This thesis explores the relationship between the needs people experience in later life and the types of care they receive. The thesis provides evidence on the role of different types of care in supporting the needs of people aged 60+ in England using the English Longitudinal Study of Ageing (ELSA). The research presented adopts a number of new approaches to capturing the multi-dimensional nature of dependency by utilising a range of binary indicators of difficulty performing 10 actions related to upper and lower body mobility, 6 activities of daily living (ADL) and 7 instrumental activities of daily living (IADL). The thesis provides a detailed analysis of the prevalence of these items when considered independently and collectively in combination. A central aim of the research is to develop a more nuanced understanding of dependency to allow for the dimensionality of the needs experienced by older people living in their own homes to be considered. The thesis utilizes a number of different approaches, including simple binary and count-based indicators of need and more complex measures reflecting dependency across different domains of need. These approaches allow a more dynamic picture of dependency in later life to be considered. Using these measures, the research explores the role of different types of care in meeting different types of need. Of these, a unique application of an existing assessment tool is presented, the Indicator of Relative Need (IoRN), which is used as a framework to derive an equivalent measure – the Array of Need (AoN). Given the aim of the study is to investigate the multi-dimensional nature of dependency, various data reduction approaches are used including principal components analysis. Finally, research from similar studies is acknowledged and work from the Survey of Health, Ageing and Retirement in Europe (SHARE) study is reproduced using ELSA. The thesis suggests that when considering the dependency needs experienced by older people living in the community, it is important to be aware that this group includes both less and more dependent older people. As such, developing a better understanding of the dynamic relationship between dependency and the receipt of informal and formal care may require more suitable measurements of dependency.

人口高齡化是一個社會問題以及商機。 日本比中國更早面對這個問題，所以在長期照護領域累積了豐富的經驗。 本論文藉由分析兩家日本長照公司商業模式的關鍵資訊（例如：提供的服務、客戶分群、營運點和特性）說明政策對日本長照公司如何在中國和日本營運的影響。 因為長期照護服務往往基於政府政策而設計， 本論文先介紹日本和中國的政策， 然後研究這兩家─ Nichii Gakkan和長壽控股作為個案公司。 這項研究結果將有助於致力進軍中國市場並需要計劃營運策略和服務內容的日本長照公司。 / Growing aging population is one social issue to face as well as business opportunities. Japan has faced the issue much earlier than China, and thus has accumulated expertise in long-term-care services fields. This thesis answers questions governmental policies effect on firms operation and on how Japanese LTC companies operate in China and Japan, by providing key information on their business models (e.g., services offered, customer segments, locations of operation, and operational characteristics). Since long-term care (LTC) services tend to be designed based on governmental policies and definitions, the thesis fist introduces policies in japan and China. It then investigates Nichii Gakkan and Long Life Holdings as case companies. This research findings would be useful for other Japanese LTC companies which aim to enter Chinese market and need to plan strategies and design service offerings.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

No description available.

No description available.

This dissertation focuses on the long term (2006 - 2015) unsolved problems with the critical nature of healthcare payments in residential social services (PZSS) in the Czech Republic. The aim is a critical reflection of the legitimacy and the causes of this condition, including past efforts to identify and solutions. The used research methods are institutional analysis in combination with critical discourse analysis. The work is conceived as a critically-oriented research on social and health policies in the field of health care financing in PZSS in the period 1998 - 2015. Main findings of the cause of this problem are the failure to use the tool health- insurance plans and their unjustifiable replacement tool called. Reimbursement regulations, the use of which in combination with by power unilateral approach in the contractual relationship between health insurance and PZSS not only leads to problems, but especially to the general alienation public health insurance from the objectives and functions of the health system itself, which provides in this case health care in PZSS.

Dans les milieux de soins, il importe d’assurer la qualité de l’ensemble des services offerts, incluant lors de la fin de vie. À cet effet, un rôle clé des infirmières et infirmiers oeuvrant en centre d’hébergement (CHSLD) est de favoriser l’implication des proches dans les soins de fin de vie, ce qui peut contribuer, entre autres, au soulagement d’une possible souffrance pour eux ou les personnes âgées. Selon Andershed et Ternestedt (2001), l’implication des proches prend plusieurs formes : recevoir de l’information (savoir), être présent (être) et effectuer des tâches ou soins (faire). Cependant, peu d’études sur la fin de vie en CHSLD abordent l’implication des proches dans d’autres contextes que la planification des soins et la prise de décisions. Considérant ce manque de connaissances, le but de l’étude était d’explorer les perceptions de proches, en plus d’infirmières ou d’infirmiers, sur l’implication des proches dans les soins de fin de vie d’une personne âgée vivant en CHSLD. Pour répondre à ce but, une étude de cas qualitative instrumentale a été réalisée. Les données ont été collectées auprès de 4 infirmières ou infirmiers et 3 proches, par l’entremise d’entrevues semi-structurées individuelles, ainsi qu’un journal de bord et la documentation du milieu. L’analyse thématique présente l’étendue de l’implication des proches, les souhaits d’implication des proches et quelques stratégies favorisant cette implication. Ces résultats peuvent servir de pistes d’amélioration dans les pratiques en CHSLD, en plus de sensibiliser les professionnels de la santé aux réalités des proches lors de la fin de vie. / In health care settings, it’s imperative that quality of all services is ensured, including end-of-life (EoL) care. A key role of nurses working in long-term care homes (LTCH) is to promote the involvement of relatives in EoL care to, among others, help relieve a possible suffering of relatives or older adults. Based on Andershed and Ternestedt’s (2001) theory, relatives’ involvement can be described in three categories: their knowledge (to know), their presence (to be) and their participation in tasks or care (to do). However, few studies address relatives’ involvement in LTCH in other aspects than decision-making and care planning. Considering this knowledge gap, we conducted a qualitative case study exploring relatives’ and nurses’ perceptions of relatives’ involvement in this context. Data was collected from a sample of 4 nurses and 3 relatives using individual semi-structured interviews, a reflexive journal and relevant documents from the LTCH. Applying thematic analysis, results showed the scope of relatives’ involvement during the EoL, how relatives wished to be involved, and facilitating strategies to involve relatives in care. These results can guide improvement in LTCH practices and raise awareness in health care professionals of the experience of relatives during the agony phase.

Volunteer caregivers provide essential services to people in the terminal stages of AIDS and their families. Volunteers are exposed to stress and burnout. This study investigated the relationships between stress, coping strategies, levels of burnout and resilience in this population. Volunteers from Societas ‘O Sosiale (SOS) Children Villages and community based organisation (CBO) partnerships, were selected using non-probability purposive convenience sampling. A total of 110 participants were given the Experience of Work and Life Circumstances Questionnaire (WLQ), Brief-Cope, Maslach’s Burnout Inventory (MBI), a Resilience scale and the Living Standard Measure to complete. Statistical analyses were performed on the data. This includes descriptive statistics, reliability analysis, factor analysis, correlations and multivariate analysis of variance. The study found that volunteer caregivers experience high stress levels and burnout related to stressors outside work, remuneration, personnel policies and high resilience. High burnout is associated with all forms of coping. Further it is shown that training in problem-solving skills, counselling, government and public lobbying for support, registration with relevant professional bodies, furnished offices, reasonable recruitment requirements and compensation are needed to help the care givers avert the effect of stressors and control stress by stopping it from turning to burnout. / Psychology / M.A. (Psychology with specialisation in Research Consultation)

Étant donné les limites du système de santé à répondre aux besoins des personnes âgées en perte d’indépendance, la relocalisation vers une ressource d’hébergement à partir de l’hôpital est fréquente. Afin d’optimiser l’accompagnement de ces personnes âgées, les infirmières doivent comprendre leurs perceptions et leurs attentes. Toutefois, les connaissances sur le sujet sont peu nombreuses. Basée sur un cadre de référence composé de l’approche écologique et du modèle des soins humanistes de l’Université de Montréal, une étude qualitative descriptive a été réalisée dans le but d’explorer les perceptions et les attentes de personnes âgées en perte d’indépendance, impliquées dans un processus de relocalisation vers une ressource d’hébergement dans le réseau public à partir de l’hôpital. L’échantillon était composé de six personnes âgées en attente de relocalisation recrutées sur cinq unités de soins. Les données qualitatives recueillies à l’aide d’entrevues semi-dirigées ont été analysées par la méthode d’analyse thématique décrite par Braun et Clarke (2006). Les résultats ont démontré que l’expérience des personnes âgées détermine leurs perceptions par rapport aux soins et aux services. Aussi, l’implication des proches dans leur parcours de vie facilite la transition. Les personnes âgées s’attendent à ce que les professionnels de l’hôpital et de la nouvelle ressource répondent à leurs besoins. De plus, ces perceptions et attentes sont influencées par des croyances et des émotions vécues par les personnes âgées. Les nouvelles connaissances issues de cette étude offrent des pistes pour l’accompagnement holistique par les infirmières des personnes âgées en tenant compte de leurs besoins et préoccupations. / Given the limitations of the health system in meeting the needs of older people losing independence, relocation to a long-term care home from the hospital is common. Nurses need to understand the perceptions and expectations of older people to support them. However, limited knowledge exists on the subject. Based on the ecological approach and the Université de Montréal’s caring model of nursing care, a qualitative descriptive study was conducted to explore the perceptions and expectations of older people, losing independence, involved in a relocation process to a long-term care home in the public sector from the hospital. The sample consisted of six older persons awaiting relocation recruited on five care units. Qualitative data collected through semi-structured interviews were analyzed using the thematic analysis method described by Braun and Clarke (2006). Results showed that the experience of older people determine their perceptions of care and services. Also, the involvement of relatives in their life course facilitates the transition. Older people expect their needs to be met by both the professionals at the hospital and at the new facility. In addition, these perceptions and expectations are influenced by beliefs and emotions experienced by older people. Knowledge developed with this study offer nurses avenues to support globally older people by considering their needs and concerns.

This research provides a comparative study of the Japanese and German nursing home sectors. Faced with aging populations, both countries share similar long-term care policies based on social insurance. However, descriptive statistics indicate significant differences in the outcomes and costs in their respective nursing home sectors. This research aims to identify the reasons for this state of affairs by examining demographic and policy differences between the two countries. To shed light on the subject from multiple angles, we conduct three types of empirical analysis—regression, the Blinder-Oaxaca decomposition, and data envelopment analysis—on regional data from the past decade. Our findings indicate that the different outcomes are driven by both demographic and policy differences where policy relates to long-term care as well as to additional welfare aid. In terms of policy, a key difference is found in the designs of the welfare programs for low-income elders. In Germany, our results are consistent with moral hazard due to the generous design of the welfare program, while in Japan, our results do not indicate moral hazard, which may be due to strict nursing home admission rules for welfare recipients.