To date, social long-term care insurance (SLTCI) systems have been introduced in six countries globally: the Netherlands, Israel, Germany, Japan, Luxembourg and South Korea. Applying an actor-centred, multi-dimensional framework and fuzzy-set analysis, the present article investigates the typical characteristics and variations of these SLTCI schemes at introduction and today. In short, we find that the SLTCI model features dominant social contribution financing, a mix of for- and non-profit providers, and state regulation. In light of the relevance of corporate self-regulation often associated with social insurance systems, the dominance of state regulation is unexpected. The analysis also reveals considerable variance between cases, most notably concerning the extent of private individual actors’ involvement. While geographical proximity of countries does not explain differences between SLTCI systems, “temporal clusters” seem to partly drive the variation of SLTCI actor configurations.

Sweden's coronavirus disease 2019 (COVID-19) response, initially based largely on voluntary measures, has evoked strong reactions nationally and internationally. In this study, we describe Sweden's national policy response with regard to the general public, the community and the health care system, with a focus on how the response changed from March 2020 to June 2021. A number of factors contributed to Sweden's choice of policy response, including its existing legal framework, independent expert agencies and its decentralized, multi-level health care governance system. Challenges to the health- and elder care system during the pandemic, such as the need to increase intensive care- and testing capacity, and to ensure the safety of the elderly were addressed largely at the regional and local levels, with national authorities assuming a primarily coordinative role. Although the overall response based on voluntary compliance has persisted, the national government started to take a more prominent role in public messaging, and in enacting legally binding restrictions during subsequent waves of the pandemic. This study illustrates that not only policy responses, but also the fundamental structure of the health- and elder care system and its governance should be considered when evaluating the impact of the COVID-19 pandemic.

Welfare governance in elder care has undergone significant changes, but we know less about the processes and actors of making welfare governance. This is problematic, as the concern for process is a key strength of the welfare governance perspective. Based on a case study of elder care in Denmark, and drawing on studies of professions, the aim is to analyse how welfare professions contribute to the making of welfare governance. Our analysis shows that welfare professions bring unique resources into play. They have strong professional agency, drawing on both broader institutional roles and more specific professional projects. The institutional work itself is highly complex and the welfare professions combine not only formal and informal coordination, but also do so in ways that are closely tailored to specific contexts. The analysis makes important empirical and theoretical contributions to the study of welfare governance in elder care.

Despite the growing use of retirement communities and ageing care facilities, little is known about how residing in retirement residences may impact aspects of older adult wellbeing. Living in these communities may hold particular influence on residents’ sense of purpose, if they feel limited in their opportunities for individual action, or could serve to promote purposefulness depending on the social connections available. The current study sought to explore contributing factors as well as barriers to purpose in older adults living in three continuing care retirement communities. Using brief semi-structured interviews, 18 older adults were asked to describe their purpose in life, community-related activities and any perceived challenges limiting their ability to pursue this purpose. Thematic analysis was used to examine themes common across interviews. Interviews presented a mixed picture of the nature of purposefulness in retirement facilities. Residents espoused several benefits of community living such as social and leisure opportunities, while also noting several obstacles to their purpose, including health concerns and the belief that purpose in life was not relevant for older adults. These findings provide insight into how older adults can derive a sense of purpose from activities within their retirement community and how facilities can better tailor programmes to promote purposefulness and support personally valued roles for residents.

This paper systematically reviews empirical research published between 2006 and 2016 on the relationship between informal care-giving to elders and labour force participation (LFP). It does so in the context of Organisation for Economic Co-operation and Development policy responses to population ageing. In this context, conclusions regarding the LFP and care-giving relationship should at least be applicable to the sub-population of working-aged individuals who are most likely to provide informal elder care. Currently, these are women in mid-life and the recipients of their care are mostly extra-residential parents. The review's key conclusion is that mid-life women care-givers of elderly parents are significantly likely to reduce their working hours and also to work fewer hours relative to their non-care-giving counterparts. In drawing this conclusion, the review shows that studies finding only modest care-giving effects on LFP either do not adequately control for care-giving intensity or their conclusions apply to sub-populations less likely to be affected by policies addressing population ageing.

Self-care agency is an important determinant of healthy aging. The Appraisal of Self-care Agency Scale (ASA-R) (Sousa et al., 2010) is one of the main instrument to assess self-care capacity. The objectives of the study were: 1) to adapt and validate ASA-R scale for use in Spanish population; 2) to examine the dimensionality, validity and reliability; 3) and to establish the convergent validity of ASA-R using a self-reported health measure. The ASA-R Scale and the 12-item Short Form Health Survey (SF-12) were administered to 488 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyze the dimensionality, validity and reliability. Convergent validity was tested by correlating the ASA-R factors with the SF-12 subscales; correlations were significant (p < .005). CFA showed that the ASA-R Three Factor Model fit well to the data, showing satisfactory fit indices, with S-Bχ2 > 0.05 (0.436), RMSEA closer to 0 (0.006), SRMR < 0.08 (0.065), GFI and AGFI close to 1 (0.924 and 0.921), and CFI and NNFI > 0.95 (0.996 and 0.995). The results also demonstrated that ASA-R is a reliable and valid instrument. The ASA-R has demonstrated to be a reliable (CR indices > 0.7) and valid (AVE > 0.5) instrument in measuring self-care agency among Spanish older population.

In the United States, informal elder care is principally the responsibility of younger relatives. Adult children perform the majority of elder care and non-relatives perform only 14 percent of care. Caregiving in the lesbian, gay, bisexual, and transgender, or LGBT, community follows a very different pattern that reflects the importance of “chosen family” in the lives of LGBT older adults. Instead of relying on relatives, LGBT older adults largely care for each other. Relatives provide only 11 percent of all elder care. This article explores the high level of caregiving by non-relatives in the LGBT community. It asks what motivates friends, neighbors, and community members to provide care for someone whom the law considers a legal stranger. It also asks what steps policy makers can take to facilitate and encourage this type of caregiving. Finally, it asks what lessons can be learned from LGBT older adults about the nature of both caregiving and community. As the aging population becomes more diverse, aging policies will have to become more inclusive to address the differing needs of various communities, including LGBT older adults. The potential lessons learned from the pattern of elder care in the LGBT community, however, extend far beyond a simple commitment to diversity.

As a religious law, adage, and recipe for generational reciprocity, the “honor commandment” looms large as a societal construct, especially with 76 million baby boomers in the United States approaching old age. This article explores how the honor commandment persists as a normative ethic in the lived practice of elder care and the ways that it is supported by, or at odds with, secular legal imperatives of elder care.

Much in the way that the biblical story of Ruth provides a broad interpretation of how to live the honor commandment, this interdisciplinary exploration is informed by contemporary experiences of elder care culled from ethnographic interviews as well as by theological, demographic, and legal source material. We argue that the honor commandment continues to support practical adherence to largely unknown legal obligations. Caring for aging and ill parents can impose burdens on the caretakers that secular laws often fail to alleviate, particularly because of changes in the structure of twenty-first-century families. We suggest potential reforms that could better facilitate honoring seriously ill elders and the grown children who care for them.

Research on care managers' experiences of the needs assessment process is scarce even though the literature on needs assessment practice is relatively extensive. One of the research areas that has not received attention yet is the way in which care managers experience the challenges that are presumably posed by increased ethnic, cultural, linguistic and religious diversity among prospective elder care recipients. This article addresses this research gap. It is based on a project that aims to shed light on care managers' experiences of the needs assessment process in general and cross-cultural needs assessment meetings in particular. The data are constituted of focus group interviews with care managers in Sweden (N=60). In this article we focus on care managers' experiences of needs assessment with older people who have immigrated late-in-life, who come from cultures considered different from the Swedish one and who have not mastered the Swedish language. This was the group of older people that the care managers mostly thought of when asked to describe their experiences of cross-cultural needs assessment meetings. The interviewed care managers discussed the challenges that these meetings present, which were related to communication due to language barriers, different demands and expectations, insecurity regarding what is customary in such meetings, as well as perceived passivity among late-in-life immigrants. The article discusses the contributions of the findings to research on care management practices in general, as well as to needs assessment practice in particular.

In recent years in Italy, population ageing, rising female labour-market participation, and the restructuring of the welfare state have combined to create increased demand for long-term care services for frail and dependent older people. The rising demand has increasingly been met by immigrant women of different nationalities, and to a lesser extent immigrant men, who are hired to provide individualised care in people's own homes and other private settings. While there have been many studies of this growing phenomenon, very little attention has been paid to the reasons that bring family care-givers to choose this care-support option. To begin to fill the gap, this paper reports the finding of a qualitative study of 26 family members who were caring for a disabled elder. Semi-structured interviews lasting between 60 and 100 minutes and that covered various aspects of long-term care in family households were conducted. The participants' responses indicate that they did not choose immigrant home eldercare assistants solely for economic reasons but also to be consistent with cultural, moral and traditional understandings of family responsibilities and care. They also provide valuable findings and insights into Italian attitudes towards the welfare state and the care-labour market. While the wealthiest respondent declared a clear predilection for the free-market and a desire to bypass the state, the majority of the respondents advocated a stronger role of the welfare state in helping people cope with the increased burden of long-term care.

This study has explored how family members of care recipients define and sustain claims of mistreatment in old-age care. Twenty-one informants were recruited from an association of relatives of care recipients in Sweden. Using argumentation analysis, four warrants about mistreatment were identified from the qualitative interview data: they referred to physical harm, psychological harm, social-care deficiencies and identity subversion. The first three categories are similar to those recognised in previous research on elder mistreatment, but the fourth, which is described in detail in the article, is less familiar: elder mistreatment as the violation of an older person's identity. The family members backed their claims about staff members' violation of a care recipient's persona or identity by using arguments that drew on their unique knowledge of the care recipient's appearance, daily routines and preferred activities. They also described their attempts to protect the dignity and identity of a care recipient, their fears of abuse, and actual cases of conflict and retribution by care staff. They consistently positioned themselves as guardians of identity through their claims of mistreatment. The study provides important knowledge about family members' moral view of elder mistreatment, which may enhance the understanding of conflicts between formal care providers and family members.

This paper uses data from the European Community Household Panel surveys of 1994 and 1996 to study the association between changes in care-giving and changes in weekly work hours. Our sample comprises women aged 45–59 years who participated in the labour force in at least one of the two years studied. Controlling for country variation, we find significant relationships between starting or increasing informal care-giving and changes in weekly work hours. No such association is found however among women terminating a care-giving commitment or reducing their care hours. Starting care-giving significantly reduces work hours for women in northern European countries (except Ireland). By contrast, women in southern Europe and Ireland respond to an increase in care-giving hours by a smaller increase or a higher decrease in work hours than non care-givers. In summary, our results show that the impact of care-giving on adjustments of weekly work hours is asymmetrical and that it differs in southern and northern Europe.

In Indonesia, as in most other societies, intergenerational relationships are considered most important for elder care. Children are expected to take care of their elderly parents. However, processes of social change such as industrialisation, urbanisation and migration can have a negative impact on care for elderly people, particularly in rural areas. This paper addresses the issue of the living and care arrangements of older people and possible changes therein. A number of hypotheses and research questions pertaining to this issue are discussed. An Elderly Household Survey was carried out among people aged 55 years and older in two different villages in the Special Region of Yogyakarta. The data concern the living and care arrangements according to the respondent’s sex, age and village. The principle finding is that most older people still live with at least one child or with other kin, or have at least one child living in the same village. Hence, they still have a potential care provider in their immediate vicinity. The situation, however, especially of women aged over 75 years, seems to be problematic.

The aim of the study was to examine Scottish private sector employers' policies with regard to flexible working arrangements for carers of physically and mentally impaired older people. The questions addressed by this study were as follows : (1) Are employers aware of the needs of carers? (2) To what extent do they view carers' needs or responsibilities as problematic? (3) What proportion of companies have specific policies regarding flexible working arrangements to accommodate carers' responsibilities? (4) What is the ‘nature’ of these policies? (5) Are flexible policies with regard to caregiving responsibilities viewed by companies as part of ‘health promotion’ in the workplace? (6) In what ways do company characteristics influence policy on carers' responsibilities?, and (7) What, if any, initiatives have been adopted to help employees plan for caregiving responsibilities? One thousand questionnaires were sent to companies drawn from the Scottish Chamber of Commerce National Directory 1993; 32 per cent were returned completed and in time for analysis. The majority (92 per cent) of companies had never previously considered the issue of employees' elder care responsibilities. Although expressing considerable sympathy, as well as some responsiveness and flexibility with regard to working arrangements for caregiving employees, the results of the survey indicate that Scottish companies in the private sector are providing little in the way of direct or indirect support to the UK community care reforms. However, informal contacts during the project indicated that the public and voluntary sectors may be more flexible and have begun to develop specific policies with regard to the needs of caregiving employees.

As part of a wider study of family caregiving, a sample of 297 women caring for an ageing parent were identified through a random statewide telephone survey involving over 26,000 households in Victoria, Australia. In addition to elder care, half these women were in paid employment and a third had dependent children. Overload was highest for carers with multiple roles, particularly those of parent or worker. Resentment in the caring role was highest for those who had fewer roles apart from elder care, particularly those who had quit work, and those without a partner. Life satisfaction was higher for partnered and working carers. These findings highlight the need for structures to support carers to maintain multiple roles, including greater flexibility in the workplace and encouragement of greater reliance on informal networks and formal services, both of which require increased societal acknowledgment of the elder care role.