Thematic Panel 1

Managing care priorities in practice: Leadership dilemmas in different contexts

Conveners and Discussants:

Helene Brodin, PhD, Associate Professor, Department of Social Work, Stockholm University, and Sara Erlandsson, PhD, Senior Lecturer, Department of Social Work, Stockholm University, Sweden

This thematic panel aims to inspire and advance research on the prioritizing dilemmas that face managers of social care for children, frail older adults and adults with disability in various organisational and national contexts. Although policymakers generally make the overarching priorities about the structuring and distribution of social care services, it is usually managers of social care services, who put policy priorities into practice.

Given that social care policies seldom are explicit regarding how to make priorities between different user groups or how to balance budget limits without affecting users’ entitlements to services, managers of social care services are often forced to base their daily decisions on policies characterised by conflicts between ends and means. Against this backdrop, this session aims to develop research exchange and advancement among scholars interested in exploring the dilemmas of leadership among social care managers in various organisational and national contexts. This research takes into account how social care managers prioritize when ends and means do not meet at the organisational level, and how they experience that their priorities affect the distribution of care services. The session welcomes papers addressing topics, such as, the degree of discretion granted social care managers in relation to priorities set by superior managers at higher organizational levels; on what basis do social care managers make their priorities; what dilemmas and conflicts do social care managers experience in making priorities; how do the priorities of social care managers affect quality of and equality in care provision; and critical interfaces between priorities of social care managers and care policies or social care legislation.

Thematic Panel 2

Age(ing in the) Friendly City: Global Guidelines / Diverse Realities   

Conveners and Discussants:

Tamara Daly Ph.D. Professor and Director, York University Centre for Aging Research and Education, School of Health Policy and Management, York University, Canada and Susan Braedley, Associate Professor and Graduate Program Director, School of Social Work, Carleton University, Canada

Led by the World Health Organization, the Age-Friendly City framework guides cities to be places for all ages, with 700 cities currently holding designation. To receive age-friendly designation, local councils identify strategies across eight domains: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community and health services.

While policy-makers grapple with adopting and implementing age-friendly strategies, they face growing diversity amongst seniors. Women make up a higher proportion of the oldest old.  In Toronto, Canada, one of the world’s most diverse cities, half identify as visible minorities, and nearly two-thirds as immigrants; eighty percent living in Canada twenty years or less are racialized.  New waves of older migrants are moving into European cities, requiring specific supports. Queer communities report discrimination in older age. Urban Indigenous peoples require specialized health and social care services.  Moreover, disability, poverty and aging policies are typically unaligned.

This panel will explore priority-setting for age-friendly cities in multi-scalar ways, attending to how seniors’ diverse needs are addressed and what it means to be age-friendly considering seniors,  as well as their paid and unpaid care providers.  The panel welcomes submissions from scholars studying priorities for age-friendly cities and will take up the following questions:

• What city-level priorities are included and excluded from age-friendly strategies?
• To what extent are the priorities and strategies councils adopt addressing gender, culture, disability, racialization, indigeneity, poverty and/or sexual orientation?
• How are paid and unpaid care providers needs addressed in strategies and priorities?
• What types of tensions and alignments exist regarding aged care amongst different levels of government and how are these resolved?
• Finally, what (if any) are promising practices for cities to address the diverse needs of seniors and those who provide their care?

Thematic Panel 3

Reablement as a mechanism for sustainability and active long-term care

Convenor and Discussant:

Tine Rostgaard, Professor, VIVE – The Danish Centre for Social Science Research, Denmark

With ageing societies and the need for sustainable solutions to providing individualized care for older people, the study of reablement is important in an international setting. It is a policy practice recommended by the European Commission, and reablement is presently tried out nationally or locally in a number of countries (Canada, Denmark, Norway, England, New Zealand, Australia and the Netherlands). Reablement implies a goal-oriented, short-term and intensive intervention of typically 12 weeks, where cross-disciplinary teams of e.g. home care workers and occupational therapists in cooperation with the older person identify and work towards a specific outcome of the intervention, i.e. it has potentials for being person-centered. The outcome is usually related to gaining independence in daily activities, such as shopping, cleaning or general physical mobility, or more overall, to improve quality of life. In Denmark, a study showed that 60% of home care users regain sufficient functional ability and for shorter or longer periods again become independent of home care services (Lauritzen, et al, 2017). Reablement seems to hold significant potential as more and more people age, and also has potential in facilitating cross-disciplinary and inter-sectoral cooperation. Investigations in Denmark also found that social care workers working with reablement were more satisfied with working conditions (Rostgaard and Matthiessen, 2016).

However, research on reablement and its conditionalities and outcomes for both users and care workers is scarce, uncoordinated and lacks focus, nationally as well as internationally. Part of the reason for the scattered approach is that it is a new and so far unexplored research field, with a lack of conceptual clarity. As Legg et al (2016, p. 741) reablement is an ‘ill-defined intervention with no sound theoretical or conceptual basis, which go against best practice’ (ibid, p. 746). We need to address how the introduction of reablement changes perceptions to ageing and individual responsibility for ageing well. Gaps exists in evidence around successful model components, which professionals to involve and how to stimulate cross-disciplinary cooperation, and which users benefit most from what type of reablement intervention. There is also lack of research into unintended effects such as loneliness, and research tends to focus on small timeframes (Aspinal et al, 2016). Finally, we need to address more overall issues such as how reablement affects understandings of right to care and quality of care as well as responsibility for individual health in a governance perspective.

This panel aims at contributing to these questions as well as investigating reablement from a policy and aging perspective. It invites papers focused on:

• Paradigms of ageing and reablement
• Professional logics
• The genesis of reablemement and spread between countries and the processes and practices applied
• Effective mechanisms in the organization and application, such as promoting user and staff motivation and engagement
• Perspectives from older people and their informal carers
• Technology of reablement

Thematic Panel 4

Technology for care and living: Solutions and challenges

Conveners and Discussants:

Virpi Timonen, Professor, School of Social Work & Social Policy, Trinity College, Ireland, and Blanca Deusdad, Senior Lecturer, Dep. Anthropology, Philosophy and Social Work. Rovira i Virgili University, Spain

Policymakers are facing the increased need for care supports without having corresponding resources from either the state or informal sources. The increasing number of older adults living alone or with a partner with disabilities implies growth in public and private expenditure on care.

This scenario is bringing about the need to prioritise care solutions. Technology is considered an important tool in overcoming this challenge, not in the least because technological ‘solutions’ to the ‘crisis’ of care are expected to help in controlling the costs of care. For instance, digitalization of care services is expected to improve communication and coordination among professionals, hence achieving efficiencies.

Approaches such as eHealth and mHealth, as well as the panoply of technological devices that are developed for individual use – ranging from wearable alarms to ambient assisted living and robotics – are raising new ethical and practical questions. The increasing availability of technologies is creating a scenario where policymakers need to decide what type of society we want, and where we need to invest: these necessitate difficult choices around priorities. For instance, if technology enables a home care worker to make 50 virtual visits a day, does this happen at the cost of relational aspects of care?  In a more organic way, what kind of use are older adults and people with disabilities making of technologies in their everyday lives, perhaps in ways that are surprising and innovative?

The topics of interest for this panel include, but are not limited to:

• Are care technologies a priority for policy makers – and indeed for the potential users of such technologies? What kind of variance is there between ‘technology enthusiastic’ systems, and those where technology is just emerging as a priority?
• What kind of questions arise around possible trade-offs between quality of care and the use of technologies? What are the trade-offs and opportunity costs of greater use of technology in other realms of life?
• What is the relationship between technology and various caregivers, both formal and informal? To what extent is technology embraced or critiqued by those who have to or are expected to engage with it most directly?
• How do older adults and people with disabilities engage with care and other technologies? What, if anything, is being done to bridge the digital divide?

We welcome both empirical (qualitative, quantitative, mixed methods) and conceptual/theoretical papers. We aspire to include papers from a variety of contexts and from scholars at different career stages.

Thematic Panel 5

The intergenerational mutual interdependence in aging societies      

Conveners and Discussants:

Tiziana Nazio, Collegio Carlo Alberto and Berlin Social Science Center (WZB) Germany & Matteo Luppi, National Institute of Public Policy Analysis (INAPP), Italy.

Increasing life expectancy and shrinking fertility are reshaping the demographic structure of western societies, with a progressive increase in the relative share of the older segment of the population. These processes have extended the number of generations coexisting in the same time span for a longer time, multiplying the possible caring relations between them. Indeed, the share of people in three- and four-generation families is rising despite fallen birth rates and delayed childbearing. Demographic transformations call for a focus on the vertical axis of the caring relationship that cuts across generations, with overlapping caring needs and potential, as well as a more blurred distinction between care providers and receivers. All these elements seem to point to a lengthening of the phase of intergenerational reciprocal mutual exchange.

At the same time, several social and institutional transformations have contributed to reduce the potential for caregiving at the family level, making no longer sustainable the traditional care model based on the focal role of women’s unpaid labour within families. The reduction in welfare spending by several welfare systems in Europe, with a growing resort to privatisation or re-familialisation, the increase in female activity rates, the widespread need for families to secure a dual income, the postponement of (female) retirement age and the shirking of family size, all point in this direction. Even when the magnitude of these changes vary across countries, the need to combine the financial sustainability of the welfare state while keeping the pace with an increasing care demand emerges as a common trait.

In particular, delayed childbirth and longer life expectancy are increasing the distance among generations and may result in a higher probability, especially for the population aged between 45-60 years, to be engaged in an overlapping of potential caring demands, toward parents but also toward children and grandchildren. The potential multiple intergenerational caring responsibility tend to coincide with a lifetime phase characterized by moderate working flexibility, also due to the limited existence of caring leave and to the concurrent pressures to postpone the retirement age. In this context, the mismatch between growing care needs and reduced family capacity suggests that families might be challenged towards a reorganization of the distribution of caring responsibilities along the horizontal line, e.g. family members, as well as vertical line, generations.

With a special focus on gender, family forms and care policies, this panel is dedicated to analyze how societal and institutional transformations as well as cultural orientations influence the intergenerational caring priorities. The aforementioned demographic and societal transformations are generating potential conflicts between care demands along the intergenerational line, both at the micro level and at the macro level. The shrinking capacity of the family to take up large shares of the caring responsibilities suggests tensions towards a reorganization of individual and family priorities in face of conflicting intergenerational caring demands. At the same time, since these changes could result in a larger call for formal support, at the institutional level there is the need to deal with the potential trade-off between care needs of different generations. In particular, the stream is addressed to understand:

– How the demographic changes are affecting families’ capacity to sustain intergenerational care relationship across generations

– How caring resources are shared between family members when multiple generations are in place, especially in relation to conflicting care demands.

– How (different) demographic pressures have been addressed by different institutional contexts and if there is evidence of a reorganization of policy priorities between the different generations’ caring demands.

To this end, the stream encourages comparative studies with socio-economic and demographic approaches, studies on gender and care arrangements, studies on family and care policies. We welcome more general comparative contributions, in-depth empirical single case studies or country comparisons.

Thematic Panel 8

Institutional violence and protect human rights of older people: Quality procedures

Conveners:

Ana Paula Gil PhD. Interdisciplinary Centre of Social Sciences, NOVA School of Social Sciences and Humanities, Lisbon, Portugal and Isabella Paoletti PhD. Centro di Ricerca e Intervento Sociale, Perugia, Italy

Discussant:

Professor Emeritus Elisabet Cedersund, Division Ageing and Social Change Department of Social and Welfare Studies, Linköping University, Sweden 

Institutional violence is a central issue for long-term care policy at a time when an increasing number of older people is requiring care in institutions. Institutional violence is defined as every act or omission committed against an older person, in the frame of an institution to threaten his/her own life, his/her economic security, physical and psychological integrity, his/her freedom or compromising seriously the development of his/her personality (WHO,2002). Institutional violence includes physical, psychological, sexual and financial abuse and acts of intentional neglect. Recently European Network of National Hu­man Rights Institutions (2017) recognised that European countries should facilitate the ongoing monitoring of the human rights situation of older person in long-term care. Quality of care leads to questioning the effectiveness of the monitoring systems of quality care control in residential sector. How can we tell which institutions provide good care or bad care? What are the methods and indicators to identify good and bad care in practices? We encourage contributions based on quality and quantitative methodologies, ethnography studies, case studies, survey studies etc. that investigate all aspects of violence against older people and in particular institutional violence, quality control in institutional care settings and human rights protection. In particular we aim to attract studies on impacts of assessment tools of quality care in different countries or interventions practices, that is, studies that exemplify how monitoring care system can ensure older people protection from poor quality care and mistreatment, and facilitate the ongoing monitoring of the respect of human rights of older person in long-term care, that is, in services, such as nursing-homes, home care and day care centres. This panel calls for special attention on the monitoring of human rights of the older persons by policy makers, researchers and professionals.

Thematic Panel 7

Making the informal formal. Incentivizing the role of family care givers and migrant care workers in the provision of long term care within the home     

Conveners:

Lorraine Frisina Doetter, and Anna Safuta, University of Bremen, Germany

Discussants:

Karin Gottschall, Professor and Heinz Rothgang, Professor of University of Bremen, Germany

The proposed panel aims to analyse the effects of policies incentivizing informal long term care provision across the globe. Such incentives might take the form of cash-for-care schemes, tax free household transfers/cash benefits, tax deductions where care is purchased out-of-pocket, as well as leave schemes dedicated to caring. Given the historical reliance on family (especially wives and daughters) for care giving, as well as the high costs associated with institutionalization, measures to reinforce or stimulate informal care and thereby allow people to age in place for as long as possible may be seen as both a culturally acceptable and cost-effective alternative to stationary care on the part of policy makers and families alike. However, the policy prioritisation of informal care over other modalities of care provision isn’t always based on evidence, but more often results from a combination of unexamined cultural assumptions about what constitutes appropriate care, financial concerns and/or existing power relations between interest groups.

There is thus a paucity of evidence as to the actual consequences – economic or otherwise – of incentivizing non-professional care. In particular, concerns arise regarding the quality of the care provided, the societal costs and trade-offs associated with shouldering the care burden (or burn-out) to (mainly female) family care givers, their reduced labour force participation, as well as the micro, meso and macro consequences of stimulating informal care provision by migrant workers. In the case of migrant care workers, also typically female, concerns related to exploitation and lack of social protection of the care giver come to the fore, alongside the challenges faced by sending countries grappling with the loss of (potential) care personnel (i.e. care drain and care chains).

The proposed panel calls for papers that take stock of policies incentivizing informal care provision, explaining the policy rationale behind such measures, and/or analysing the various pros and cons of informal care arrangements for the care recipient and their families, the care givers, and the long term care system as a whole. The panel especially welcomes contributions that take a comparative perspective and which draw on evidence from Central and Eastern Europe and the global South.