One of the challenges of population aging is the rising demand of elder care. Adult children fill a substantial portion of this care need. To understand its implication on their labor market choices and welfare outcomes, we build a simple static model where households can spend time and money producing care. We calibrate the model using data from the American Community Survey, the Health and Retirement Study, and National Health and Aging Trends Study/National Study of Caregiving to match moments in the labor market and caregiving patterns. With the calibrated model, we consider a few government programs under a projected aging population structure. Our results show that care subsidy and Medicaid expansion both cause a shift from informal care to formal care, relieving adult children from care burdens and thus improving their welfare. Caregiver allowance appears to have little effects on caregiving behaviors, which leads to minimal welfare improvement.

Behavioural design has been gaining momentum to address critical societal challenges such as elderly care. At the same time, it struggles to deal with complex challenges and integrate multiple contextual factors' influence in domains like healthcare. Behavioural design processes lack guidance on how to prevent this and instead define problems that are ecologically valid. Conventional design methods do guide designers to do this. Thus there is a need to investigate how design methods can support behavioural designers to explore the context and integrate multiple perspectives on the problem, resulting in context-sensitive problem definitions. To respond to this need, we present a case where designers used a combination of design methods to investigate the complex context of hygiene in nursing homes. We show how combining different design methods supported the designers in advancing their understanding of a complex context and the problematic behaviours that occurred in it. We conclude by discussing the importance of using design methods to reveal important insights at the early stages of the behavioural design process.

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.

Older parents in China rely heavily on their adult children for instrumental assistance. In different multi-child families, multiple offspring may co-operate in providing instrumental support to older parents in distinct ways in terms of how much support they provide on average and how much differentiation exists between them when they provide such support within a family. We aimed to identify different within-family patterns in relation to multiple offspring's instrumental support to an older parent in Chinese multi-child families, and to investigate potential predictors for different within-family patterns. Using data from the China Family Panel Studies (2016), we had a working sample of 5,790 older adults aged 60+ (mean = 68.54, standard deviation = 6.60). We employed latent profile analysis (LPA) to classify within-family patterns and multinomial logistic regression to investigate predictors. Our findings identified three within-family patterns: dissociated (59.10%), highly differentiated (29.60%) and united-filial (11.30%). Older parents in the highly differentiated families tended to be older, mothers, divorced/widowed and to have poorer physical health compared to their counterparts in the dissociated families. In contrast, the composition characteristics of multiple adult children played more important roles in determining the united-filial within-family pattern. The united-filial families were more likely to have fewer adult children, at least one adult daughter and at least one co-residing adult child.

The aim of this study was to explore older workers’ motivation for a full or extended working life. With particular focus on assistant nurses aged 55–64 years, working in the elderly care sector. Focus group interviews were conducted with five different groups of assistant nurses. Inductive thematic analysis was used to analyse the interviews and five main themes were developed from the data: ‘Organisational issues’, ‘Health-related problems’, ‘Private issues’, ‘Meaningfulness and appreciation’ and ‘Social support’. Several of the main themes concerned problems with too high work demands of the assistant nurses. These findings suggest that it is important to improve the working conditions of assistant nurses in order to create a more sustainable working life. Increasing the number of staff and improving recovery opportunities and work–life balance could be important steps to improving the working conditions for this group. Finally, upgrading the competency and professionalism of assistant nurses could help to increase the motivation for a full or extended working life.

Due to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries – France and Sweden – where various policy measures aiming at developing and delivering integrated care can be identified: at the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double – local and national – approach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected.

Intergenerational help and care among members of the family belong to the most important dimensions of contemporary welfare regimes. Recent research has indicated that a major part of caring responsibilities is placed on the middle-aged generation. The ‘pivot generation’ is expected to provide help to their adult children and grandchildren as well as to their ageing parents. It has been hypothesised that people helping their parents are discouraged from looking after their grandchildren because they experience lack of energy and time. Using data from the four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), this paper analyses the effect of providing help to ageing parents on the likelihood and intensity of looking after grandchildren. It takes a four-generation perspective: grandchildren, children, parents and grandparents. The results show that the support of parents is not associated with less-frequent and less-intense care of grandchildren. On the contrary, a positive association between caring responsibilities has been observed. The highest tendency to care for grandchildren has been found for people regularly helping their parents. This effect holds after controlling for grandparents’ characteristics and country effects. It is suggested that caring responsibilities tend to accumulate rather than compete with one another and therefore could represent a potential risk of overburden for those who have a general tendency to care.

Objectives: The aim of this study was to explore stakeholders’ points of views regarding the applicability and relevance of a framework for user involvement in health technology assessment (HTA) at the local level. We tested this framework in the context of the assessment of alternative measures to restraint and seclusion among hospitalized adults and those living in long-term-care facilities.

Methods: Twenty stakeholders (health managers, user representatives, and clinicians) from seven regions of Quebec participated in a semi-structured interview. A thematic analysis of the transcribed interviews was performed.

Results: The findings highlighted the relevance and applicability of the framework to this specific HTA. According to interviewees, direct participation of users in the HTA process allows them to be part of the decision-making process. User consultation makes it possible to consider the views of a wide variety of people, such as marginalized and vulnerable groups, who do not necessarily meet the requirements for participating in HTA committees. However, some user representatives emphasized that user consultation should be integrated into a more holistic and participatory perspective. The most frequent barrier associated with user involvement in HTA was the top-down health system, which takes little account of the user's perspective.

Conclusions: The proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.

Objective: The objective of this paper is to determine prevalence and characteristics of acute care for elders (ACE) units and hospital characteristics associated with the presence of an ACE unit.

Methods: Data on characteristics and prevalence of ACE units were obtained by surveying all established geriatric medical divisions across U.S. medical schools. Data on hospital characteristics such as number of beds, revenue, number of Medicare inpatients, and average length of stay were obtained from the 1999 American Hospital Association Annual Survey Data. Descriptive statistics and t test were used to analyze the characteristics of ACE units. Stepwise logistic regression was used to analyze the hospital characteristics associated with the presence of an ACE unit.

Results: The survey identified 16 geriatric divisions and programs with ACE units. Hospitals that have ACE units differ significantly with respect to number of beds and total revenue, compared with institutions that do not have an ACE unit. Stepwise logistic regression indicated total hospital revenue was the only factor significantly associated with the presence of an ACE unit.

Conclusions: ACE units are attractive interdisciplinary models to address the particular needs of the elderly during their hospital stay. Low presence of ACE units warrants further research as to reasons more hospitals have not included them, given the available evidence for clinical, functional, and economic benefits.