Against the backdrop of successful family planning in China, the aging of the society’s population is increasing. With the increasing number of older adults, the support of the elderly has become a significant issue for society. Filial piety and respect for the elderly are the fundamentals of Chinese society and its long history. One aspect of filial piety focused on the responsibilities of the family in eldercare. It advocates that the elderly need not only material help but also spiritual comfort and emotional support. This culture of filial piety in a traditional Chinese society illustrates a path for responding to problems of the aging population. However, with the advent of an industrialized society, China’s family structure has undergone fundamental changes. There is an increasing trend of families choosing to send the elders to long-term institutional care rather than home or community care. This has led to conflict between traditional filial piety principles and the new model of aging healthcare. As a result, it is important to understand whether the new institutional care in China will meet the material and spiritual needs of the elderly. This paper aims to examine how Chinese values connect with eldercare treatments nowadays with the interplay of filial piety Confucian familism. More specifically, this paper discusses how Confucian values play in the relationship among eldercare locations, accessibility to care, and how filial piety has been expressed in the senior home before and during the COVID-19 pandemic in China. Also, since the available data on service and quality in nursing homes in China is limited, it is important to understand what administrators and caregivers are experiencing as a first step. This paper examines the following issues during the COVID-19 outbreak. 1. To what extent does Filial-piety Confucian familism play a role in young and elder generation’s attitudes regarding elder health care? 2. What challenges do the nursing homes face before and during the pandemic? 3. How was filial-piety expressed in the nursing home before and during the pandemic? Methodology and Methods This project conducted a total of 15 in-depth interviews with selected interviewees, including both selected administrators and caregivers in five nursing homes in Shanghai, China. As the researcher was born and raised in Shanghai, the insights for this research came partially from the real-life experience and a personal understanding of Chinese culture. The researcher conducted this qualitative study in Shanghai during the time when there were restrictions on travel and interaction due to COVID-19. Regarding the location specialty, the researcher was able to conduct interviews in Shanghainese and observe the cultural rituals inherent in the region. The interviews were conducted to observe examples of experiences that administrators and caregivers observed or participated in. As such, the results are based on examples more so that opinions or attitudes. All interviews were recruited through email exchanges and discussions were over WeChat (a Chinese communication app) and phone calls due to the pandemic restrictions. Key Findings This study found that numerous young people in China chose to place their parents in nursing homes due to busy work schedules, house demolitions, and the need for long-term medical care for their parents. However, senior care institutions are still in the stage of exploration and standardization. Inevitably, there are some problems, including a shortage of professional medical staff and a limited level of medical services that can be provided. It was found that this new and flourishing model of elderly care is also facing a series of problems that are prevalent around the world, such as high bed vacancy rate, endless psychological problems of the elderlies, and increased operating costs of nursing homes. This information has led us to question whether the elders are living well and to try to understand views of nursing homes and filial piety. We found that most elders have gradually changed their traditional concept of filial piety to a more modern one. The administrators and caregivers we interviewed said that “filial piety” is a respect from the heart, a mutual emotional exchange and understanding. It possesses equality and democracy between two generations. Their comments suggest that more elderly people living in nursing homes have low attachment to traditional notions of filial piety. In contrast, more children have a solid attachment to traditional filial piety because they struggled mentally before sending their parents to a nursing home. In addition, the study found that filial piety was expressed differently before and during COVID-19. Prior to the pandemic, the administrators and caregivers suggested that individuals were more inclined to fulfill practical obligations and compassionate reverence needs. Whereas, during the pandemic, filial piety was expressed less practically and more emotionally due to the closure of institutions. Future Research Further studies should expand the sample size by including more nursing homes in various districts of Shanghai. It would be helpful if researchers can interview the caregivers and administrators in person and visit some of the care homes to gather other information on the unique needs of clients and families. Further studies could seek to discover how filial piety plays a role in the nursing home after the pandemic has passed. The challenges of the aging models can be further analyzed and recognized through exploring public policies and the needs of China’s overall society. For example, China's future pension system might need to respond to how filial piety evolves. A comprehensive pension security system based on current filial views could be established where children might play different roles in the older adults' material life, care, and spiritual comfort. This research offers suggestions to consider in future research relating to finding a role for elderly care homes in society in reducing some of the negative perceptions of these homes, developing a model that meets the needs of elderly and children, and training and developing staff. Firstly, research might seek to understand how to address some of the negative perceptions of the nursing homes and, possibly, change the view that nursing homes do not mean an abandonment of the elderly. Rather, research might seek to illustrate ways that nursing homes might implement a modern version of filial piety which provides a way that elderly can live in a care home as well as participating with their children in their family homes. Secondly, the study might get input into a template or model for designing nursing homes to recognize the evolving changes and pressures on traditional views of filial piety. As needs of children and elderly in a society have changed, so have their expectation of filial piety and, given these changes, how do we develop elderly institutions to respond to the economic needs of children and society at large? Thirdly, the research might investigate the response to the concerns raised from administrators about the shortage of trained staff. This might involve identifying needs of qualified care professional and encouraging their training and developing in colleges, vocational and technical colleges, secondary vocational schools, and county vocational education centers. / Graduate

Healthcare services for the aging population in the United States are a complex configuration of acute healthcare organizations, and post acute nursing facilities, home healthcare, and community based services. The system encompasses all services that imply the need for clinical, medical, or professional judgment (Baldrige National Quality Program, 2006). Most Americans believe the system exists to provide preventive services, management for chronic conditions, and health care services to meet the needs of the people (National Committee for Quality Assurance (NCQA), 2004). However, the healthcare delivery system is fragmented across a broad array of settings (Coleman, Smith, Frank, Min, Parry, & Kramer, 2004), plagued by gaps in quality of care, and does not provide optimal care to the majority of American citizens (NCQA, 2004). As a result, national efforts are focused on the identification of quality indicators, performance measures, and the driving need for consensus standards across a multiplicity of providers, payers, and stakeholders. The overarching focus of this effort is to bridge the gaps in health care quality, and reduce documented disparities for vulnerable populations (National Quality Forum (2004). Healthcare transitions occur as patients receive a broad range of services across a multiplicity of providers, payers, and settings. Aging patients > 65 are most vulnerable during these transitions. A poorly executed transition can result in complications for the patient, duplication of tests and services, discharge delays, increased lengths of stay, early readmissions to the acute care setting, frustration for families and care givers, and dissatisfaction with overall services. Management of care and accountability across settings is limited and patients are falling through the cracks in the foundation of the healthcare system (Covinsky, 2003). The intent of this research was to examine healthcare transitions for patients > 65 admitted to a large acute healthcare system, and to identify measurable quality indicators for an innovative delivery model designed to optimize early discharge from the hospital through rapid rehabilitation. This was a quasi-experimental, cross-sectional design measured at the patient level. The research included a total sample of 250 patients representing both the intervention and the control group. The intervention group consisted of 100 patients who were rapidly discharged to a transitional care facility in the community, and 150 patients randomly selected to a control group that did not transition to rapid rehabilitation. The groups were matched as closely as possible by age, gender, race, primary diagnoses, and the complexity of case. Inefficiency was measured by 3 indicators (1) length of stay, (2) total expenses before contractual allowances, and (3) discharge delays from the hospital. Ineffectiveness was measured by 3 indicators: (1) readmission within 30 days, (2) patient safety with falls serving as the proxy, and (3) overall patient satisfaction. Descriptive analysis was performed utilizing SPSS 15.0. Path analysis was method of choice for data analysis and AMOS 7.0 was utilized for the measurement model. Descriptive analysis found a broad range of diagnosis related groups across 183 women and 67 men with a mean age of 80 for both groups. Initial analysis found the intervention group had a mean length of stay of 9.17 days, and experienced 20 readmissions. The control group had a mean length of stay of 6.77 days, and 30 readmissions. The statistical analysis suggested length of stay and cost of healthcare services are statistically significant indicators at the 0.05 or lower level and that patient safety has the potential to be developed as an indicator for effective outcomes. The identification of quality indicators, measurement of efficiency and effectiveness, and establishing predictors for successful healthcare transitions is dependent on the quality and integrity of data abstracted from hospital information systems, accuracy of information in patient records, and the consensus of standards and definitions across a multiplicity of stakeholders. Further research and collaboration is necessary to ensure that patient transition to innovative care programs such as rapid rehabilitation is based on well-defined patient selection criteria. The intent of the methodologies and quality indicators explored in this research supports the increasing need to ensure that inferences and quality measurements drawn from healthcare information is based on valid, reliable, and well defined data sources (Pan, Fergusson, Schweitzer, & Hebert, 2005). This research suggests hospitals are making steady progress to overcome challenges to safe, quality health services as outlined by the Institute of Medicine (2001) for system redesign, but finds specific implications for hospital leadership. There is a need to thread evidence based practice initiatives into hospital and clinical structures to accommodate new delivery models, processes, and case management. Health services information needs to be housed in a central repository or data warehouse to increase transparency of reportable information across systems and to ensure that valid and reliable information is utilized to draw inferences about performance of hospital systems (Selden & Sowa, 2004) and that quality measurements are established to ensure a scientific foundation for the management of healthcare services (Wan, 2002).

The Triratna/FWBO Buddhist movement has been associated with younger people and a lifestyle in which single sex residential communities and work projects (TBRLs) have been prominent. There is now a trend towards a wider range of lifestyles including fewer people living communally. Demographic changes include 50+ average age for ordained members and some people developing Long-Term Care (LTC) needs, with limited family and financial support. This raises questions as to the extent to which ‘Buddhist identity’ can be supported in LTC situations, with informal care, mainstream LTC services and possible care-based TBRLs all relevant.Data-gathering was initially on the basis of a general investigation of LTC issues in Triratna/FWBO using an eclectic, primarily qualitative design which had features of both a case study and a cross-sectional survey. 17 interviews included participants with current LTC needs, others asked to anticipate future care preferences, and people with relevant expertise. A questionnaire was formulated to explore attitudes to possible care-based TBRLs, with 107 participants and numerous additional comments. There was a strong consensus that Buddhist-based LTC services would, for example, provide better vegetarian diets and have an understanding of Buddhist names taken at ordination. These features were included in a conceptualisation of Buddhist identity which contrasted ‘Buddhist’ and ‘Non-Buddhist’ life, and noted ‘Dreams’ and ‘Nightmares’ as to LTC. Effective basic care was seen as essential to the general level of well-being needed for Buddhist practice, whilst a higher level of support might facilitate access to Buddhist ‘life goods’, and assist people in self-verifying themselves as committed Buddhists through ongoing practice. Informal support from fellow Buddhists was available in many contexts, but not at levels of intensity and duration characteristic of some family-based care, and it was seen as modulated by perceptions of burden, ‘busy-ness’ and other factors. There was a ‘legacy of suspicion’ of mainstream LTC, mainly focussed on residential care, with acknowledgement of some good/respectful carers and care services. TBRLs in LTC were generally welcomed, being seen as suitably altruistic work which might feature an atmosphere of ‘mutuality’ between staff and clients who were Buddhist or of Buddhist sympathy. Comparative material was used here from Methodist, Jewish and Lesbian/Gay/Bisexual/Transgender (LGBT) communities in LTC contexts, with the last of these conceptualised as comparable to the Western Buddhist community as a currently emerging identity in terms of later life services. Practicality and feasibility were discussed with reference to existing TBRLs, and experience of paid-for care input between Buddhists. The latter appeared supportive of Buddhist identity and readily linked to the personalisation agenda in social care. Buddhist-friendly services were seen as a possible context for generativity, and the concept of ‘a natural part of life’ was explored in terms of the emergence of LTC in the Triratna/FWBO movement, and of Buddhism as a gradually more familiar identity which might be encountered in the sphere of LTC.

The purpose of this exploratory study was to operationalize the responses from a sample of the community dwelling older population from Denton County, Texas on disaster preparedness education given by Denton County Health Department (DCHD) personnel. The goals and objectives were drawn from the Texas Public Health and Medical Emergency Management 5-Year Strategic Plan 2012-2016. It was hypothesized that after the disaster preparedness education was received, then comprehension, retention, and application of the information would increase and the goals set forth by the DCHD would be reached. Thirteen sites were used to educate the 224 participants between August 2011 and April 2012. The data were received using a pre-test survey before the training, a post-test immediately after the training, and a follow-up survey call approximately 30 days later. Using Cronbach's alpha, logistic regression and regression analysis through SAS, the data revealed that all DCHD goals were met by this training method and outcome which include the sample population increasing comprehension, retention, and action on the information learned.

Canadian society is facing a marked demographic shift as the baby boom generation ages. By 2031 almost 25 percent of Canadians will be over sixty-five; many of those will be north of eighty and the oldest boomers will be turning eighty-five. One person in four will be a senior. The lack of acceptable intermediate solutions between independence and institutionalization has been pointed out as one of the significant problems facing elderly persons; traditional ‘institutional’ care which keeps older people apart and medicalizes old age, is no longer desirable. Likewise, the ‘golden ghettoes’ model may be appealing to those who can afford it but does not contribute to producing diverse, inclusive urban places. This thesis is an exploration of an alternative strategy. It investigates how architecture can provide a platform for social connection in a residential environment that allows in equal measure both independence without isolation, and informal community with safety and security. The design proposal establishes five architectural strategies which address the fundamental spatial implications of encouraging aging-in-place. This exploration is supplemented with a cohousing strategy, providing a formal organizational tactic that encourages groups of residents to mutually support each other, strengthening social inclusion and reducing the use of formal care and support only where absolutely necessary. The methodology employed examines the mutually dependent and interactive scales of City, Neighbourhood, Building, and Dwelling in conceiving of housing for an aging population that becomes a catalyst of urban integration and community regeneration.

Canadian society is facing a marked demographic shift as the baby boom generation ages. By 2031 almost 25 percent of Canadians will be over sixty-five; many of those will be north of eighty and the oldest boomers will be turning eighty-five. One person in four will be a senior. The lack of acceptable intermediate solutions between independence and institutionalization has been pointed out as one of the significant problems facing elderly persons; traditional ‘institutional’ care which keeps older people apart and medicalizes old age, is no longer desirable. Likewise, the ‘golden ghettoes’ model may be appealing to those who can afford it but does not contribute to producing diverse, inclusive urban places. This thesis is an exploration of an alternative strategy. It investigates how architecture can provide a platform for social connection in a residential environment that allows in equal measure both independence without isolation, and informal community with safety and security. The design proposal establishes five architectural strategies which address the fundamental spatial implications of encouraging aging-in-place. This exploration is supplemented with a cohousing strategy, providing a formal organizational tactic that encourages groups of residents to mutually support each other, strengthening social inclusion and reducing the use of formal care and support only where absolutely necessary. The methodology employed examines the mutually dependent and interactive scales of City, Neighbourhood, Building, and Dwelling in conceiving of housing for an aging population that becomes a catalyst of urban integration and community regeneration.

Public transit, an important mobility service for many, has incurred ridership decline in the U.S. for the past three years. In 2014, U.S. transit ridership was 10.74 billion unlinked passenger trips. In 2015, total ridership was 1.0 percent fewer, and the 2016 decrease was 2.2 percent from 2015. The consistent abandonment of transit in the U.S. does not seem to be ending. In 2017, ridership predicted from year-to-date data is 2.4 percent less than 2016. Furthermore, per capita ridership has decreased 17 percent since 1980. Both the short-term ridership trend and long-term per capita ridership trend is concerning given the increased spending and service provision during the same periods. In seeking to understand the many factors that influence transit ridership trends, it is important to analyze each so that policymakers and practitioners can respond and position transit accordingly. Numerous demographic and economic phenomena help explain this decline in transit use. This research focuses on five of these considerations – age, vehicle availability, telecommuting, fuel price, and geographical distribution of the population.

Aging population is a one of the key problems for the vast majority of so called "more economically developed countries" (MEDC). The amount of elderly people who suffer from multiple disease and require permanent monitoring of their vital parameters has increased recently resulting in extra healthcare costs. Modern healthcare systems exploited in geriatric medicine are often obtrusive and require patients presence at the hospital which interferes with their demand in independent life style. Recent developments on telecare market provide a wide range of wireless solutions for distant monitoring of medical parameters and health assistance. However, most of the devices are programmed for spot checking and operate independently from each other. There is still a lack of integrated framework with high interoperability and on-line continuous monitoring support for further correlation analyses. The current study is a step towards complete and continuous data collection system for elderly people with various types of health problems. Research initiative is motivated by recent demand in reliable multi-functional remote monitoring systems, combining different data sources. The main focus is made on fall detection methods, interoperability, real-life testing and correlation analyses. The list of main contributions contains (1) investigating communication functionalities, (2) developing algorithm for reliable fall detection, (3) multi-sensor fusion analyses and overview of the latest multi-sensor fusion approaches, (4) user study involving healthy volunteers and elderly people. Evaluation is performed through a series of computer simulation and real-life testing in collaboration with the local medical authorities. As a result we expect to obtain a monitoring system with reliable communication capabilities, inbuilt on-line processing, alarm generating techniques and complete functionality for integration with similar systems or smart-home environment. / En åldrande befolkning utgör ett av de viktigaste problemen för de allra flesta så kallade "mer ekonomiskt utvecklade länder" (MEDC). Mängden äldre människor som lider av multi-sjukdomar och kräver ständig övervakning av vitala parametrar har ökat på senare tid, vilket resulterar i ökade sjukvårdskostnader. Geriatrikens moderna sjukvårdssystem kräver ofta att patienterna är närvarande på sjukhuset, vilket kraftigt begränsar en självständig och oberoende livsstil. Den senaste utvecklingen på telemedicinområdet erbjuder ett brett utbud av trådlösa lösningar inom hälsovård för distansövervakning av medicinska parametrar. De flesta lösningarna innebär punktkontroll av enskilda parametrar och arbetar oberoende av varandra. Det saknas fortfarande integrerade lösningar med hög interoperabilitet och kontinuerlig on-line övervakningsstöd för att kunna genomföra ytterligare korrelationsanalyser. Detta arbete utgör ett steg mot ett fullständigt och kontinuerligt datainsamlingssystem för äldre personer med olika typer av hälsoproblem. Forskningsinitiativet motiveras av senaste tidens efterfrågan på tillförlitliga multifunktionella system för distansövervakning, som kombinerar olika datakällor. Huvudfokus utgörs av falldetektionsmetoder, interoperabilitet, verkliga tester och korrelationsanalyser. Listan över de främsta bidragen innehåller (1) att undersöka kommunikationsfunktionaliteter, (2) utveckla en algoritm för tillförlitlig falldetektion, (3) multisensor-fusion-analyser och översikt över multisensor-fusion-strategier, (4) en användarstudie med friska frivilliga äldre. Utvärderingen sker genom en serie av datorsimuleringar och tester i verklig miljö i samarbete med lokala hälso- och sjukvårdsmyndigheter. Målet är ett övervakningssystem med tillförlitliga kommunikationsmöjligheter, inbyggd on-line-bearbetning, tekniker för larmgenerering och funktionalitet för integration med liknande system eller i en smart hemmiljö.

This document discusses the impact of aging on the labour market in the Czech Republic to examine the labour market situation and propose options for solving the consequences of aging. The theoretical part is introduced by two publications, in which is the impact of aging on the labour market based on the projection of the demographic changes in OECD countries by 2050. Next part of this paper focuses on the definition of basic demographic indicators. Afterwards, there are described approaches of international organizations to this problem. The analytical section begins with the demographic characteristics of the population in the Czech Republic, followed by the projection of future demographic trends. Then, the paper analyzes the situation on the labour market in the Czech Republic. The paper is closed up by the review of the labour market in the Czech Republic and by recommendations for the identified issues, which are divided into 4 parts, according to policy goals set in The Implementation Regional Strategy by United Nations.

The aim of my thesis is to analyze the German economy and chart position of Germany in the European Union. Emphasis will be placed on the current economic position of Germany and changes caused by the global financial and debt crisis. The first chapter introduces the political system and assesses the socio-economic characteristics of the country. The second chapter describes the economic development of both East and West Germany after World War II. The success of the social market economy of West Germany is assessed, contrasting the development in East Germany that focused on heavy industry. The economic situation after the unification of Germany is analyzed in the third chapter by using macroeconomic indicators such as GDP, inflation, current account balance and unemployment. Further attention is paid to foreign trade and investment abroad by German and foreign investments in Germany. The second part of third chapter describes the global financial and subsequent debt crisis and its impact on the German economy. The last chapter deals with the position of Germany in the European Union and solving current problems in the Eurozone.