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This book asks why some countries devote the lion's share of their social policy resources to the elderly, while others have a more balanced repertoire of social spending. Far from being the outcome of demands for welfare spending by powerful age-based groups in society, the 'age' of welfare is an unintended consequence of the way that social programs are set up. The way that politicians use welfare state spending to compete for votes, along either programmatic or particularistic lines, locks these early institutional choices into place. So while society is changing - aging, divorcing, moving in and out of the labor force over the life course in new ways - social policies do not evolve to catch up. The result, in occupational welfare states like Italy, the United States, and Japan, is social spending that favors the elderly and leaves working-aged adults and children largely to fend for themselves.
As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.
Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.
Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.
Recent community care changes have raised fundamental issues about the changing role of the public, voluntary and informal sectors in the provision of social care to older people. They have also raised issues about the health and social care interface, the extent to which services should be rationed and the respective roles of residential care and care at home. From Poor Law to community care sets these debates in the context of the historical growth of welfare services from the outbreak of the Second World War through to the establishment of social services departments in 1971. Based on extensive research on primary sources, such as the Public Records Office and interviews with key actors, the book considers the changing perceptions of the needs of elderly people, the extent to which they have been a priority for resources and the possibilities for a policy which combines respect for elderly people with an avoidance of the exploitation of relatives. This is an updated second edition of The development of welfare services for elderly people, first published by Croom Helm, 1985. It is essential reading for practitioners and policy makers interested in gerontology, policy studies, community care and postgraduate students studying and training in a range of health and social care related professions.