Disparity in the Burden of Caring for Older Persons between Families Living in Housing Estates and Traditional Communities in Thailand.

Thailand's rapid population aging and reliance on family-based long-term care requires research into disparities in family caregiver burden. Since the type of residence matters to the caregiving outcome, this research aimed to examine the difference in caregiver burden between residents of private housing estates and traditional village communities. This cross-sectional study was conducted with 1276 family caregivers of community-dwelling Thai older adults, in Chiang Mai province, Thailand. The caregiver burden was examined using the Caregiver Burden Inventory (CBI), and the care recipients' dependency status was examined using Barthel's Activity of Daily Living (ADL). Descriptive analysis, multivariate analysis of variance test, and multiple logistic regression analysis were performed. Family caregivers living in a traditional village community were 1.607 times more likely to experience emotional burden (adj. OR 1.607, 95% CI: 1.049, 2.462) and 2.743 times more likely to experience overall caregiver burden (adj. OR: 1.163, 95% CI: 1.163, 6.471) compared to those in the private housing estate group. Our findings showed significant differences in caregiver burden based on residential area, contributing with insights to evidence-based policies, interventions, and programs to minimize disparities and promote family caregivers' health and well-being.

Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave.

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

[A model for assessing and correcting the risk of developing pressure ulcers in the system of long-term care for geriatric patients with limited mobility.]

The article is devoted to the results of the third stage of the scientific and practical project on the introduction of advanced social practices based on innovative gerontotechnologies into the system of long-term care for geriatric patients. It has been established that senile xerosis or skin «frailty¼ occurs in 75% of the population over 65 years old, when increased dryness of the skin leads to peeling, the formation of microcracks, the appearance of senile itching, sleep disturbances, the development of pressure ulcers and, as a result, a decrease in motor activity. During the project, a tactic was developed for the care of «frail¼ skin in patients with senile xerosis and the risk of pressure ulcers. The article presents information about the current problems of diagnosis, correction and prevention of pressure ulcers in patients with limited mobility of elderly and senile age. The results of a comparative analysis of the severity of pressure ulcers and their impact on the quality of life in the system of long-term care for geriatric patients with limited mobility before and after the use of Cicalfate+ Eau Thermale Avène («Pierre Fabre¼, France) emollient were presented. A model was built and practical recommendations were given on the use of the most informative and adequate scales for predicting and assessing the risk of developing pressure ulcers in patients of older age groups.

Explaining Variations in Long-term Care Use and Expenditures Under the Public Long-term Care Insurance Systems: A Case Study Comparison of Korea and Japan.

BACKGROUND: Establishing universal coverage of formal long-term care (LTC) services is an urgent policy need for aging populations that requires efficient management of quality and financing. Although current variation in LTC service use between and within countries suggests the potential for improvement by efficient management, this topic remains underexamined. We aimed to identify the sources of variance in LTC use and expenditures through a unique cross-country comparison of Japan and South Korea, which have formal public LTC insurance (LTCI) schemes that are analogous but have unique operational and demographic structures. METHODS: Taking administrative regions as the unit of analysis, we assembled data on the LTC utilization rate of people aged ≥65 years, and expenditures per recipient from 2013 to 2015 as the outcome variables. Explanatory variables included demand-related factors, such as regional demographic and economic conditions, and supply characteristics derived from existing public databases. We conducted weighted least squares regression with fixed effects for the pooled data and used Blinder-Oaxaca decomposition to identify sources of outcome variance between the two countries. RESULTS: The average LTC utilization rate was 6.8% in Korea and 18.2% in Japan. Expenditures per recipient were approximately 1.4 times higher in Japan than in Korea. The difference in the utilization rate was mostly explained by between-country differences in supply- and demand-related factors, whereas the difference in expenditures per recipient was largely attributed to unobserved country-specific factors. CONCLUSION: The current findings suggest that LTC utilization is determined largely by the demographic and functional characteristics of older people, whereas expenditures are more likely affected by institutional factors such as the insurance governance scheme and the policy choice of the target population segment and coverage. The results suggest that strategic choice of LTC institutional schemes is required to ensure financial sustainability to meet changing demands caused by population aging.

Impact Evaluation of Cash-For-Care in Latin America's New Long-Term Care Policies: A Randomized Controlled Trial Pilot Study in Costa Rica.

Latin America is aging rapidly. Thus, governments in the region are reformulating their social protection policies. In 2022, Costa Rica passed a national long-term care law. A discussion developed on how to provide such care, whether through public or private in-kind benefits or cash-for-care (CfC) to beneficiaries. CfC has been used in developed countries with various outcomes. However, there are still no evaluations of its effects in middle-income countries. The objective of this study was to evaluate the impact of CfC pilot study on female caregivers in a middle-income country. The expectations of the program were to find positive effects of CfC on caregivers. After conducting a literature review, we developed four domains of analysis: labor market participation, time for personal activities, use of CfC, and caregiver burnout. The results indicate that CfC has no significant impact on caregivers' integration into the labor market, or ability to have leisure time. However, there was a positive effect on the funding of basic needs and mitigation of factors predicting burnout.

Utilization and performance of long-term care system for older people with disabilities and dementia in Zhejiang Province, China.

Introduction: To explore changes in performance, weaknesses, and utilization of the long-term care (LTC) system for older people with disabilities and dementia (OPWDD) in Zhejiang Province, China, thereby providing a reference for decision-making amid a progressively aging population. Methods: A performance evaluation model of the LTC system for OPWDD was constructed using three dimensions: input, process, and outcome. Performance indicators and trends were calculated based on data collected from statistical yearbooks, documents, and work reports of the Bureau of Statistics and other government departments in Zhejiang Province, China, published in 2015-2021. Results: Significant improvements were observed in most LTC performance indicators for OPWDD, such as input, process, and outcome, with notable enhancements in fairness, accessibility, and affordability of LTC services. By 2021, there were 6.20 nursing and rehabilitation beds in medical institutions and 3.77 general practitioners per 1,000 people aged 65 and above, up 144.14% and 13.73%, respectively, from 2015. The rate of health management for older people was 70.91%, representing a 10.33% increase from 2015. The actual reimbursement ratio of hospitalization expenses covered by basic medical insurance for older people rose 7.05%, from 72.76% in 2015 to 77.89% in 2021. Social security satisfaction rose 12.4%, from 71.3% in 2015 to 83.7% in 2021. Certain indicators, however, showed no significant improvement and tended to decline, such as the number of beds at older care institutions and caregivers per 1,000 people aged 65 and over. Discussion: It is imperative to further balance the allocation of care resources, using a people-centered and integrated LTC system. The proportion of rehabilitation and nursing beds for older people should be consistently increased to effectively alleviate the shortage of care beds. Furthermore, a talent incentive policy should be improved to train caregivers and provide whole-person and whole-life course care based on OPWDD needs.

Using the Soft Systems Methodology to Link Healthcare and Long-Term Care Delivery Systems: A Case Study of Community Policy Coordinator Activities in Japan.

Due to the rapidly aging population in Japan, the government has been attempting to link the healthcare delivery system with the long-term care delivery system. However, there are complex challenges that must be overcome to link the two systems. A new methodology should be used to organize complex community challenges and propose solutions. This study aimed to visualize the unique challenges and worldviews of interested parties in each community, using the soft systems methodology (SSM). We aimed to visualize issues and clarify challenges associated with linking the healthcare and long-term care delivery systems; in turn, clarifying the thought process behind solution proposals. We gathered information regarding those who are actively linking these systems in communities in a Japanese municipality (community care coordinators) and organized the information according to the SSM procedure. By organizing information using the SSM, we were able to summarize the present situations of the community healthcare and long-term care delivery systems, visualize issues, clarify challenges associated with linking these two systems, and propose solutions. The SSM may be useful in organizing complex community information and deriving solutions.

Intergenerational contract in Ageing Democracies: sustainable Welfare Systems and the interests of future generations.

As the assumptions of perpetual economic and population growth no longer stand, the welfare systems built on such promises are in peril. Policymakers must reallocate the responsibility for providing care between generations. Democratic theories can help establish procedures for finding solutions, particularly in ageing democratic countries. By analysing existing representative and deliberative democratic theories, this paper explores how the interests of future generations could be included in such procedures. A hypothetical social health insurance scheme with the pay-as-you-go financial arrangement is selected as an illustrative case. This paper argues that due to the intrinsic bias towards the current generation, both representative and deliberative democratic health policymaking are limited in making decisions that account for future generations. Instead, their interests could be at best represented by benevolent representatives.

[Implementation of advanced social practices based on innovative gerontotechnologies in the system of long-term care for elderly and senile patients.]

From 2017 to the present a scientific project «The use of dermatoprotectors to improve the quality of life of geriatric patients with age-associated xerosis (AAX)¼ has been realized as part of a typical model of a long-term care system in order to introduce the innovative gerontotechnologies as advanced social practices in further optimization of social and medical care for elderly and senile patients in Leningrad Region. The article presents the results of a comparative analysis of the effectiveness of the dermatoprotectors application in the improvement of the quality of life, prevention and correction of AAX. The AAX clinical manifestations have been studied before and after the emollients use. The cohort under study has included geriatric patients with senile asthenia from seven institutions of social protection of the Leningrad Region. In the foreign literature, such patients are called «fragile¼. The data thus obtained indicate that AAX as a manifestation of skin «fragility¼ during aging can be considered as a component of the geriatric syndrome of senile asthenia in patients of older age groups. The development of skin «fragility¼ significantly reduces the quality of life of geriatric patients and requires timely prevention and correction with adequately selected dermatoprotectors.

[Social interactions in long-term care.]

Modern society is becoming more and more complex, not only technologies are changing, but also its socio-age structure. For the first time, mankind found itself in a situation where there are more elderly people than young people, and it turned out to be not ready for this. A new task arises - the coordination of interactions and interests of many subjects of social interaction in the interests of the elderly. The traditional administrative influences of the state are becoming insufficient; mechanisms of self-organization of society and the autonomy of citizens are gradually taking shape. A new problem has become not only the rapid aging of society, but also an increase in the number of elderly people requiring constant care in the last years of their lives, since the already existing «closed institutions¼. Nursing homes are less popular today. The article provides an overview of Russian legislation on long-term care for the elderly, as well as an analysis of the successes and barriers to interaction in organizing care for the state, commercial and non-profit institutions in St. Petersburg. Petersburg is a city of the elderly population and developed social services for the elderly. Therefore, we have the right to conclude that social services in St. Petersburg can be viewed as a promising model for the development of long-term care for the elderly. The purpose of the article is to analyze the peculiarities of interactions between various subjects of the system of long-term care for the elderly that is emerging in St. Petersburg. We are interested in situations when the existing legal norms/regulation/interference in interactions are sufficient for the tasks of care to be solved, and the participants did not suffer. And vice versa, when the existing regulations are insufficient, and either the tasks are not being solved, or the injured party is an elderly person or his family.

Designing Long-Term Care Systems: Elements to Consider.

Population aging presents huge challenges for most countries around the world. In this context, long-term care systems appear as a feasible solution to the multidimensional issues arising from demographic change. However, designing a long-term care system is complex. This article presents a structure to analyze long-term care systems based on four components: beneficiaries, benefits, providers, and financing. It uses the experience of three countries to illustrate the many choices available when designing the system, emphasizing the need to understand each component and their interactions. The analysis highlights the existence of several alternatives when designing and implementing long-term care systems.

Global Convergence: Aging and Long-Term Care Policy Challenges in the Developing World.

Aging around the world poses a global challenge in eldercare. This challenge is particularly felt in low- and middle-income countries (LMICs), where population aging outpaces the development of aged care policies and services. This Perspective highlights the phenomenon of global convergence in several unsettling trends and challenges shared across LMICs. These include the weakening of informal family care systems for the elderly, growing need for formal long-term care of the frail and disabled who can no longer be adequately supported by family members, and mounting pressures for policy responses to tackle these societal challenges. It is argued that policymakers should take a proactive stance. That is, when family care for the elderly falls short and family caregivers are increasingly under strain, the government should step in and step up support to fill in the gap by developing appropriate policies and a continuum of long-term care services that are accessible and affordable for the majority of older people in need. Three general principles are then suggested with regard to long-term care provision, financing, and quality assurance, which transcend national borders and can be used to guide long-term care policymaking across LMICs.

Aging in Taiwan: Building a Society for Active Aging and Aging in Place.

Taiwan's accelerated rate of aging is more than twice that of European countries and United States. Although demographic aging was not a major concern in Taiwan until 1993, when it became an aging society, aging issues now have become an imperative topic both in policy and in practice in the country. As this article demonstrates, in response to the challenge of the rapidly growing older population and the inspiration of cultural values of filial obligation and respect to elders, the concepts of active aging and aging in place are leading the policies and practices of gerontology to meet the diverse needs of the aging population in Taiwan. However, challenges remain, including the question of how to promote systematic endeavors, both in policies or research on aging, and how to encourage greater involvement of nongovernment organizations in the aging issue. In addition, some emerging issues about aging are addressed in this article including inadequate resources for older rural adults, building an age-friendly environment, and the increasing number of people with dementia.

The long-term care insurance system in Germany:Origin, planning, effects and reflections / 中国卫生政策研究

Confronted with many problems such as the aged population, increase in the demand for long-term care and financial pressure resulted from the previously defective social security system, after years of efforts, Germa-ny eventually succeeded in putting forward an effective national compulsory long-term care system in 1994 . The sys-tem which is based on the original health insurance system and supports multiple payments involves both local govern-ments and private organizations. Specific rules are clarified in terms of the insurance relations, application qualifica-tions, payment conditions and financial mechanism. Shares and contributions of the long-term care have been in-creased after years of practice. Besides, the number of applicants and beneficiaries is rising. Yet on the other hand, problems and controversies still exist in service quality, qualifications and contents for application and financial mech-anism. Germany’s experience in improving the social security system, the quality management of long-term care and effective control of financial balance serves as a significant reference for China in planning and implementing long-term care insurance system.

Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services.

OBJECTIVES: To examine, in beneficiaries with long-term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2-year effects of service type on those health outcomes. DESIGN: Secondary analyses of the existing LTCI data set from 2008 to 2010. SETTING: South Korea. PARTICIPANTS: LTCI beneficiaries with dementia aged 65 and older (N=31,319). Participants were divided according to the service type that they were receiving home care (HC), institutional care (IC), and combined care (CC). MEASUREMENTS: A LTC approval checklist was used to determine the level of LTCI coverage of each participant and to assess cognitive function, behavioral symptoms, and physical function. Linear mixed models and multiple regression models were used. RESULTS: There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three service types (P<.001) and overall improvements in those outcomes over 2 years in the three groups (P<.001). After limiting the sample to those who had received LTCI services for the full 2 years (2008-2010) and adjusting for baseline characteristics, individuals receiving HC were more likely to have better cognitive and physical function than those receiving IC or CC but were likely to have more behavioral symptoms 2 years after the LTCI enrollment (P<.001). CONCLUSION: LTCI service type (HC, IC, CC) predicted cognitive function, behavioral symptoms, and physical function at 2-year follow-up in beneficiaries with dementia. Further research is necessary to examine the effect of LTC services on health outcomes in a longer observational cohort.

The barriers to govern long-term care innovations: the paradoxical role of subsidies in a transition program.

This study deals with the governance of a transition program (2007-2011) that tried to radically change a fragmented, supply-driven long-term care system into an integrated, demand-driven system to deal with an aging population. The transition program was subsidized by the healthcare ministry and enabled 26 projects throughout the Netherlands. The idea was to first experiment with innovative long-term care practices outside the system and then to scale-up these innovations to change the system. However, previous research does not highlight examples of long-term care innovations that scaled-up. Hence, the goal is to explore the barriers to govern the scaling-up of the long-term care innovations. The barriers were identified by participating in the program and interviewing ministry, program and project actors. The core barrier was the lack of commitment to the empowerment. It resulted from the subsidy focus of the projects and the lack of protection of the innovations, and from conflicts of interests and power struggles on the ministry-level. A transition program requires more than providing a subsidy. Policymakers have to learn from innovations outside the system in order to change it. Simultaneously, projects should not be entirely subsidized, otherwise there are no incentives to scale-up the innovations.

Integrated care for older people in Europe-latest trends and perceptions.

As a researcher and consultant I have coordinated local pilots and European research projects to analyse and improve long-term care for older people by better integrating health and social care systems. One of my conclusions from the wide range of initiatives that have been taken over the past two decades in Europe has been the need to treat long-term care as a system in its own right. Long-term care systems require a discernable identity; specific policies, structures, processes and pathways; and the leadership and resources that can underpin expectations, drive performance and achieve better outcomes for people that are living with (and working for those with) long-term care needs. Progress in developing LTC systems can be identified today in all European countries. Integrated care solutions at the interface between health and social care, and between formal and informal care, have appeared. These have been achieved partly by means of (slow) political reforms, partly as a response to market-oriented governance, and in many cases through pioneering community and civil society initiatives. It will depend on such initiatives, and their ability to convince both citizens and policy-makers, whether new societal approaches to long-term care are created that meet the demands of ageing societies.