finally, based on a microsimulation model, this study predicted the trends of informal care intensity, source, and cost for older adults in urban and rural areas from 2020 to 2040. Results In 2040, the size of the disabled older population in China will expand further. In rural areas, the total number of disabled people in 2040 (39.77 million) is 1.50 times higher than that in 2020; In urban areas, the total number of disabled people in 2040 (56.01 million) is 2.51 times higher than that in 2020. Compared with 2020, older adults population with mild, moderate and severe disability in 2040 would increase by 87.60%, 101.70%, and 115.08%, respectively. In 2040, the number of older adults receiving low-, medium-, and high-intensity care in China will be 38.60 million, 22.89 million, and 41.69 million, respectively, and older people will still rely on informal care provided by spouses and children (from spouses only: 39.26 million, from children only: 36.74 million, from spouses and children only: 16.79 million, other: 10.39 million). The total cost of informal care in 2040 will be 1,086.65 billion yuan, 2.22 times that of 2020 (490.31 billion yuan), which grows faster than the economic growth rate. Conclusion From 2020 to 2040, the informal care needs of older people in rural areas will increase first and then decrease due to the demographic structure and rapid urbanization. In contrast, the informal care needs of older people in urban areas will continuously increase from 2020 to 2040, with the growth rate gradually slowing down. This study provides an evidence-based rationale for scientifically measuring the economic value of informal care and reasonably allocating care resources.
... The problem of reconciling paid work and eldercare poses a challenge to social and economic policy in our ageing society. Demographic changes have given rise to an increasing number of middle-aged employees who are also providing informal eldercare (Koreshi & Alpass, 2023;Colombo et al., 2011b;OECD, 2023). Western governments face these rising care demands and healthcare costs by shifting from formal care and towards informal care (Lindt et al., 2020) and establishing 'Ageing in Place' policies. ...
... Insomnia and daytime sleepiness are associated with adverse cognitive and functional outcomes (Foley et al., 1995(Foley et al., , 2004Ohayon, 2002;Ohayon and Vecchierini, 2002;Gooneratne et al., 2003;Ozminkowski et al., 2007;Vaz Fragoso and Gill, 2007;Kaufmann et al., 2013), and may impair older adults in their role as caregivers to the detriment of the care recipient. As caregivers provide immense social and economic benefits to our society (Colombo et al., 2011), it is imperative that we understand whether sleep disturbances represent a modifiable target to support them in their caregiving role. ...
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Objective Aging-related changes and caregiver burden may increase the risk for sleep disturbances among older caregivers, yet few studies have examined the prevalence of insomnia and daytime sleepiness in this group. We examined the relationship of caregiver status with insomnia and daytime sleepiness among persons of advanced age (>75 years of age). Design Cross-sectional. Setting Community. Participants Yale Precipitating Events Project participants (n=383, mean age 84.4 years, 67% female, 12% African American, 25% caregivers). Measurements Caregivers were persons who reported caring for another person in the past week or caring for/helping a friend or relative >4 times in the past month. We examined the correlates of caregiver status, including demographic (age, sex, race/ethnicity, education, marital status), psychosocial (living alone, Medicaid eligibility, depressive symptoms, social support, hours volunteered), and physical (obesity, chronic conditions, medication use, self-rated health status, physical activity, functional disability, cognitive impairment) factors. We used the Insomnia Severity Index (ISI) to establish insomnia severity (ISI score 0–28) or clinically significant insomnia symptoms (ISI ≥8). We used the Epworth Sleepiness Scale to establish daytime sleepiness (ESS score 0–24) or hypersomnia (ESS ≥10). In nonparametric multivariable regression analyses, we examined the relationship of caregiver status with insomnia or daytime sleepiness. Results Compared to non-caregivers, caregivers were younger, more educated, less likely to be Medicaid eligible and had lower rates of depression, obesity, poor self-rated health, low physical activity, functional disability, and cognitive impairment. Mean ISI and ESS scores were in the normal range and similar among non-caregivers and caregivers (ISI scores of 6.9±5.6 and 6.9±5.4, and ESS scores of 6.4±4.7 and 6.1±4.3, in non-caregivers and caregivers, respectively). Multivariable-adjusted models demonstrated no significant differences in ISI and ESS scores between non-caregivers and caregivers (regression coefficients for ISI and ESS scores of −0.01 [95% CI = −1.58, 1.21] and −0.10 [−1.05, 1.21], respectively). Conclusion When compared to older non-caregivers, older caregivers had more advantageous demographic, psychosocial, and physical profiles and had similar levels of insomnia and daytime sleepiness on standardized questionnaires. Future research is needed to elucidate contextual factors (e.g., caregiving intensity and care partner disease) that may increase the risk of sleep disturbances among caregivers of advanced age.
... As the population ages, the number of older adults who require institutional long-term care (LTC) in settings such as long-term care hospitals (LTCHs) or nursing homes (NHs) is increasing worldwide [1]. However, the needs for better access and high-quality services is growing [2]. ...
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... Expansion of universalism was particularly evident in countries that had until the 1990s only devoted residual public resources to LTC. Cautious not to strain the fiscal sustainability of their social protection systems however, this universalism took the form of "restricted" or "targeted universalism," in which care was provided to people in need, but needs assessment limited the scope of the eligible population (Colombo et al., 2011;Ranci and Pavolini, 2015). As mentioned above, the introduction of market mechanisms under their several guises was also underpinned by cost-consciousness and efficiency considerations (Szebehely and Meagher, 2013), while also responding to increased calls for greater empowerment and responsiveness by some groups of users (Rodrigues and Glendinning, 2015). ...
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Background: Care staff in the disability sector experience high levels of work-related stress and burnout, which contribute to high staff turnover and limited residential service capacity and affect both staff well-being and the quality of care provided. Little is currently known about the impact that exposure to secondary trauma has on care staff, which could put them at risk of experiencing empathy-based stress. This qualitative study aimed to explore how empathy-based stress is experienced by care staff supporting children and adolescents with intellectual disabilities and/or autism in residential and respite services, and the factors they perceive as contributing towards or protecting them from experiencing empathy-based stress. Methods: Twelve care staff from four different community-based organisations in Ireland (two residential care and two overnight respite) took part in online semistructured interviews, which were recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. Results: Four themes were identified, which had two to three subthemes each: (i) Challenging Periods (exposure to distress and trauma, empathy and feeling powerless), (ii) Organisational Factors (lack of support from management, training and staff cohesion), (iii) Personal Resilience (awareness, focussing on the positives) and (iv) Impact of Empathy-Based Stress (negative work affect, adverse impact on health and well-being). Conclusion: Staff were exposed to service user distress or trauma, which at times initiated an empathy-based stress process. A build-up of factors, both individual and contextual, led to adverse physical and psychological outcomes and negative work affect. These findings have implications for policy and practice within disability care settings and suggest that interventions at a personal and organisational level and the adoption of a trauma-informed approach may help to reduce empathy-based stress in care staff and improve quality of care for service users.
Chapter
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Chapter
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In this commentary, we first briefly review the significant utilities of household and living arrangement projections and the main types of methods for conducting household projections. In the second and third sections, we summarize basic ideas, data needed, assessments and applications of ProFamy extended cohort-component methods/software for households and living arrangement projections; and we emphasize the importance to extend the ProFamy methods and software from deterministic to probabilistic households and living arrangement projections. In section 4, we demonstrate that the ProFamy approach provides an adequate and highly feasible modelling framework to extend probabilistic households and living arrangement projections (PHPs), in which the population size/structure projection outcomes are in consistence with those of probabilistic population projections (PPPs) released by United Nations Population Division (UNPD). In the last Section, we discuss and recommend applying the user-friendly R package DemoRates of ProFamy software to estimate rural/urban (or race)-sex-age-specific standard schedules and the demographic summary measures, to conduct analyses and projections, such as single-parent households, caregivers, and care needs/costs for disabled older adults, age-friendly housing and households-based energy demands, etc. for healthy aging and sustainable development studies. Finally, we discuss the prospects of our ongoing international collaborative research project to substantially extend ProFamy cohort-component method from deterministic into probabilistic households and living arrangement projection (PHPs). As compared with ProFamy deterministic projection method, the PHPs produces a lot of additional outcomes of probabilistically projected households and living arrangements in 2021–2100 with uncertainty intervals that are crucial for healthy aging and sustainable development studies.
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The past decade has been marked by cuts in public funding of adult social care alongside an increased policy focus within the UK on extending working lives through ‘50 PLUS Choices’. This study uses the UK Household Longitudinal Study (2009/10–2018/19) to examine the relationship between informal care provision and labour market participation. The analysis focusses on mid-life, a period of life course characterised by both the uptake of informal care provision responsibilities and withdrawal from the labour market. Across the observation period, employment increased amongst both mid-life carers and non-carers, but the gap widened – with carers being much less likely to be employed. Discrete-time survival models assess the effect of caregiving on the likelihood of changing from full-time to part-time work or leaving work altogether. A range of indicators of caregiving, including care intensity, type of care provided and relationship to the person cared for, are all associated with reduced employment. The analysis supports the argument that policies promoting higher labour force participation amongst older workers are incompatible with cuts in funding for adult social care; to realise ‘50 PLUS Choices’, older working carers need to be better supported in juggling the competing demands of care and work.
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Background Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. Methods This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as ‘insufficient’/’sufficient’ or ‘insufficient’/‘moderate’/‘high’ in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Results Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Conclusion Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.
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This series of reports is one of the research results of the Mc-COVID-19 project, “MC-COVID19: Coordination mechanisms in Coronavirus management between different levels of government and public policy sectors in 15 European countries”, funded by the Spanish National Research Council (CSIC) within the CSIC-COVID-19 programme, as well as of the GoWPER project, “Restructuring the Governance of the Welfare State: Political Determinants and Implications for the (De)Commodification of Risks”, CSO2017-85598-R Plan Estatal de Investigación Científica y Técnica y de Innovación.
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In rapidly ageing societies, caring and responsibilities for parents in old age is a widely discussed topic. This is particularly relevant in societies with low fertility and high rates of childlessness. Lithuania is one of the countries where demographic ageing rates have risen sharply in a short period of time. This process has been driven not only by low fertility but also by emigration of middle-aged and young people and increasing life expectancy. There is no lack of research on demographic changes in ageing societies in the country, but very little is known about the attitudes of childless men and women towards caring for their parents in old age. The aim of the study is to determine the attitudes of childless and child-bearing individuals towards parental responsibilities in Lithuania. Our analysis is based on the 2018-2019 ‘Families and Inequality Survey’ dataset collected in Lithuania. The data covers 3,005 individuals aged 34-48 at the time of the survey. The representative sample was obtained by using a stratified sampling method. Face-to-face interviews were carried out with respondents in their homes by using a standardized questionnaire. The data were analysed using descriptive statistics and chi-square methods. We found that the proportion of men (12.0%) who do not want to have children is statistically significantly higher (p=0.003) than the proportion of women (7.6%). We found that childless people were less likely than those with children to agree with the statement that children should look after their parents. In addition, women were more likely than men to agree with these statements. Our findings are important from a practical point of view – when considering social care and pronatalist policy measures. Research project is financially supported by the Research Council of Lithuania (LMTLT), agreement No. P-MIP-22-24.
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Frailty, which is accompanied by negative health outcomes associated with aging, is an increasingly serious public health problem. Long-term care insurance (LTCI) is an effective intervention for frailty in older adults, but few studies have linked LTCI to frailty prevention. This study aimed to determine the role of LTCI in preventing worsening of frailty in older adults. This study used five-wave panel data from the China Health and Retirement Longitudinal Study (CHARLS) 2011 to 2020 to construct an indicator system to assess the frailty index (FI) of surveyed older adults and used a difference-in-differences (DID) method to assess the policy effect of LTCI on frailty among older adults. We found that the full-sample mean of the FI of older adults in China was 0.196, and the implementation of LTCI had a significant negative effect on the FI of older adults. The effect was heterogeneous across sex, age, education and medical insurance groups. LTCI had a more significant negative effect on male group, the middle-aged group, the less educated group, and the URRBMI group, while the effect was less significant for the female and the UEBMI group, and not significant for the more educated and other age groups. That is to say, older Chinese adults are generally frail to different degrees, and the implementation of a LTCI system can prevent worsening of frailty among them, but the effect is not equal across populations. The institutional coverage of LTCI should be further strengthened in the future to slow down the frailty process of the enrollees, so as to promote healthy aging.
Chapter
This chapter attempts to capture the mechanism shaping public managers' support for the work-eldercare balance, drawing on evidence indicating that a lack of such managerial support for combining paid-work with eldercare responsibilities results in intentions to resign, poor job performance, absenteeism and a low sense of well-being. Yet, little is known about public managers' support for public servants who struggle to reconcile work and eldercare. Using qualitative research design, this study investigates 20 public managers regarding their awareness, perceptions and supportive behaviors toward the work eldercare balance within the broader organisational setting and under the ‘Ageing in Place’ policy. The themes which emerged were identified as either direct and indirect support and classified under five categories—manager, team, organisational, social policy and family.
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This chapter identifies a set of priority investment areas needed to strengthen resilience, reinforcing the foundations of countries’ health systems and their ability to respond to evolving pandemics and other emerging shocks. It then produces order-of-magnitude estimates of the expected costs of such investments, drawing extensively from existing OECD data and analytical studies. These priority investments represent an estimated 1.4% of GDP, on average across OECD countries (ranging from 0.6% to 2.5%), compared with pre‑pandemic expenditure of 8.8%. A combination of targeted spending and measures to reduce wasteful spending could mitigate the overall increases in health spending in the medium to long term.
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This chapter will provide an introduction to the topic of unpaid caring and the increasing significance of older spouse carers in performing this role. It will begin with an overview of the incidence of unpaid caring both in the UK and around the world with particular reference to the experiences of older spouse carers and older carers more generally. There will then be a consideration of research on this issue. This will highlight the fragmentation in method and focus that has characterised research into both older age and unpaid caring, which has contributed to the neglect of older spouse carers and has undermined the full understanding of their experiences.
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Due to the fragmentation of research into unpaid caring and older age and its commonly adopted individualised focus, the interaction between structure and constraint on one hand and meaning and action on the other has been neglected especially with regard to the experiences of older spouse carers. It will be the purpose of this chapter to explore these issues by focusing on the way in which access to resources and contextual factors more generally can influence the experience of caring.
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This book explores the experiences of older people who provide care within marriage, highlighting the neglected role of older spouse carers and the positive social contributions they make. Drawing on relevant data, literature and research including in-depth interviews conducted with 26 older spouse carers, the author challenges classed, gendered, and other assumptions and expectations around older age and unpaid caring. These include the beliefs that older age is a time of passivity and dependency, that caring is a primarily female role that transcends class divides and that this caring is a normal part of the spousal relationship and not worthy of special attention. In addition to challenging these assumptions, the book will consider the implications of findings for service provision. This book will be of interest to scholars and researchers in Social Care, Sociology, Gerontology, and Gender Studies. In addition, practitioners and policy makers may also find this book of interest.
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