For more than a decade we have heard warnings about the aging population and the threat that the growing numbers of older people pose for the health care system. “Aging in place” is promoted in high income countries as a solution. However with the majority of both women and men in the labour force combined with the increasing numbers of older people living with complex health issues, there is at the very least a continuing need for residential care that provides twenty-four-hour supports.

For-profit delivery and managerial practices taken from the for-profit sector have been promoted as means for governments to reduce costs and increase choices in these residential care homes. At the same time, as Forbes puts it, today’s best business opportunities can be found in population aging, including in residential care.

Building on networks and research growing out of a seven-year interdisciplinary, international project on long-term residential care, this symposium will bring together papers from Sweden, Canada, the UK and Germany to look at the extent of marketization and the consequences for those who provide and those who need such care. Below is a list of the first authors of each paper and the issues the paper will address.

Convener and discussant

Pat Armstrong, York University, Toronto, Canada, patarmst@yorku.ca

In most mid-20th century industrial societies, long-term care for senior citizens was mainly organized as unpaid work in the private family household, and was seen as woman’s duty. Since the 1990s welfare state policies towards long-term care (LTC) for older people in need of care have experienced fundamental reforms in many countries.

Since then, most European welfare states have introduced new social rights for seniors in need of care and extended the care infrastructure based on publicly funded care provision. In part, long-term care reforms were based on the political support for the marketization of care. As a consequence of the welfare state change, informal, unpaid work in the private sphere of the family has on the one hand been partly transformed into formal, paid care work in the formal employment system outside the family. The provision of extra-familial care services is commonly referred to as “de-familialising” type of welfare state policy as it offers family members – mainly women – the choice not to provide care for their relatives in need of care. On the other hand, many welfare states have also introduced pay for caring family members as well as elements of social security, and despite de-familalising policies many older people still receive care by – mostly female – family members.

The stream aims to analyse the change in welfare state policies towards extra-familial care and family care work, and the consequences for workers in both types of work, as well as for social inequality and gender inequality and poverty.

Conveners and Discussants

Birgit Pfau-Effinger, University of Hamburg, Germany pfau-effinger@wiso.uni-hamburg.de
Hildegard Theobald, University of Vechta, Germany, Hildegard.Theobald@uni-vechta.de

Cash-for-care payments for older people were introduced in Europe mostly in the ‘90s and have had a prominent role in Long-Term Care policies so far. The time passed suggests to investigate the transformations these benefits undergone since their inception. How has their design actually changed? What are the main effects and their implications, and what are the challenges for future policies? The Symposium aims at answering these questions, comparing the experiences of several European countries.

The goals of the Symposium, in fact, consists in a) highlighting the transformations occurred in cash-for-care payments since their introduction, identifying similarities and differences among various countries, and b) providing a comparative discussions of these changes and of their effects, reflecting upon the challenges raised for future policies.

The topics covered by the comparative analysis include the role of cash-for-care payments in the overall LTC system, trends in coverage and intensity, care regulation, and changes in the arrangements concerning carers. Among the transformations discussed, a peculiar attention is also paid to those due, if any, to the recent economic crisis. The countries considered are Austria, England, France, Germany, Italy, The Netherlands.

Convener

Cristiano Gori, Department of Sociology and Social Research, University of Trento, Italy cristiano.gori@unitn.it

Nursing homes are collective settings and dominated by care routines that may threaten the autonomy and personhood of the individual. A problem is that nursing homes tend to adopt characteristics of the total institution. The aim of this symposium is to discuss and critically evaluate promising policies and practices relating to the goal of Swedish eldercare policies to make nursing homes homelike, private and personalized. The symposium will devote particular attention to the problem of what to regard as “non-institutional” in terms of a presence rather than absence of certain contexts, roles and activities.

Convener and discussant

Håkan Jönson, School of Social Work, Lund University, Sweden, hakan.jonson@soch.lu.se

Longer life expectancy, especially an increase in the number of old-old, 80+ indicate that elder care by family members will stretch over many years, combining work and caregiving. Population aging, thus, is one of the major factors influencing changes in intergenerational family relations, and pose challenges to countries in health, labor supply and economic growth. The theme of globalization became influential in social gerontology and a force driving changes in later life through its impact on aspects of social policy and acceleration of migration and urbanization on family life.

The session will contribute to research, policy and practice on linkages between intergenerational family care relations to work, economics and health of elders and their families in various cultural contexts, looking also at future challenges. A recent review on the impact of informal care outlined that caregiving tends to lower the quality of the caregiver’s psychological health, which also has a negative impact on physical health outcomes. Similarities found in the aging process, imply a global approach that emphasizes sharing of research knowledge cross-nationally and cross-culturally. A large body of the caregiving literature has focused on the relationships between elders and their family caregivers through the lenses of caregivers’ stress and burden. However, family care is changing, with a shift towards more complex roles and responsibilities as older adults engage in paid work, and care for multiple family members across and within generations.  There is a need for further research and investigation in order to better identify and appreciate the complexities of intergenerational relationships which impact individuals, families and wider society. Thus, to fully understand the above issues a broader, interdisciplinary contextual perspective is needed which will facilitate the generation of new knowledge. Contributors are from different countries, disciplines and will reflect on various aspects of elder care.

Conveners and Discussants

Ariela Lowenstein, Dept. of Gerontology and Center for Research & Study of Aging, The University of Haifa Israel, ariela@research.haifa.ac.il
Ruth Katz, Dept. of Human Services, The University of Haifa Israel, ruth@soc.haifa.ac.il

Organizing care for older people is one of the most important issues in European countries due to the rapidly aging population, characterized by a rise in the share of the elderly caused by longer life expectancy and declining fertility rates. We can expect a big increase in the need for care on one hand, and a smaller number of potential informal carers on the other. Both trends are likely to place greater demands on formal care systems across Europe.
In the proposed symposia, we would like to address several recent articles related to characteristics of long-term care (LTC) systems, related to usage of SHARE (Survey of Health, Ageing and Retirement in Europe) data. We will firstly address evidence on the explanatory potential of the societal characteristics of care (e.g. characteristics of LTC systems, provision of formal home care), using a significantly broadened set of LTC system' characteristics of the countries. Although econometric studies of LTC systems have become widespread, the evidence on the contextual factors, determining the extent and type of LTC is still sparse.
Next, surprising findings from the data (confirmed in the recent literature) show that the informal carers are sometimes those of worse health, in particular in the within-household context. We will provide a new and detailed explanation for this observation, based on causal inference models and some policy prescriptions for future measures for the support to informal long-term carers.
Attempts to assess unmet needs for LTC are growing, as the countries need to implement the reforms in this field. Yet, most of the existing measures can be hard to implement in practice. We will present a new classification of LTC needs based on LOSS scale, using SHARE data, with high applicability for future research and, in particular, policy usage, with an application to Slovenia.
Finally, we will address new empirical evidence, showing that GALI measure of disability is significantly more related to health care needs than ADL and/or IADL measures, while the exact opposite holds for the assesment of LTC needs of older people (complementing some findings in the recent literature), and present its explanation and (significant) consequences for future policy approaches to the issue of assessing health care and LTC needs at the international level.

Conveners
Andrej Srakar, Institute for Economic Research, Ljubljana and Faculty of Economics, University of Ljubljana, srakara@ier.si
Eva Helena Zver, MSc, IMAD - Institute for Macroeconomic Analysis and Development of Republic of Slovenia, eva.zver@gov.si

Discussant
Maša Filipovič Hrast, Faculty of Social Sciences, University of Ljubljana, Slovenia