Abstracts & Papers in Stream 1

The Long-Term Care Insurance has emerged as a significant policy agenda in East Asian countries. Korea started to implement the new insurance in 2008 and Taiwan government is going to implement it from 2011. However, the issues of use and provision of services in the field level have still received scant attention from scholars. The aim of this research is to understand the experiences of carers going through the processes of using LTC services, particularly the home visiting service. It also aims to explore how care managers, provider managers and care workers were involved in providing services. For this, exploratory research was conducted in Suwon which was one of the thirteen areas for the third pilot projects for the LTCI in Korea. Semi-structured in-depth interviews were carried out with 12 carers, 1 elderly service user, 12 care managers, 7 provider managers and 7 care workers.

This research found that firstly the majority of care workers did not know about care plans and did not refer to them in providing services, although the majority of carers were satisfied with the services provided. Secondly, there were some tensions or conflicts between service users and providers. Some carers pointed out what they felt were unsatisfactory practices relating to the working style and language of care workers. However, many provider managers and care workers reported that the 'demanding requests' and 'sexual harassment' by service users were the main causes of conflicts. Finally, a number of needs were presented from the different perspectives. Carers' unmet needs were summarised into three kinds: short service time, the shortage of service providers, and the need of informal service. Care workers also reported a number of their needs in terms of their poor treatment, risky working conditions, and unrealistic training system.

(University of York, yongho.chon@gmail.com)

Reengineering Elderly Community Services - A Hong Kong Experience

In 2000, the University of Hong Kong was commissioned by the Hong Kong Government to launch a consultancy study on the review of elderly community services, with the aims to assess whether the various services in the community were meeting the changing needs of the elderly people, and to find ways of better service integration. A series of recommendations were drawn up which include the revamping of elderly centres into District Elderly Community Centres (DECCs) and Neighborhood Elderly Centres (NECs). The proposal of revamping was subsequently launched in 2003.

In 2005, the University of Hong Kong was again commissioned to conduct a study to examine the effectiveness of DECCs and NECs in performing their roles and functions to effectively meet the needs of the elderly people living in the community. In the evaluation report released in 2007, it was stated that the user satisfaction towards the various types of services provided by the centres was very high. The officers-in-charge were also largely positive towards the effectiveness of the service units as well as the impacts of the re-engineering exercise on the service users and the centres. However some service gaps and limitations were also identified, e.g. the lack of outreaching services to the hard-to-reach elderly, the difficulties in organizing program for family carers. Service proposals were formulated and launched to address these issues.

As the authors have been involved in the service review, the subsequent evaluation study and continuous dialogue with the service operators, we can highlight some of the lessons learned in the re-engineering exercise, e.g. involvement of stakeholders, trust and resistance issues, change management, relationship with other government reforms and measures. This experience may shed light on future welfare service reforms in Hong Kong as well as other Asian countries.

Authors: Dr. LEE, Carmel K.M., Dr. LAW, C. K., Ms. HO, Lisa
Affiliation: University of Hong Kong

E-mail- carmelee@hkusua.hku.hk

In the last two decades, the personalisation of care services has been a policy agenda in both Japan and England. Both societies have developed the long-term care schemes to increase the choice and control of older people and their carers over the access and provision of care services. This agenda is derived not only as a response to ageing of the population but also to address the increased cost of health and social care. In this context, this paper provides a comparative analysis of the current direction of the 'personalisation of care' agenda in Japan under the Long Term Care Act 2000 (and its subsequent reforms) and in England with the Individual Budget scheme piloted since 2006. In particular, the comparative analysis explores three relevant areas of the personalisation agenda: 1) differentiated concepts and meanings of 'personalisation' in the two schemes; 2) the role of service coordinators (care managers in the Japanese term); and 3) the position and recognition of informal carers. How the differentiated directions within the personalisation between the two societies impact upon the quality of care, particularly the relational aspects of care between providers and recipients, will be another focal point of this paper.


Dr. Misa Izuhara
School for Policy Studies
University of Bristol

Dr. Junko Yamashita
School for Sociology, Politics and International Studies
University of Bristol