Posted: April 20th, 2022

• Contribute to the advancement of the profession of healthcare

CHAPTER
395
GLOBAL DEMOGRAPHICS AND THE
MANAGEMENT OF LONG-TERM SERVICES
AND SUPPORTS
Mary Helen McSweeney-Feld, PhD, Carol Molinari, PhD,
Min Cole, Serif Esendemir, PhD, and Xiaomei Pei, PhD
Chapter Focus
Global healthcare delivery systems in the twenty-first century face serious
challenges related to the aging of the population, the prevalence of chronic
and disabling conditions, and the growing demand for long-term services
and supports across a variety of care settings. In this chapter, we will provide
an overview of the demographic, historical, and cultural forces that affect the
demand for long-term care, while also exploring key issues related to the supply of long-term care services. Sections of the chapter will focus specifically
on staffing issues and the use of technology for effective long-term care management. Finally, the chapter will highlight five countries at varying stages of
aging—Japan, Sweden, China, Turkey, and the United States—and examine
their unique experiences, challenges, and solutions.
Learning Objectives
Upon completion of this chapter, you should be able to
• explain global trends in aging and disability in both developed and
developing countries;
• identify the historical and cultural forces influencing the growing
demand for long-term services and supports;
• describe the roles of formal and informal caregivers in providing longterm services and supports;
• discuss common management challenges related to long-term services
in various developed and developing countries; and
• understand solutions for addressing gaps in the delivery of long-term
services and supports.
12
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AN: 1985979 ; Michael Counte.; The Global Healthcare Manager: Competencies, Concepts, and Skills
Account: s4264928.main.eds
396 The Global Healthcare Manager
Competencies
• Advocate for and participate in healthcare policy initiatives.
• Advocate for the rights and responsibilities of patients and their families.
• Demonstrate commitment to self-development, including continuing
education, networking, reflection, and personal improvement.
• Contribute to the advancement of the profession of healthcare
management by sharing knowledge and experience.
• Develop others by mentoring, advising, coaching, and serving as a role
model.
• Demonstrate an understanding of the interdependency, integration, and
competition that exist among healthcare sectors.
Key Terms
• Active life expectancy (ALE)
• Activities of daily living (ADLs)
• Aged society
• Aging in place
• Aging society
• Assisted living facility
• Chronic health condition
• Continuing care retirement
community (CCRC)
• Direct care worker
• Disability
• Filial piety
• Health-adjusted life expectancy
(HALE)
• Healthy life years (HLYs)
• Home and community-based
services
• Hyper-aged society
• Instrumental activities of daily
living (IADLs)
• Long-term services and
supports
• Means-tested
• Medical home
• Memory care unit
• Population aging
• Skilled nursing facility
Key Concepts
• Coordination of care
• Dementia care
• Demographic shift
• Emerging technologies
• Epidemiological transition
• Formal and informal caregivers
• Integrated care
• Long-term care
• Mandatory insurance
• Public spending
• Universal coverage
• Workforce shortages
• Workforce turnover
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Chapter 12: Global Demographics and Long-Term Services and Supports 397
Introduction
Healthcare systems throughout the world are facing mounting pressures from
growing numbers of older adults, many of whom have complex care needs
associated with chronic or disabling conditions. As people live longer, they are
more likely to require long-term services and supports, whether at home or in
various care settings, to help manage their regular life activities. In this chapter,
we will examine many of the long-term care challenges that today’s global healthcare managers face; the demographic and cultural forces that have contributed
to those challenges; unique features of the long-term care workforce; and the
technological advances that are likely to shape the delivery of long-term services
and supports in the years ahead. The chapter concludes with a discussion of longterm care approaches employed in five specific countries—Japan, Sweden, China,
Turkey, and the United States. Spending on long-term care, as a percentage of
gross domestic product, is anticipated to increase in the years ahead, especially
in countries with rapidly aging populations. Current levels of public spending
on long-term care for various countries of the world are shown in exhibit 12.1.
Demographic and Cultural Forces Affecting Demand for
and Supply of Long-Term Services and Supports
The Aging of Populations
Population aging is a global demographic shift whereby older adults are
making up an increasing proportion of the overall population (Takagi and
Molinari 2017). This trend reflects both increased longevity and lower fertility
across the various regions of the world. Between 2025 and 2050, the older
adult population is expected to almost double to 1.6 billion globally, whereas
the total global population will increase by just 34 percent (He, Goodkind,
and Kowal 2016: 2024 – Do my homework – Help write my assignment online).
Population aging is a global trend, though the speed with which the process occurs is uneven from one region to another. Many developing countries,
including China and Turkey, are considered aging societies, meaning that their
older adult populations are growing rapidly, to the point that people aged 65
years or older make up between 7 and 14 percent of the population (Takagi
and Molinari 2017). A number of more developed countries—including the
United States and many European nations—are regarded as aged societies,
meaning that the population of older adults has already reached 14 to 21 percent of society. Some countries, such as Japan, are categorized as hyper-aged
societies, meaning that older adults make up more than 21 percent of the
population (Coulmas 2007). Growth among older populations in developed
countries is expected to continue in the coming years but at a slower rate than
long-term services
and supports
Care, services,
and assistance
provided across
various settings
to help people
address difficulties
in performing their
activities of daily
living.
population aging
A global
demographic shift
whereby older
adults are making
up an increasing
proportion of the
overall population.
aging society
A society in which
people aged 65
years or older
make up 7 to 14
percent of the total
population.
aged society
A society in which
people aged 65
years or older
make up 14 to
21 percent of the
population.
hyper-aged
society
A society in which
people aged 65
years or older
make up more
than 21 percent of
the population.
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398 The Global Healthcare Manager
in developing or emerging nations, especially those in Asia and Latin America
(He, Goodkind, and Kowal 2016: 2024 – Do my homework – Help write my assignment online).
The epidemiological transition toward older populations is largely the
result of declining fertility rates, as well as lower mortality rates stemming from
the medical advances of the twentieth century. In some countries, inflows of
immigrants have affected population aging. In Italy and Spain—European countries with relatively old populations—immigration has slowed an overall decline
in population numbers. Population aging may also be influenced by government
policies, such as China’s one-child policy, which will be discussed later in the
chapter. In the coming decades, a number of countries, including China, South
Korea, and Thailand, are expected to experience population aging coupled with
overall decline in total population (He, Goodkind, and Kowal 2016: 2024 – Do my homework – Help write my assignment online).
Individuals with Chronic and Disabling Health Conditions
Another factor driving the increased demand for long-term services and supports is the growing numbers of adults with chronic and disabling conditions.
In considering this factor, we need to first establish the definitions of key terms.
Chronic health conditions are those conditions that last three months or
longer and affect an individual’s health or independence. A disability can be
a physical, sensory, cognitive, or intellectual impairment, or a type of chronic
disease. A disability, as explained by Kunkel, Brown, and Whittington (2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay,
111), reflects “a combination of an individual’s health and social circumstances
that determines one’s ability to function within a given social context.”
chronic health
condition
A condition
that lasts three
months or longer
and affects an
individual’s health
or independence.
disability
A physical,
sensory, cognitive,
or intellectual
impairment, or
type of chronic
disease, that
limits a person’s
ability to function
in a given social
context.
0.0%
Netherlands
Finland
Sweden
Denmark
Norway
Belgium
Japan
Switzerland
France
Iceland
Ireland
Czech Republic
OECD 30
Luxembourg
Austria
United Kingdom
Canada
Germany
Slovenia
Korea
Spain
Italy
Portugal
United States
Israel
Latvia
Poland
Hungary
Estonia
Greece
Slovak Republic
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.5% 4.3
3.5
3.2
2.6
2.4
2.2
2.2 1.9 1.9
1.8 1.8
1.4 1.4 1.3 1.2 1.2 1.1 1.1
1.0
0.8 0.7 0.6 0.5 0.5
0.4 0.4 0.3 0.3 0.2
0.0 0.0
4.0%
Notes: Figures are for 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay; OECD 30 = Average of 30 members of the Organisation for Economic
Co-operation and Development.
Source: Reprinted with permission from Organisation for Economic Co-operation and Development
(2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online).
EXHIBIT 12.1
Public Spending
on Long-Term
Care (health
and social
components)
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399
Levels of disability can be assessed based on a number of measures,
including the individual’s ability to function and carry out activities of daily
living (ADLs) and instrumental activities of daily living (IADLs). ADLs
include routine and fundamental activities such as eating, bathing, and dressing,
whereas IADLs include activities—such as cleaning, shopping, and managing
finances—that enable people to live independently (McSweeney-Feld and
Molinari 2017). Levels of disability may also be assessed using such measures
as active life expectancy (ALE), or disability-free life expectancy, and healthy
life years (HLY). Health-adjusted life expectancy (HALE) is a measure
that adjusts for the severity of an individual’s disability impairments (Kunkel,
Brown, and Whittington 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Measuring and estimating growth in the global population of adults
with disabilities can be difficult, given that reliable data for many developing
countries are unavailable. Furthermore, in some countries, functional measures
such as ADL limitations may have different interpretations or not be culturally appropriate. Consequently, we need to look at developed and developing
nations separately when considering this factor.
Among developed nations, people born in some Western European
countries—notably, Denmark and Malta—can be expected to live nearly 70
HLYs, on average. People in the Baltic states of Estonia, Latvia, and Lithuania, however, have an average of only 48 to 50 HLYs (Kunkel, Brown, and
Whittington 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay). Among developing nations, those with greater economic
growth tend to have lower rates of disability, though some exceptions to this
rule have been observed. The Philippines and Malaysia, for instance, are not
as economically advantaged as Russia or Ukraine but have greater HALEs
(Kunkel, Brown, and Whittington 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
The future of global disability rates is difficult to predict. Some types of
disability may decline in response to improvements in medical services, though
others may increase as a result of demographic trends or lack of sufficient services
and supports, especially in developing economies. Global rates of Alzheimer’s
disease and other dementias are increasing, and sensory impairments, such as
loss of hearing or vision, affect millions of people worldwide. According to the
World Health Organization (WHO), more than 253 million people worldwide
live with vision impairment, and 81 percent of that group is aged 50 years or
older (WHO 2017). Disabling loss of hearing affects approximately one-third of
adults aged 65 or older (WHO 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). The percentages of people with sensory
impairments are likely to grow as the population continues to age.
Supply Issues Affecting Long-Term Services and Supports
In the United States and the advanced global economies of Asia and the European Union, the importance of long-term services and supports for older adults
and people with disabilities is well recognized. Many models of long-term care
delivery in these nations have focused on the role of the acute care or curative
activities of daily
living (ADLs)
Routine and
fundamental life
activities, such as
eating, bathing,
and dressing.
instrumental
activities of daily
living (IADLs)
Life activities—
such as cleaning,
shopping,
and managing
finances—that
enable people to
live independently.
active life
expectancy (ALE)
The portion of total
life expectancy
during which
an individual
is not affected
by disability;
also called
disability-free life
expectancy.
healthy life years
(HLYs)
The estimated
number of years an
individual will live
without disabilityrelated limitations
on daily activities.
health-adjusted
life expectancy
(HALE)
A measure of
life expectancy
adjusted for
the severity of
an individual’s
disability.
Chapter 12: Global Demographics and Long-Term Services and Supports
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400 The Global Healthcare Manager
sector, where individuals receive assistance from professionals in hospitals or
other institutional settings. In other nations—particularly developing nations
with fragile healthcare systems—long-term services and supports have remained
the responsibility of family members and informal caregivers. Some countries
have passed laws and regulations to formally establish the responsibilities of
family caregivers.
In traditional societies, families have long provided care for their older
members. Since the start of the twentieth century, however, declining fertility
rates, the rise of industrialization, and changes in family structures have limited
the ability of family members to provide the bulk of this support. As a result,
a number of countries have established government-sponsored programs to
provide services to complement the family’s traditional role.
The United States and many other developed nations have experienced
a trend toward independence in family relationships across the life cycle. As a
result, many older adults in those countries live alone or just with a spouse so
that their care needs are not a burden on family members who might be supporting younger dependent children. The number of “elder orphans”—individuals living alone without a family member available to provide care—in the
United States is likely to increase as the baby boomer generation (those born
between 1946 and 1964) ages. Ianzito (2017) reports that approximately 23
percent of US boomers will eventually be without family caretakers.
In developing nations, where the norms of family caregiving tend to
remain strong, the co-residence of multiple generations continues to be a
common living arrangement for older adults (Kunkel, Brown, and Whittington 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay). With further economic growth, however, alternative approaches
to the delivery of long-term services and supports will be necessary to enable
younger members of the population to pursue careers while still providing for
older family members.
Vignette: Dementia Care
A major challenge in the provision of long-term services and supports worldwide involves the growing number of older adults with cognitive impairment
due to Alzheimer’s disease and related dementias. According to Alzheimer’s
Disease International (2015 – Research Paper Writing Help Service, 2016: 2024 – Do my homework – Help write my assignment online), approximately 47 million people worldwide were living with dementia in 2016: 2024 – Do my homework – Help write my assignment online, and experts have predicted that this
number will roughly double every 20 years—up to 75 million in 2030 and
to 131 million in 2050. Much of the increase will be in developing countries.
In 2015 – Research Paper Writing Help Service, about 58 percent of people with dementia were living in low- and
middle-income countries; this number is expected to increase to 68 percent
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401
Workforce Challenges in Long-Term Care
Long-term care is highly labor intensive, and the global delivery of long-term
services and supports depends on both formal, trained professionals and informal, unpaid caregivers. Direct care workers, especially aides, represent the
largest component of the long-term care workforce, and the development of
this workforce segment has been identified as a key concern facing healthcare
in the twenty-first century (Institute of Medicine 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers; Molinari and Zhang
2015 – Research Paper Writing Help Service). Many countries, including China, are facing a shortage of facilities and
trained professionals ready to provide formal care (Kunkel, Brown, and Whittington 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay). Globally, the majority of long-term care is provided by family
members, friends, and other informal caregivers.
Although demand for direct care workers is increasing, turnover is high
and recruitment is difficult, in large part because of noncompetitive wages and
benefits, negative industry image, and inadequate training (Stone and Harahan 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer). In the United States, turnover among home health aides ranges
between 40 to 60 percent (National Direct Service Workforce Resource Center
direct care worker
An individual in the
health workforce
who provides
care and personal
assistance to
individuals who
are frail, sick, or
injured or who
have physical or
mental disabilities.
by 2050 (Alzheimer’s Disease International 2015 – Research Paper Writing Help Service). The growth in the proportion of older adults with Alzheimer’s diagnoses is especially significant
in China, India, and other countries of South Asia and the western Pacific
(Alzheimer’s Disease International 2015 – Research Paper Writing Help Service).
In many countries, the traditional model for caring for people with
dementia has emphasized care provided in the home by unpaid, family caregivers. In countries with established residential long-term care communities,
traditional models have involved memory care units, secure areas within
nursing homes that focus specifically on dementia care. In recent years,
however, newer models of care have emerged, particularly in European
countries. In the Netherlands, Hogeweyk—a “dementia village”—allows
individuals with dementia to live in a small town where conditions reflect
their earlier lifestyles, while at the same time being observed by trained
staff around the clock (Hogeweyk 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). In the United Kingdom, the Butterfly model of care emphasizes emotional connection and emotional intelligence, as individuals live in small homes of six to seven beds and receive
specialized care from dedicated, trained personnel (Sheard 2013). The Iris
Murdoch Center of the University of Stirling, in Scotland, has a virtual care
home, with the aim of demonstrating dementia-friendly design features and
promoting the integration of new design ideas and concepts into existing
long-term care communities (Dementia Services Development Centre 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap).
memory care unit
A unit in a nursing
home that focuses
specifically on
dementia care.
Chapter 12: Global Demographics and Long-Term Services and Supports
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402 The Global Healthcare Manager
2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers), whereas turnover for nursing assistants in assisted living facilities was
29 percent (National Center for Assisted Living 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap).
Workforce studies have indicated that about 45 percent of direct care
workers live below 200 percent of the federal poverty level and that, in 2009,
28 percent of direct care workers were uninsured (PHI 2011). The long-term
care occupations often offer limited opportunities for career advancement, and
many workers receive inadequate training and preparation for the evolving roles
and responsibilities they must take on (Stone and Harahan 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer; Stone and
Wiener 2001). Nursing, home health, and home care aides report that they
do not feel their jobs are respected and valued (Bishop et al. 2009). Media
reports that highlight stories of poor-quality care by providers can exacerbate
the sense of low prestige felt by workers in the field. Furthermore, rules and
regulatory policies in long-term care focus primarily on protecting consumers,
not on addressing workers’ concerns (Stone and Wiener 2001).
As individuals grow older and develop chronic conditions, many strongly
prefer to age in place in their homes and communities rather than move into
institutional settings. As a result, the home and community-based services
provided by direct care workers have come to encompass an increasingly broad
and complex array of physical and mental health needs, requiring skills in such
areas as medication management, palliative care, and dementia care (Stone
and Bryant 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). Given the nature of these responsibilities, the relatively
minimal training and preparation provided for people in direct care positions
seem increasingly incongruent (Stone and Bryant 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). In the United States,
for instance, a person can become a Medicare- or Medicaid-certified home
health aide with less than two weeks of training if they pass a competency test
(Molinari and Zhang 2015 – Research Paper Writing Help Service).
The direct care workforce will be best positioned to meet today’s challenges if it is given comprehensive training, effective supervision, and continued
empowerment. Training and education are especially vital today, given the need
for direct care workers to work with new, consumer-centered service delivery
models and information technology systems that help better coordinate care.
Furthermore, significant cost savings can be achieved when home care aides’
scopes of practice are expanded and nurses have greater ability to delegate
tasks to well-trained workers (Molinari and Zhang 2015 – Research Paper Writing Help Service). Effective training in
many areas, however, is hampered by shortages of personnel able to educate
and prepare people for careers in long-term care.
The Evolving Role of Technology
Some of the challenges associated with shortages of trained providers can be
addressed through the increased use of technology in the provision of services.
aging in place
The practice of
remaining in one’s
own home and
community during
old age.
home and
community-based
services
Health-related
services and
assistance that
are provided in
the home and
community in
which an individual
is already living.
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403
For instance, delivery of long-term care can be enhanced by telehealth capabilities and other health-enabling and ambient assistive technologies that collect
data and provide communication in the home. Robotic devices may also provide
some basic services at affordable prices.
According to McWilliams (2015 – Research Paper Writing Help Service), the global market for elder-care technology products was valued at $4.4 billion in 2015 – Research Paper Writing Help Service and is expected to grow to
$10.3 billion by 2020. Broadly speaking, such products include basic assistive
items (e.g., eyeglasses, canes, walkers) as well as wearable technologies, safety
monitoring systems, and applications for smartphones, tablets, social media,
and other internet-based features.
In developed countries, technology has helped to extend life through a
variety of devices and services, as well as through the use of high-technology
medicine. In developing economies, too, portable technologies have enabled
the inexpensive collection of healthcare information and improved communication between healthcare providers and people living in remote areas. Personal
response systems can benefit individuals affected by serious health conditions,
enabling faster emergency response and, therefore, reduced hospital utilization
and mortality (De San Miguel and Lewin 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers).
Technological improvements can make a product or an environment
more accessible to people with disabilities, while also benefiting others as well.
For example, an automatic door opener benefits not only individuals using
walkers and wheelchairs but also staff and family members carrying meal trays,
supplies, or other items. The use of health information technology to make
home environments “smart” and responsive, to automate buildings, and to
maintain patient information in electronic health records can help providers
improve care coordination as well as quality of care.
Emerging technologies have the potential to significantly improve care,
as long as the costs are affordable and the human element of care is retained.
Such technologies should be seen as a complement to, as opposed to a substitute for, personal long-term services and supports.
Models for Care Management and Care Transitions:
International Frameworks and Perspectives
Throughout the world, long-term services and supports are provided in a wide
variety of settings—from institutional and well-defined residential settings to
people’s own homes in the community—and across several types of delivery
systems. Under universal coverage systems, national and local governments
fund and administer long-term care coverage for all citizens. Under mandatory
insurance programs, the government requires people of certain age groups or
employment statuses to pay premiums toward insurance for long-term care.
Chapter 12: Global Demographics and Long-Term Services and Supports
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404 The Global Healthcare Manager
Some countries have mixed systems, in which public means-tested elements
and private insurance both play important roles. In other countries, services
may be provided with few public funds or with no formal system (Niles-Yokum
and Wagner 2015 – Research Paper Writing Help Service). A summary of government policies and services in selected
countries is provided in exhibit 12.2, with further discussion in the sections
that follow.
Japan
History and Demographics
With high life expectancy, a low fertility rate, and a strikingly low number of
immigrants, Japan stands at the forefront of the population aging trend. In
2015 – Research Paper Writing Help Service, people aged 65 or older represented 26.6 percent of Japan’s population, making it the oldest country in the world (He, Goodkind, and Kowal
2016: 2024 – Do my homework – Help write my assignment online). Experts believe that older adults may represent as much as one-third
of Japan’s population by 2025.
Traditionally, Japanese culture has emphasized filial piety, the idea that
younger family members have an obligation to take care of their elders. As a
result, families have taken on significant caregiving responsibilities, and care
through the hospital system has been used for more serious illnesses. In recent
years, however, changing family structures have caused a growing number of
older adults to live separately from their families, necessitating the restructuring of service networks.
In 2000, Japan introduced a national long-term care policy that redefined
the role of the government in providing care for older adults. The country
established a national long-term care insurance program, known as Kaigo
Hoken, that is administered separately from the national health insurance policies and is funded by general tax revenues as well as insurance premiums. The
policies are mandatory. All citizens older than age 40 must contribute (Yong
and Saito 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap), and the insurance covers long-term care services for people
aged 65 years or older with severe disabilities (Applebaum, Robbins, and Bardo
2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay). Eligibility for services is determined through a standardized care needs
assessment questionnaire. Depending on level of eligibility, individuals may be
entitled to such benefits as home care services, house cleaning, meal delivery,
day care, and institutional care services (Takagi and Molinari 2017).
The Long-Term Care Delivery System
Residential Care
Residential care is covered under Japan’s long-term care insurance plan, with
three types of nursing home settings available: (1) facilities, or residence homes,
that serve older or frail adults; (2) facilities that provide more institutional care
means-tested
Having eligibility
criteria based on
income or financial
need.
filial piety
A cultural norm,
prevalent in
much of Asia,
emphasizing
that younger
family members
are expected to
take care of their
elders.
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405
Japan Sweden China Turkey United States
Percentage of
population 65+
(2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay)
25.8% 19.8% 9.6% 8% 14.5%
National longterm care system Universally available as a mandatory insurance program Universally available as part of welfare system (but varies by
municipality)
No formal long-term
care system
Available to lowincome and alone older
adults through national
security system
Available to lowincome older adults
through means testing
Home and
communitybased services
Widely available Widely available Available, but no specific programs exist
and reimbursement is
limited
Mostly available to
urban aged; limited for
countryside aged
Available through programs for low-income
individuals
Support for informal caregivers Local cities and non- profit organizations
offer support group,
consulting, and respite
care services
Each municipality
offers its own financial
payment program,
respite care, consultation, and training
programs
Rarely available The Ministry of Family and Social Policies
supports informal caregivers to help older
adults to age in place
Financial payment is limitedly available in some
states; local offices offer
support group, consulting, training, and respite
care services
Reforms and
future direction
Emphasis on prevention to control cost of
services; revision of
eligibility criteria to
improve finance and
quality of services
Improvement of medical care and social
service agencies;
reduction of discrepancies in service quality
and availability across
municipalities
Expansion of service
network to support
community-based
care; goal of adding
more than 3 million
institution-based
beds
Movement toward
services to encourage
older adults with low
income to age in their
communities; gradual
increase in private institutional care for older
adults with high income
Emphasis on
community-based
services through innovative programs, such
as the Program of AllInclusive Care for the
Elderly (PACE)
Sources: Adapted from Takagi and Molinari (2017). Data from Applebaum, Robbins, and Bardo (2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay); KPMG International (2013); US Census Bureau (2015 – Research Paper Writing Help Service).
EXHIBIT 12.2
Long-Term Care Policies and Services in Japan, Sweden, China, Turkey, and the United States
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406 The Global Healthcare Manager
for people with significant medical needs; and (3) facilities that provide dementia
care (Yong and Saito 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). Studies of the plan have shown that utilization
rates are high, especially for private institutional care, where move-in fees, or
nyuknokin, are significant. Public nursing homes are also available, though
potential residents face a long wait list. Japan’s plan also provided funding for
start-up nursing home construction, so a number of private, lower-cost homes
have emerged to provide services in more remote areas, though quality levels
tend to vary (Brasor and Tsubuku 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Local governments also provide special facilities for individuals with
limited financial means, including people with mental or physical disabilities.
These “care houses” often attract low-income older adults who are given a
room and sometimes meals in exchange for signing over their welfare payments.
(Brasor and Tsubuku 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Home and Community-Based Services
A community-based integrated care system was created under Japan’s long-term
care insurance plan, and it provides for the delivery of home and communitybased services. Two key initiatives were introduced in 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap. The first initiative
provided for regular and as-needed home visits, with close collaboration between
long-term care and nursing staffs. The second initiative involved the creation
of a composite service, adding healthcare to the “small-scale multifunctional
in-home care” service that was established in 2006 – Write a paper; Professional research paper writing service – Best essay writers. Under both initiatives,
local authorities hire service providers for a fixed monthly fee (Morikawa 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Future Directions and Challenges
Filial piety remains part of Japanese culture, and family caregivers still play an
important role in the lives of the country’s older adults. However, the availability of younger family members to provide long-term services—as well as
their desire to provide such care—has changed, shifting the balance between
private and public caregiving entities (Takagi and Molinari 2017). At the same
time, restrictive immigration policies have limited the number of workers available for caregiving services. The country has sought to develop leading-edge
technology, including sophisticated robotics, to alleviate some of its workforce
shortage issues.
Sweden
History and Demographics
Sweden has long been recognized as the first European country to have a
long-term care plan and a publicly funded welfare state, and it ranks among
the top European nations in investment in long-term services and supports as
a percentage of GDP (Eurostat 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Life expectancy in Sweden ranks among
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407
the longest in the world—79.1 years for men and 83.2 years for women, as of
2010 – Essay Writing Service: Write My Essay by Top-Notch Writer (Swedish Institute 2013). People aged 65 or older represent 18 percent
of the country’s inhabitants, and this number is projected to rise to 23 percent
by 2030, partly because of the large number of people born during the 1940s
(Swedish Institute 2013). More than 5 percent of Sweden’s population is aged
80 or older (Statista 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online).
The Long-Term Care Delivery System
Residential Long-Term Care Services
Swedish municipalities planning housing and residential areas are required to
ensure that they meet the needs of all types of individuals with disabilities, regardless of age. These accessibility requirements have been given greater prominence
in legislation over the years. A growing number of older adults want to live in
“senior housing,” ordinary homes for people aged 55 and over where accessibility is a priority. Some are newly built, while others are regular homes that have
been made more accessible as part of conversion or renovation work. Long-term
care services are organized at the local level, with municipalities purchasing care
from both public and private providers, and many recipients have the possibility
of choosing across competing providers. There has been limited measurement,
however, of the effectiveness and safety of care, and few mechanisms for guaranteeing quality standards for services of the type found in healthcare.
Home and Community-Based Services
When a person with disabilities is no longer able to live independently, that
person can apply for assistance from municipally funded home-help services
(Swedish Institute 2013). The extent of care provided is determined by each
municipality based on an assessment of need. In some cases, around-the-clock
assistance enables older people with disabilities to keep living in their homes
throughout their lives. Additional services include adult day services for individuals with dementia or other cognitive impairments, as well as transportation
service in taxis and vehicles adapted for people with disabilities. In 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer, 11
million such journeys were completed, representing a national average of 34
per eligible person (Swedish Institute 2013). Sweden also pays for preventive care for its citizens and supports the use of health coaches. In addition,
Swedish healthcare providers often provide prescriptions for healthy activities
(sometimes in combination with medication) and monitor such activities on
an ongoing basis (Swedish Institute 2013).
Caregivers and Care Coordination
Given that much of the care and treatment formerly provided in hospitals is now
being provided in people’s homes, the work of qualified, coordinated, multiprofessional teams is essential. To ensure high standards, the government, from
2011 to 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay, invested a total of 1 billion Swedish kronor (SEK) in additional
Chapter 12: Global Demographics and Long-Term Services and Supports
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408 The Global Healthcare Manager
training programs for staff working with older adults (Swedish Institute 2013).
The Swedish government also invested SEK 4.3 billion in measures aiming
to “improve coordination of home health care, elderly care, hospital care and
health-center care provided to elderly people” (Swedish Institute 2013).
Future Directions and Challenges
Meagher and Szebehely (2014: 2024 – Essay Writing Service. Custom Essay Services Cheap, 55) point out that the traditional Swedish
system is undergoing significant change. They explain:
There has been some retrenchment in eldercare evident in falling coverage and
stronger targeting of people with higher levels of need. This development has led
to the informalization of care for some groups of older people. In disability care,
there has been a considerable expansion of services, perhaps most notably in the
introduction of a personal assistance scheme for people with severe disabilities.
These divergent trends in services for older people and people with disabilities have
coincided with a convergent development across both care fields: the marketization
of services and the emergence of large, corporate, for-profit providers.
Between 1995 and 2005, the number of private companies in Sweden’s
social services sector increased fivefold (Swedish Institute 2013). However,
media investigations have unearthed alarming shortfalls at several such companies, and some critics have argued that organizations are allowing profit to have
a negative impact on the standard of care (Paul, Schaeffer, and Coustasse 2017).
China
History and Demographics
China is an aging society with changing social structures, and it faces daunting
challenges in meeting the demand for long-term services and supports. China’s
older adult population is growing rapidly, up to 136.9 million in 2015 – Research Paper Writing Help Service. Older
adults represent 10.1 percent of China’s total population, and this percentage
is projected to increase to 17.2 percent by 2030 (He, Goodkind, and Kowal
2016: 2024 – Do my homework – Help write my assignment online). Additionally, the number of Chinese adults aged 85 or older is expected
to grow at a rate of 1 million per year until 2025 (Wu and Dang 2013).
One reason for the rapid aging of China’s population is the one-child
policy that the country’s Communist government introduced in 1979 in
response to concerns over excessive population growth. The policy called for
each family to have only one child, though some exceptions were allowed. The
one-child policy was eventually phased out and replaced with a two-child policy
in 2016: 2024 – Do my homework – Help write my assignment online, but by that time the number of children available to care for elderly
parents had been significantly reduced. The number of available caregivers was
further affected by the migration of young Chinese families to urban centers
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409
during the 1990s, which left many older adults in rural areas without family
members to provide care and support.
Along with the dramatic growth in China’s population of older adults
will come commensurate growth in the number of older adults with physical
and mental disabilities and chronic diseases such as cardiovascular disease,
diabetes, hypertension, and stroke. These conditions—and their impact on the
demand for long-term care—will require the attention of China’s policymakers
in the years ahead (Whitman and Burns 2017).
Of China’s older adult population, 52 percent reside in urban areas, and
48 percent are in rural areas (National Bureau of Statistics of China 2017).
Generally, rural nursing homes offer lower levels of care than urban ones. Many
rural older adults remain in their villages taking care of their grandchildren
while their adult children work in larger cities. Older adults in urban areas,
meanwhile, often must contend with environmental concerns—such as a lack
of elevators or ramps in older apartment buildings—that create barriers for
people with mobility issues and increase isolation. Compounding these challenges is the fact that nearly a quarter of older adults in China have income
levels below the poverty line (Keck 2013). Cases of suicide and abuse among
older adults have been increasing (Wu and Dang 2013).
Many of the challenges faced by China’s older adults run contrary to
key aspects of China’s cultural history, which is based on Confucianism, with
a strong emphasis on the role of the family and filial piety. In an attempt to
reinforce these principles, filial piety has been codified into Chinese law (Wong
2013). The Law on the Protection of the Rights and Interests of Elderly People,
which came into effect in 2013, is part of an effort to bring aging-related issues
into the national strategy; reinforce the family caregiving role; regulate longterm care; create a basic structure for aging services; emphasize the lifestyle,
well-being, and spiritual needs of older adults; and support livable community
development regulation (Wu and Dang 2013).
The Long-Term Care Delivery System
China has two broad systems that provide care to older adults: (1) a social welfare system of community-based elder services, residential facilities, and nursing
homes and (2) a medical system consisting of physicians, hospitals, and primary
care clinics (Whitman and Burns 2017). The services provided include long-term
institutional care in nonacute settings, with significant levels of medical and support services, as well as noninstitutional “senior care services,” encompassing a
wide range of home and community-based services (Whitman and Burns 2017).
Home and Community-Based Services
With its tradition of filial piety, China has a strong commitment to family
and community support. Younger relatives are required by law to visit older
adults at least once a year. Most individuals with disabilities receive assistance
Chapter 12: Global Demographics and Long-Term Services and Supports
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410 The Global Healthcare Manager
in their homes either from family members or from live-in housemaid, or bao
mu, services. More formal community-based services are also being developed,
including large numbers of community service centers (Chu and Chi 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers).
In 2001, the Chinese government started the Starlight program to build
new community service centers using national and local welfare lottery funds. By
2004, 32,490 Starlight homes for seniors were built, but the program became
unsustainable because it lacked systematic policies for eligibility, regulation,
and evaluation. Most of the Starlight centers remain open but are not used by
people who need the services (Cao and Liu 2013).
Long-Term Care Services
As of the end of 2013, China had 42,475 senior facilities with 4.9 million beds,
and about 72 percent of the total facilities were owned by the government
(Whitman and Burns 2017). Long-term care communities are supported by
government funding but may also receive money through medical insurance
plans and private (out-of-pocket) expenditures. About 87 percent of China’s
facilities provide basic daily living supportive services, 10 percent provide
nursing care at a high dependency level, and 3 percent provide hospice care
(Wu and Dang 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay). The privately owned facilities are primarily in urban
and metropolitan areas, whereas most of the government-owned facilities are
in rural areas. Unequal competition for financial resources between privately
owned facilities and government-owned facilities has led to low rates of profit
for many private institutions (Wu and Dang 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
In 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers, China’s senior housing industry sought to address the ongoing demographic challenges and the movement of younger family members to
urban areas, and housing developers adopted the continuing care retirement
community (CCRC) concept, which originated in the United States. Under
the CCRC model, a comprehensive range of nursing and housing options are
available within a single community, and services can be modified as individuals
age and their needs change (McSweeney-Feld 2017). China’s adoption of the
model led to the development of large-scale senior housing complexes with
varying levels of care across hospital, nursing, and rehabilitation components.
The move to adopt the CCRC model was influenced by reforms in the real
estate market that started in 1998 (Yu 2016: 2024 – Do my homework – Help write my assignment online). Local governments became willing
to provide land for senior housing development, and thus an incentive was created
for private developers to develop senior housing and CCRCs. Chinese CCRCs
primarily target high-income seniors such as scholars, professionals, people successful in business or entertainment, and individuals supported by their children
in China or overseas. Key challenges faced by Chinese CCRCs have involved
difficulties identifying the actual needs of older adults at each project location
and measuring the financial aspects of providing care (Wu and Dang 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
continuing
care retirement
community (CCRC)
A model for longterm care in which
a comprehensive
range of nursing
and housing
options are
available within a
single community
and services can
be modified as
individuals age
and their needs
change.
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411
Post-Acute Services and Care Coordination
China continues to encourage the use of hospitals for any medical need. Often,
older adults have long hospital stays, either because of a lack of available postacute care facilities or because of the expectations of patients and providers
(Whitman and Burns 2017). Most rehabilitation, medical, and nursing services
facilities are located in the eastern part of China; often very few are available
in the western areas (Wu and Dang 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
To better address the growing needs of older adults, China’s central
government, starting in 2013, launched a series of policy directives to support
the delivery of “integrated care” (yiyang jiehe) in communities. Local governments have responded to the directives with plans and pilot projects, leading
to the emergence of integrated service networks in large cities, where both
older adults and the necessary resources are concentrated.
China’s move to integrated care has involved the consolidation of social
and health resources at the community level. For example, community health
centers in the city of Shanghai have expanded their services to include nursing, rehabilitation, and palliative care. The centers have reached out to older
residents in the community, and residents’ access to the services is supported
under existing medical insurance schemes.
Future Directions and Challenges
As part of its national strategic plan, the Chinese government has made strides
to establish a long-term care system with comprehensive social care as the
foundation, supported by institutional care. Its institutions have added millions
of new beds to better meet the demands of the population (Feng et al. 2013).
Nonetheless, the nation still lacks a comprehensive strategic and visionary plan,
and the relationship between the government, the market, clients, families,
and communities is not clearly defined. In addition, China’s long-term care
workforce has severe shortages in administrative, professional, and frontline
caregiving roles across all levels and settings of care.
Turkey
Demographics and History
Like many other developing countries, Turkey faces a variety of concerns
related to population aging and sociodemographic transition. According to the
Turkish Statistical Institute (TÜİK), adults aged 65 years or older represented
8.2 percent of the Turkish population in 2015 – Research Paper Writing Help Service—doubling the percentage (4.1
percent) from 1975. The number is expected to reach 20 percent by 2050
(TÜİK 2013, 2016: 2024 – Do my homework – Help write my assignment online).
Chapter 12: Global Demographics and Long-Term Services and Supports
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412 The Global Healthcare Manager
Historically, elder care services in Ottoman-Turkish society evolved, in
parallel with the Western experience, over the course of four periods. The first
was the traditional late Ottoman period (1832–1895). The earliest skilled nursing homes were built during this time, though they were similar to the rough
almshouses of Western nations (Esendemir and Ingman 2011). The second
period (1895–1957) was a period of stagnation for the opening of nursing
homes, as keeping older adults with their families remained the norm. The
collapse of the Ottoman Empire in 1923 may have contributed to the stagnation. After 1957, nursing homes became an alternative to home-based care,
ushering in a transitional period (1957–1980). Finally, in the modern period
(1980–present), institutional care became prevalent in large cities. Nonetheless, home-based care provided by families is still dominant.
The preference in Turkey for family- or home-based care can be tied to
religious beliefs that emphasize traditional filial values, even though the family structure has weakened somewhat over time. Elder care is still considered
to be primarily the responsibility of family members, particularly the elder’s
son’s wife (Aytaç 2002). In addition, economic conditions may contribute to
the predominance of family-based care, given that many families are unable to
afford separate houses for parents. Finally, many people in Turkey are influenced
by the negative perceptions of nursing homes seen in many countries around
the world (Moody 1992). When family members institutionalize their parents,
they often feel guilty or are labeled as such by society.
The Long-Term Care Delivery System
Long-Term Services and Supports
Turkey has no long-term care insurance system. Metropolitan cities such as
Istanbul, Ankara, and İzmir have somewhat better services available than other
parts of the country, but the country in general struggles to meet the needs of
its growing population of older adults. In 2013, Turkey’s General Directorate
of Disabled and Elderly Services published a set of quality standards intended
to guide institutional reform (Karadeniz 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Turkey does have a program for compensating caregivers. If a person
with a disability, regardless of age, receives care from a family member while
living at home, the family member receives a means-tested monthly payment
of the net minimum wage from Turkey’s Ministry of Family and Social Policies
(ASPB). If the person receives services in a care home, the ASPB payment is
double the minimum wage (Karadeniz 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Efforts to establish a long-term care insurance scheme have begun,
including a draft report and projections prepared by ASPB. A reform introduced
in 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay enables ASPB to assist needy people aged 65 or older by purchasing
care services under the Public Procurement Law. In addition, ASPB can finance
care services provided by other public institutions and municipalities, which
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413
helps stimulate local governments and municipalities to offer care services
(Karadeniz 2014: 2024 – Essay Writing Service | Write My Essay For Me Without Delay).
Turkey has also taken steps toward integration of care, including elder
care services. The Ministry of Health and the Ministry of Family and Social
Policies, for instance, have begun working with city administrations on a common information network to support better coordination.
Caregivers
Because elder care in Turkey is still based primarily on informal care provided by family members, the professional system for long-term care is largely
undeveloped. Typically, informal caregivers lack the education and expertise
to effectively deal with problems related to such demanding conditions as
Alzheimer’s disease or Parkinson’s disease. Educated nurses are generally only
available for work in hospitals, and they generally lack the extra gerontological
and geriatric education to meet the specific needs of the older population. To
address this issue, a number of universities have opened aging care departments
to prepare nursing students.
Future Directions and Challenges
Providing needed services for Turkey’s rapidly aging population will be a
challenge in the years ahead. Although the number of old-age institutions has
increased in recent years, the institutionalization of older adults is unlikely to be
the solution. More likely, the future direction—and future opportunities—will
emphasize services and supports to help older adults more successfully age in
place or age in their communities.
The United States
History and Demographics
The United States, like the other countries discussed in this chapter, is undergoing a significant demographic shift with major implications for the delivery
of long-term services and supports. As Americans live longer and members of
the baby boom generation grow older, the number of older adults in American
society is increasing at a rapid pace. In 2013, the 65-or-older population in
the United States was 44.7 million—representing 14.1 percent of the total
population—and 6 million of those people were older than 85. By 2050, the
number of older adults is projected to reach 89 million (CDC 2013).
From the early 1900s to the 1930s, almshouses—often regarded as “poor
farms” for elderly “inmates”—provided some long-term care for people in need,
though typically in harsh conditions. The Social Security Act of 1935 provided
pensions for older people, and growing numbers of private boarding houses and
Chapter 12: Global Demographics and Long-Term Services and Supports
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414 The Global Healthcare Manager
nursing homes developed in the decades that followed. In 1965, the Medicare
and Medicaid programs were established (McSweeney-Feld and Molinari 2017).
Long-Term Care Delivery System
Medicare provides nearly universal medical insurance for people aged 65 or
older, but it does not cover nonmedical long-term services and supports. The
only US public policy that offers coverage for nonmedical long-term care is
Medicaid, which is limited to low-income individuals (Takagi and Molinari
2017). Eligibility for Medicaid’s long-term care benefits—which generally
cover services in nursing homes as well as at home on a limited basis—is
determined via means testing, based on a set of guidelines concerning income
level, household and family structure, and personal assets. Medicaid is funded
jointly by tax revenues of the federal and state governments. People who are
above the income eligibility level for Medicaid have to pay for their long-term
care expenses either out of pocket or through private long-term care insurance.
Residential Services
Common residential arrangements available in the United States include
assisted living facilities, where staff help residents with activities of daily
living, and skilled nursing facilities, which also provide some medical, nursing, and rehabilitation services (McSweeney-Feld 2017). Various models and
variations have emerged over time, including CCRCs (discussed earlier in the
chapter), where independent living, assisted living, and skilled nursing services
are combined on a single campus. Many of these residential options, however,
are either primarily private pay (e.g., assisted living) or require a high entry
fee (e.g., many CCRCs). The Affordable Care Act (ACA) of 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer introduced
incentives for individuals to receive care in their homes and communities, rather
than in institutional settings. The ACA has thus contributed to an expansion
of home care services and the development of other models for the provision
of care at home, such as patient-centered medical homes.
Home and Community-Based Services
A growing number of initiatives in the United States seek to fund Medicaid
home and community-based service waivers for low-income older adults who
need nursing home–level care. The Money Follows the Person (MFP) program
and the Program of All-Inclusive Care for the Elderly (PACE) are both aimed
at enabling frail, low-income older adults to receive care in their own homes
and communities. Newer technologies such as telehealth and remote patient
monitoring systems are also being adopted for home and community-based
care, and they have demonstrated the potential to prevent hospital readmissions, keep individuals out of institutional settings, lower the cost of services,
and increase the quality of care.
assisted living
facility
A facility in which
staff help residents
with activities of
daily living and
work to ensure
residents’ health
and well-being.
skilled nursing
facility
A facility that
provides medical,
nursing, or
rehabilitation
services on a
residential basis.
medical home
A care approach
in which a primary
care physician
works with other
specialists and
providers to enable
coordinated access
to services when
and where they are
needed.
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415
Across every state, a not-for-profit network called the Aging Network
provides care management and coordination of services for older adults with
long-term care needs. The network includes Area Agencies on Aging (AAAs)
and Aging and Disability Resource Centers (ADRCs). The network can provide
information and referrals, as well as such services as nutrition assistance and
transportation for lower-income individuals.
Caregivers
The Family Medical Leave Act of 1993 requires US employers with 50 or
more employees to allow up to 12 weeks of unpaid family leave for employees
who need to serve as caregivers (US Department of Labor 2016: 2024 – Do my homework – Help write my assignment online). Under this
rule, caregivers still face the loss of wages, but they are at least able to keep
their employment while attending to their family members’ needs. Federal
funding through the Older Americans Act of 1965 also supports the National
Family Caregiver Support Program, which helps eligible informal caregivers
access programs and services such as support groups, training, and respite care
(Administration for Community Living 2017). Consumer-directed home care
programs, another type of support for family caregivers, allow older adults in
some states to employ their family members as paid caregivers (Ruggiano 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap).
Future Directions and Challenges
As the US population ages and the number of people with chronic conditions
increases, the depth and scope of long-term services and supports will need
to expand. Since the passage of the ACA, the US healthcare system has implemented a variety of new approaches to promote the health and safety of people
who need long-term services and supports. Special attention has been placed
on opportunities for better integration and coordination of services, as well as
on potential innovations in service delivery and reimbursement (McSweeneyFeld and Molinari 2017). Additional trends include a heightened emphasis on
preventive care and primary care services, attention to social and environmental
determinants of health, and new uses for emerging technologies.
Homework help – Summary
As populations of older adults and people with disabilities increase throughout
the world, mounting pressures will be placed on healthcare delivery systems, and
new approaches for addressing people’s care needs will have to be developed
and implemented. In this chapter, we have discussed the various historical and
demographic forces that have brought us to the current situation, and we have
examined the steps that health systems in several countries have taken to adapt
to current and future challenges.
Chapter 12: Global Demographics and Long-Term Services and Supports
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416 The Global Healthcare Manager
In developed nations, government pension systems and medical care
systems are likely to benefit from solutions that encourage consumer self-help
and education, as well as strategies that use emerging technologies to support
individuals, families, and communities in new and innovative ways. In developing
nations, changing demographics, family structures, and economic conditions may
necessitate the creation of new long-term care delivery systems with residential
care options to complement existing home and community-based service models.
In both developed and developing nations, strategies and solutions need to reflect
the appropriate cultural values and preferences of the individuals who need care.
As long-term care systems evolve, key service delivery issues will emerge.
Workforce shortages remain a global concern. Integration efforts to facilitate
seamless transitions of care—between acute care settings, rehabilitative services,
people’s homes and communities, and other care settings—will be essential.
Promising new directions can be seen in applications of robotics, telehealth, and
ambient assistive technology, as well as in the development of new dementia
care models that are both safe and empowering. However, these and other
solutions will require significant investments of money and labor and may be
subject to economic and political uncertainties in the years ahead.
Ace my homework – Write my paper – Online assignment help tutors – Discussion Questions
1. What are the key demographic forces affecting the provision and
management of global long-term services and supports?
2. What are the key demand and supply issues affecting global long-term
care?
3. Describe five models of long-term care service delivery.
4. Compare and contrast home and community-based long-term care with
residential long-term care.
5. Define disability, and describe the various ways it can be measured.
6. What tends to be the predominant form of caregiving in developing
nations?
7. What is the largest component of the long-term care workforce, and
what are some of the challenges in developing and retaining these
workers?
8. What is filial piety, and in what parts of the world is it an important
concept for long-term service provision?
9. What are continuing care retirement communities? Where do they exist,
and how have they evolved over time?
10. How does technology influence the delivery of global long-term care
services, and what will be its role in the future?
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References
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