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Sustainable Care: Facing Global Ageing More Effectively

A special issue of Sustainability (ISSN 2071-1050).

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 40733

Special Issue Editor


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Guest Editor
Care and Health Policy Evaluation, University of Kent, Canterbury, UK
Interests: ageing demographics; long term care demands; care and health workforce and migration
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Population ageing is happening across the world, and at a faster pace in less economically developed countries than has ever been observed before. Across the globe, changes in demographic and socio-economic structures require the creation of new sustainable care models that are effective in enabling large segments of the society who are growing older to continue contributing to the economic and social dynamics of the society while ensuring meeting the care needs for those requiring support. At the core of long-term care provision is its workforce, where the provision of care is essentially a human activity relaying on relationship building, compassion and competency. Thus ensuring an adequate supply of well-trained and highly skilled care workforce becomes a priority within such systems. However, most economically developed countries have aged populations, with a shrinking working age population. Global mobility widens the pool of works and allows many countries to rely heavily on migrant labour to fill such gaps. The latter creates new care gaps in migrants’ home countries, as their own populations are growing older with increasing care needs.

At the same time, new technologies are carving an important role in maintaining and enhancing care systems. From assistive technologies aiming at delaying intensive care needs and enhancing individuals’ independence to organisational tools and recruitment platforms, technologies are also facilitating new models of care such as caring at a distance, whether it is by informal family members or by professionals.

One might argue that ensuring the dignity and wellbeing of those requiring care and support through high quality and enabling support should be the core ethos of a sustainable and effective care system. Yet with increasing fiscal pressures to provide such support, the wellbeing of the workforce can be easily overlooked, despite a clear link between workers’ wellbeing and quality of care.

This special issue welcomes articles that addresses the concept of creating sustainable care from a global perspective. We welcome empirical and conceptual papers from different disciplines that addresses some of the issues highlighted above. Articles could address the situation in one country or region or adopt a more comparative approach. In particular, we would welcome articles that addresses one or more of the following themes:

  • Conceptual development of the meaning and definitions of sustainable care, who are the core actors and how do they interact?
  • How migration and mobility contribute to, or hinder, the effectiveness of sustainable care systems
  • The role of technology in shaping and influencing sustainable care
  • The workforce, emotional work and quality of care
  • Developing models of care, including the role of social capital and informal support, especially in low and middle income countries
  • The interplay between individuals, their families, the formal care workforce and systems of care

Prof. Dr. Shereen Hussein
Guest Editor

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Keywords

  • Assistive technology
  • care workforce
  • migrant labour
  • long-term care
  • ageing populations

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Published Papers (9 papers)

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Research

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13 pages, 1040 KiB  
Article
Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries
by Aviad Tur-Sinai, Netta Bentur, Paolo Fabbietti and Giovanni Lamura
Sustainability 2021, 13(13), 7277; https://doi.org/10.3390/su13137277 - 29 Jun 2021
Cited by 21 | Viewed by 4158
Abstract
The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries [...] Read more.
The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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19 pages, 966 KiB  
Article
Impact of the COVID-19 Pandemic on Family Carers of Older People Living with Dementia in Italy and Hungary
by László Árpád Kostyál, Zsuzsa Széman, Virág Erzsébet Almási, Paolo Fabbietti, Sabrina Quattrini, Marco Socci, Giovanni Lamura and Cristina Gagliardi
Sustainability 2021, 13(13), 7107; https://doi.org/10.3390/su13137107 - 24 Jun 2021
Cited by 13 | Viewed by 4017
Abstract
The COVID-19 pandemic has had a major effect on both older people with dementia and families caring for them. This paper presents the results of an online survey carried out among Italian and Hungarian family carers of people with dementia during the first [...] Read more.
The COVID-19 pandemic has had a major effect on both older people with dementia and families caring for them. This paper presents the results of an online survey carried out among Italian and Hungarian family carers of people with dementia during the first pandemic wave (May–July 2020, n = 370). The research questions were the following: (1) How has the pandemic changed the lives of family carers? (2) How did government restriction measures change the availability of care-related help? (3) What other changes did families experience? Results show that about one-quarter of both subsamples experienced a deterioration in their financial status. A decline in both general and mental health was also reported. Due to “lockdown”, family carers’ burden increased substantially. Utilization of care-related help decreased, and the share of those left with no help increased in both countries. Cross-country differences emerged in terms of dementia care system, severity of the first pandemic wave, and measures put in place by governments. Findings outline the weaknesses of support structures and their country-specific vulnerabilities to a worldwide pandemic. To better protect people with dementia in the future, it is essential to strengthen their family carers, and support structures need to be re-evaluated and re-designed. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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27 pages, 2443 KiB  
Article
Optimizing Assistive Technology Operations for Aging Populations
by Jesica de Armas, Jessica Rodríguez-Pereira, Bruno Vieira and Helena Ramalhinho
Sustainability 2021, 13(12), 6925; https://doi.org/10.3390/su13126925 - 19 Jun 2021
Cited by 4 | Viewed by 3455
Abstract
The combination of increasing life spans and low birth rates is accelerating the pace at which the share of older adults in the population worldwide is rising. As people age, their autonomy tends to decrease which leads frequently to the need to use [...] Read more.
The combination of increasing life spans and low birth rates is accelerating the pace at which the share of older adults in the population worldwide is rising. As people age, their autonomy tends to decrease which leads frequently to the need to use support equipment to perform their daily living activities. Governments, at all levels, are establishing programs to enable this population to live with dignity at home, receive more proper care, and to participate in all life’s activities in a joyful and independent way. Within these programs, we can find the Assistive Technology (AT) organizations that makes available to the population assistive technology equipment as wheelchairs or hospital beds. These organizations collect and store donated products for lend them to needed users. The management of these products’ flow, the location of the access centers, and design of the transportation schemes is not straightforward, due to several complexities, such as a highly uncertain demand and offer, budget limitations, and restricted availability of human resources within the organizations, most of which are volunteers. In this paper, we analyze the AT operations, based on a Circular Economy perspective, and we develop tools that can help the managers of these programs to make better logistics decisions. These tools are based on mathematical models and efficient algorithms that have been developed to solve location, inventory, and routing operational problems in the AT organizations. We have been inspired by the social program of the Barcelona City Council, Banc del Moviment, but the tools can be used and extended to other programs around the world. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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18 pages, 798 KiB  
Article
Socio-Economic Predictors of Hiring Live-In Migrant Care Workers to Support Community Dwelling Older Adults with Long-Term Care Needs: Recent Evidence from a Central Italian Region
by Oliver Fisher, Paolo Fabbietti and Giovanni Lamura
Sustainability 2021, 13(10), 5349; https://doi.org/10.3390/su13105349 - 11 May 2021
Cited by 4 | Viewed by 3252
Abstract
To meet the rising demand for home care, many families in Italy hire live-in migrant care workers (MCWs). However, the reliance on MCWs to provide long-term care (LTC) and a lack of alternative formal care services raises concerns around equality in access to [...] Read more.
To meet the rising demand for home care, many families in Italy hire live-in migrant care workers (MCWs). However, the reliance on MCWs to provide long-term care (LTC) and a lack of alternative formal care services raises concerns around equality in access to care. This study aimed to determine the socio-economic predictors of hiring live-in MCWs among older adults with LTC needs in Italy, the objective care burden placed on MCWs, and the financial barriers that people in need of care and informal caregivers face when hiring MCWs, analysing data from a cross-sectional questionnaire with 366 older adults with LTC needs and their primary family caregivers living in the Marche region. Binary logistic regression was used to calculate the predictors of hiring a live-in MCW. Having a primary caregiver that had a high school education or above significantly increased the odds of hiring a live-in MCW (Odds Ratio (OR) = 3.880), as did receiving a social pension (OR = 2.258). Over half (57.5 percent) of the people in need of care had difficulties in affording the costs of hiring an MCW in the past year. To increase the sustainability of the Italian MCW market and reduce socio-economic barriers to accessing care, the Italian Government should increase funding for LTC benefits and add means testing and restrictions on the use of cash-for-care allowances. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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15 pages, 390 KiB  
Article
Sustainable Care in a Familialist Regime: Coping with Elderly Care in Slovenia
by Maša Filipovič Hrast, Valentina Hlebec and Tatjana Rakar
Sustainability 2020, 12(20), 8498; https://doi.org/10.3390/su12208498 - 15 Oct 2020
Cited by 14 | Viewed by 2929
Abstract
In countries with prevalent family care and less developed care services, it is important to understand the ways families cope with the care needs of their frail family members as part of policy learning to make care systems more sustainable. Filial care is [...] Read more.
In countries with prevalent family care and less developed care services, it is important to understand the ways families cope with the care needs of their frail family members as part of policy learning to make care systems more sustainable. Filial care is a vital element of family care, yet is significantly restrained by the involvement of carers in the labour market; unequal gender distribution of the care burden; and insufficient recognition of, and policy support, for family care. This article considered the issue of the sustainability of elderly care in a familialist country, Slovenia, by identifying the coping strategies families adopt for the provision of care. To this end, in-depth qualitative data based on a purposeful sample of 55 community-resident users of social home care services and their 55 family carers were used. We identified five external coping strategies: use of formal care services, use of extended family network, use of wider community network, cohabitation, and home adjustments. Among internal strategies, we detected work-related adjustments; abandoning leisure activities; abandoning vacations; establishing new routines; accepting and finding satisfaction in care; increased psychological distress, such as worries and overburdening; and some unmet care recipient needs. Very few strategies may be described as supported by policy actions, despite such support being essential for increasing the sustainability of the family-based care model. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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16 pages, 9370 KiB  
Article
A Digital Coach Promoting Healthy Aging among Older Adults in Transition to Retirement: Results from a Qualitative Study in Italy
by Sara Santini, Flavia Galassi, Johannes Kropf and Vera Stara
Sustainability 2020, 12(18), 7400; https://doi.org/10.3390/su12187400 - 9 Sep 2020
Cited by 14 | Viewed by 5418
Abstract
Global aging and increasing multimorbidity are questioning the sustainability of healthcare systems. Healthy aging is at the top of the world political agenda, as a possible means for hindering the collapse of care systems. In the aging process, the transition to retirement can [...] Read more.
Global aging and increasing multimorbidity are questioning the sustainability of healthcare systems. Healthy aging is at the top of the world political agenda, as a possible means for hindering the collapse of care systems. In the aging process, the transition to retirement can lead to an improvement or a deterioration of physical and psychological health. Digital health coaching technology can support older adults at this stage, but what must be the role of such a solution in promoting healthy aging and shaping sustainable care? This qualitative study, carried out in Italy in 2019, involved 15 older workers, retirees, and colleagues. Based on a user-centered design approach, this study aims at gathering older adults’ feelings on a digital health coaching technology for exploring this solution’s potential in promoting healthy aging. Findings highlighted that the digital health coach may help older adults improve several health determinants, e.g., physical activity, cognitive capabilities, and social life, but it can also entail the risk of stigma and break people’s privacy. The latter can be guaranteed by technology customization and codesign. Further research on the digital health coach benefits to boost healthy aging is needed to understand its potential for shaping future sustainable healthcare. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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17 pages, 293 KiB  
Article
Between Privileged and Oppressed? Immigrant Labor Trajectories in Norwegian Long-Term Care
by Laila Tingvold and Anette Fagertun
Sustainability 2020, 12(11), 4777; https://doi.org/10.3390/su12114777 - 11 Jun 2020
Cited by 11 | Viewed by 3391
Abstract
An increase in older people coupled with growing life expectancy has created a higher demand for long-term care (LTC) services in the global North. Recruitment of staff with an immigrant background has been a solution to meet this demographic challenge. Research shows that [...] Read more.
An increase in older people coupled with growing life expectancy has created a higher demand for long-term care (LTC) services in the global North. Recruitment of staff with an immigrant background has been a solution to meet this demographic challenge. Research shows that linguistic barriers and cultural differences can influence immigrant carers’ abilities to offer adequate care, while less is known about workplace training and intra-collegial support. This article explores systems and practices of training offered to new employees with immigrant backgrounds, and how the qualification process unfolds in daily work in nursing homes in Norway through an intersectional perspective focusing on the interlocking of gender, class and migrancy. The article shows that organizational conditions together with incomplete training combined with attitudes of ‘willful ignorance’ maintain privilege and oppression in these workplaces. The increased immigrant participation and their labor trajectories indicate the emergence of a new immigrant niche in the lower tiers of the LTC sector. The article contributes to the literature of migration, gender, healthcare services and labor by exploring immigrants’ situated labor experiences within changing institutional conditions in LTC. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)

Review

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16 pages, 1281 KiB  
Review
An Evidence Review of Ageing, Long-Term Care Provision and Funding Mechanisms in Turkey: Using Existing Evidence to Estimate Long-Term Care Cost
by Mohamed Ismail and Shereen Hussein
Sustainability 2021, 13(11), 6306; https://doi.org/10.3390/su13116306 - 2 Jun 2021
Cited by 6 | Viewed by 4685
Abstract
Turkey is transitioning from an ageing to aged population at a fast pace. This process requires immediate policy and practice planning and actionable strategies. Formulating and implementing such policies needs to acknowledge parallel demographic and socio-economic changes to ensure adequate resources and appropriate [...] Read more.
Turkey is transitioning from an ageing to aged population at a fast pace. This process requires immediate policy and practice planning and actionable strategies. Formulating and implementing such policies needs to acknowledge parallel demographic and socio-economic changes to ensure adequate resources and appropriate services are developed to enhance the growing older population’s quality of life and wellbeing. Limited long-term care (LTC) provision, funding mechanisms and reliance on informal support primarily provided by women pose considerable challenges to all stakeholders, including the state, families and older people. This paper provides an evidence review on older people's status and their health and care needs, current LTC policies, provision and funding mechanisms in Turkey. It employs a mixed review methodology, making use of published statistics, indicators and literature. The study also adapts existing LTC funding estimation models to predict LTC cost for Turkey. The review highlights the increasing share of older people in Turkey, the fast pace of population ageing, and escalating health and LTC unmet needs. Older people are reported to have high levels of depression, loneliness and co-morbidity with regional, gender and educational differentials. The Turkish LTC and welfare models rely on the family, particularly women, in meeting increased demand. A hierarchical model with random intercept was implemented and estimated the LTC cost in Turkey to be 0.02% of GDP, acknowledging the high proportion of people at labour participation age range and low female employment levels. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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Other

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12 pages, 591 KiB  
Case Report
Mapping Long-Term Care in Jamaica: Addressing an Ageing Population
by Ishtar Govia, Janelle N. Robinson, Rochelle Amour, Marissa Stubbs, Klara Lorenz-Dant, Adelina Comas-Herrera and Martin Knapp
Sustainability 2021, 13(14), 8101; https://doi.org/10.3390/su13148101 - 20 Jul 2021
Cited by 6 | Viewed by 7468
Abstract
Jamaica’s ageing population, high prevalence of non-communicable diseases (NCDs), and associated functional impairments suggest the need for a sustainable long-term care (LTC) system. This paper describes the current LTC system in Jamaica. A review of empirical and grey literature on LTC was supplemented [...] Read more.
Jamaica’s ageing population, high prevalence of non-communicable diseases (NCDs), and associated functional impairments suggest the need for a sustainable long-term care (LTC) system. This paper describes the current LTC system in Jamaica. A review of empirical and grey literature on LTC was supplemented with consultations and interviews and group discussions for knowledge exchange, impact and engagement events with stakeholders being conducted as part of a project on dementia care improvement. Four key findings emerged: (1) Jamaica’s LTC system depends substantially on informal care (both unpaid and paid); (2) there is a need for strategic coordination for LTC across the state, cross-ministerial, private, and volunteer sectors; (3) compulsory insurance and social protection schemes appear to exacerbate rather than narrow socioeconomic inequalities in LTC; and (4) there is a lack of systematic LTC data gathering and related information systems in both the private and public sector—for both institutional and community-based care. For LTC in Jamaica and the broader Caribbean region to be sustainable, more evidence-informed policies and practices that address inequalities in access to services, ability to pay for care, direct support from government, and the risk of needing LTC are needed. Full article
(This article belongs to the Special Issue Sustainable Care: Facing Global Ageing More Effectively)
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