Policymakers and Service Providers of Welfare - Literature review Example

Title: International Literature Review Student’s Name: Name of Course: Institutional Affiliation: Date Submitted: International Literature Review Introduction The elderly and disabled persons are among those who go through the greatest difficulties in their daily activities in human settlements. Majority of them are in the low-income bracket, and for this reason, lead a low quality of life. Moreover, many human settlements are not designed in such a way as to cater for the needs of the elderly and disabled people. In most cases, these people are excluded from the labor market and social networks since they are unable to maintain mobility. Indeed, the problems that the elderly and disabled people face persist as a result of the multiple deprivations that they suffer. Some national governments have put in place elaborate welfare models for meeting the need of these people. The national governments are always motivated not merely by the moral compulsion, but also by their sense of awareness of the high cost to be incurred in terms of economic development in case of non-participation in the welfare models (Thornton, Sainsbury & Barnes, 1997). In Australia, the welfare model that is in place for taking care of the elderly people is an effective one although there are many areas where improvements are necessary. Likewise, the country instituted a policy framework for the disabled people in 1993-1994 within the Social Justice Strategy (Ageing Policy Statement, 2007). However, this is merely a commitment to ensure that disabled people enjoy the same rights like all the other Australians. It does not carry any entitlement to services on the basis of need or the notion of right to employment (Kothiyal, 2000). This paper reviews literature on the various welfare models that have been adopted in seven countries: The Netherlands, Sweden, Finland, USA, Canada, Japan, and Singapore. The aim is to compare these models with the Australian welfare model and to make recommendations on how the Australian model can be improved. Background In Australia, the legal provision for the integration of all disabled persons is bound up many legislative measures at both State and Commonwealth levels. The Human Rights and Equal Opportunities Commission Act (1986) provided a commission with the right to investigate all complaints of discrimination arising on grounds of color, race, religion and political opinion. However, this act has not outlawed discrimination. Increased attention has tended to focus on groups that are traditionally at a disadvantage with regard to access to disability services: the Torres Strait Islander and Aboriginal people, people with psychiatric disabilities, people from non-English speaking background and the elderly. During the 1970s and 1980s, the underlying philosophy of the Australian government with regard to the provision of services and support to the disabled people was undergoing review (Thornton & Lunt, 1995). The Handicap Program Review of 1983 examined the Commonwealth provision, leading to the creation of the Disability Services Act, 1986. Apart from offering support to the Commonwealth Rehabilitation Service, the Act also stated two employment models and offered a funding mechanism that shifted that diverted the emphasis far away from the existing segregated employment services. The Commonwealth/State Disability Agreement, which was signed in 1991, clearly set out a framework to rationalize as well as improve the manner in which services were being provided to the disability people. The Disability Reform Package (RDP), which was introduced in November 1991, aimed at providing a more active system through which income support could be provided to the disabled people. The current Disability Services Program contains several industry-based initiatives that target the corporate sector in order to encourage employment to the disabled people (Wehman, 1988). The initiatives enjoy the support of employers, and in some instances, involve the continued placement of many disabled people in jobs as well as policy and attitudinal changes. The strategies adopted make use of three broad approaches: cross-company, single-company-based, and broadly-based. With regard to the elderly people, there are limited government schemes that are operational in Australia. The most commonly referred-to government schemes are the ‘staying at home’ and ‘home help’ programs. Both of these are not widely publicized. In most cases, it is up to individuals to take the initiative of approaching such agencies, and waiting lists tend to be long. Often, only those elderly people with insistent and forceful family members can succeed in accessing the services. The family members of the elderly in Australia are increasingly unable to afford all the money and time required to take for their elderly people (Waddington, 1994). They are highly likely to be working in insecure jobs, juggling odd shifts, working long hours, or struggling to maintain their standards of living with low wages. These problems are most heavily felt in Sydney, where living and housing costs remain higher compared to other parts of the country. Majority of the wealthy aged may have a private medical cover, access to sporting and recreational activities or hired home assistance. However, many poorer pensioners are often forced to live in impoverished and isolated existence. Sixty five percent of all the people of over 75 years are reliant on government pension. A single pensioner receives about $200 weekly, an amount that cannot sustain an active and healthy lifestyle for an elderly person (Stuck, 1999). According to FECCA, the national peak body that represents and advocates for linguistically and culturally diverse communities in Australia, the population of older Australians from culturally and linguistically diverse backgrounds, who have diverse needs, continues to grow. In order to maintain active ageing and better health for all Australians, the Australian Department is faced with accelerating its understanding of the older Australian’s needs. In the absence of a deep understanding of the circumstances of the ageing population, the Australian government has not been addressing their needs appropriately and flexibly. Those old people who seek hostel accommodation or nursing home tend to face a perennial shortage of places and high fees. In order to guarantee a place, most nursing homes that offer extensive care demand bonds. In 2005, the average bond was worth $127,000, a figure that marks a fourfold increase since 1995. For full pensioners, a basic nursing home accommodation is worth more than $10,000 (Krothe, 1997). Literature review USA The Disability policy and legislation in the U.S is based on inclusion, independence, and empowerment. Employment is regarded as a pivotal tool of achieving these goals (Warren, 2002). During the 1990s, measures aimed at improving the ability by federal agencies to track the unemployment rates of disabled people were introduced. Additionally, a reaffirmation was made on the commitment to enforce the Americans with Disabilities Act in 1997 (Thornton, 1997). During the reaffirmation process, the belief among American policy implementers was that free enterprise and civil rights did not come into conflict. The contemporary issue was not the perceived conflict between civil rights and free enterprise; it was free enterprise for all vs. unwanted, unjust dependency and discrimination that continued to make life miserable for the disabled population (Thornton, 1997). In the American society, changes in the production structures have had crucial consequences for people with disabilities (Grant, 1996). Many changes have taken place in the labor market; secure jobs have become fewer, while the number of part-time, temporary jobs has increased. Some people hold the opinion that the information available about all these changes is not inadequate, and its impact on the qualitative and quantitative position of people with disabilities in the labor market is not well known (Thornton, 1997). Disabled people in the U.S are regarded as a ‘buffer’ in times of changes in the labor market. Just like the members of racial communities, the employment issue for disabled people has ended up becoming one of the ways through which the labor market attempts to accommodate change (Lee, 1985). Steinbach (1992) did a study on the effects of social networks on mortality and institutionalization among elderly people within the US. Data gathered from the Longitudinal Study of Aging (LSOA) indicated that participation in social activities as well as talking to relatives and friends related negatively to the possibility of mortality. Haveman-Nies (2001) sought to evaluate the dietary quality of American and European elderly people through the use of various derivatives of dietary patterns. The focus was to determine the way these approaches relate to lifestyle and nutritional factors. The associations of lifestyle and nutritional factors indicated adequate categorization into various quality groups. According to Steven (2000), the projected demographic changes in the US population will force families, policymakers, and healthcare practitioners to confront the problem of increased number of people with disability in the community. Concerns about the level of adequacy of community support, particularly those salient to women, will remain, considering that they constitute a disproportionate number of the disabled elderly in the country. These people are vulnerable since they are highly likely to end up living alone without adequate financial resources. The research done by Steven (2000) indicated that there are large gender disparities in the US with regard to provision of informal home care for the disabled people, even in the contexts of married households. For this reason, Steven (2000) recommends that programs that provide support the disabled elderly persons should pay attention to these disparities when they are developing intervention strategies within the community. According to Wiener (2002), the ageing population in the US will have a significant impact on the way health care is organized and delivered. Particularly, the shift of focus from acute to chronic illnesses as well as the growing shortage of qualified healthcare workers will be necessary. The ageing population will be in dire need of focus on chronic diseases such as the heart disease, Alzheimer’s disease, and osteoporosis. Moreover, the style of medicine will have to change from the current one-time interventions which correct only a single problem to an ongoing-management approach, whereby multiple diseases and disabilities are dealt with. Doctors and patients will need to maintain an ongoing relationship in order to help patients cope with their illnesses instead of curing them. Moreover, chronic illnesses often come with disability, meaning that there is need for long-term care services, key among them nursing homes. Canada The size of Canada’s elderly population continues to grow. The way in which health services are being used by this population has been a subject of discussion among country’s policymakers. Using National Population Health Survey data for 1994-1995, Rosenberg (1997) assessed the health status of the elderly population in Canada using the measures of prevalence of chronic illnesses, level of activity limitations, and self-assessment of overall health. Rosenberg found out that the main issues that need to be confronted in the future relate to the preparedness of healthcare providers in meeting the challenges of the future elderly population. Lai (2000) studied the problem of depression among the elderly Chinese living in Canada. According to Lai, depression remains one of the most commonly occurring mental problems among the elderly people. In Canada, 10% of the entire elderly population has been affected by this problem. The most disturbing thing about this scenario is that little or no effort has been made in order to monitor the health status of this vulnerable group. The Chinese constitute the biggest visible minority in Canada according to the 1996 census. Lai’s (2000) findings indicate that there is need for the health care needs of elderly Chinese to be put into consideration by policymakers, with emphasis being put on future mental health needs of the growing elderly population. In terms of housing for the elderly people, the Ministry of Municipal Affairs and Housing has in the past initiated various effective projects. In Toronto, for instance, where housing remains expensive, provincial land-assembly projects have been initiated, where a variety of housing options are offered for elderly people. Older consumers were considered an integral part of the planning process, whereby a team of consultants with expertise in the housing and social needs of senior citizens were involved in project decisions. Although slum clearance was deemed necessary, it was noted to be exceedingly disruptive to the elderly and disabled residents. In order to deal with this problem, the policymakers ensured that lodgings had to be within walking distance of the places where slums were cleared in order for the elderly to access accommodation and social services with ease. Sweden The Swedish government formulated a political goal of helping the disabled people as early as 1976 (Sundström, 2006). The goal was aimed at making the society accessible for all, by providing disabled people with opportunities to participate in their community, and to live, as much as possible, just like everybody else. Throughout the 1960s and 1970s, the perceptions on disabled people in Sweden had begun to change, and organizations for disabled people were being established as well as organizational networks developed (Thorslund, 1987). During this time, laws and ordnances were being developed in order to improve all workers’ conditions, including those workers who had disability (Aronson, 1997). However, there is no law in Sweden that asserts the rights of all disabled people. Typically, special paragraphs that emphasize on integration have been incorporated in the existing legislations in order to ensure that no discrimination takes place. The recent introduction of a Disability Ombudsman is likely to lead to the introduction of anti-discrimination measures for the disabled (Béland, 2006). With regard to the elderly people in Sweden, city governments can apply for funds to the National Government in order to renew urban neighborhoods (Baldock, 1992). The needs of the elderly and disabled have to be put into consideration before the funds are given. In order to ensure that this happen, the national governments have put in place two inventories that are needed to support the case for eligibility (Herlitz, 1997). The first inventory, the housing stock, requires an assessment of housing for quality with regard to all citizens, including the elderly and disabled. The second inventory, which involves the services that are available in the neighborhood, is based on the residents’ evaluation of their future needs in terms of crucial social and economic services. Therefore, the services in all neighborhoods have to be diversified with not just banks, shopping, and post office facilities, but also with services such as security services, and home care for senior citizens (Brink, 1988). The Netherlands The written constitution of The Netherlands, which was promulgated in 1983, is against discrimination on the grounds of race, sex, belief, religion, political opinion, or ‘on any other grounds’ (Tacken, 2000). In other words, no specific legislation relates to the disabled people. Although many policy proposals were presented before and approved by parliament during the 1990s, they never made it into the statute book. Instead, policy objectives were pursued only for certain aspects through various legislations and policy documents. For certain jobs, the concept of occupational disability apply, whereby focus is on the general ability or capacity for various jobs. Portrait (2000) considers three categories of care services for the elderly Dutch to be vital in the formulation of a holistic policy: institutional care, formal care at home, and informal care. According to Portrait, these care alternatives can best be modeled jointly, whereby stochastic dependence is acceptable between different care options. Special attention ought to be accorded to the concept of an elderly person’s health status as well as to the variability of options within the framework of the suggested model (Wiener, 2003). In Netherlands, there are many groups of elderly people, who come from varying racial and ethnic origins. This brings about important implications for both curative and preventive care for elderly people (Reijneveld, 1998). Poor living conditions and cultural factors appear to contribute to the poor health of the elderly people who belong to minority groups, particularly immigrants from Morocco, Turkey, and former Dutch colonies (Morel, 2007). For this reason, pressure on health services is set to increase in the future because of the high increase in the needs of old people. One of the dimensions of pressure on the Dutch government will most likely involve the construction of home care centers. As Ribbe (1993) points out, these homes play a crucial role in the Dutch health care system. These multifunctional institutions are a source of clinical and ambulatory care for both psychogeriatric and somatic elderly people who have disabilities, multiple pathology, and handicaps (Ribbe, 1993). Indeed, a trend is emerging in Netherlands, whereby nursing home care is being organized for the aged through substitution dependencies and projects. Finland In Finland, studies indicate that elderly people who come from disadvantaged socioeconomic settings portray lower levels of performance in virtually every domain of physical activity (Rautio, 2005). In this country, the existing socioeconomic differences in different self-reported disability studies are well described although little is known about their association with different objective measures of the elderly people’s physical capacity (Rautio, 2005). Elderly Finnish immigrants who live in Sweden face peculiar challenges, and their ethnic backgrounds play a critical role in the attitudes that the immigrants adopt while living in Sweden (Martelin, 1994). One of the solutions that have been suggested involves provision of culturally appropriate care whereby the providers come from the same background as the elderly individuals (Teeri, 2006). In cases where this approach has been adopted, the providers with Finnish background are generally considered more qualified and superior to their Swedish counterparts (Teeri, 2006). This is mainly because of the sense of understanding and trust that the Finnish caregivers offer. With regard to disability, there are over 70 organizations nationally, which represents the disabled people’s interests (Kivelä, 1988). The organizations are mandated with the work of providing rehabilitation, housing, as well as undertaking research and development initiatives. For this reason, the ideals of inclusion of disabled people in the Finnish society as well as provision of equal opportunities for them are universally accepted polity goals (Tuominen, 1998). The policy goals are being pursued through rights legislation and service provision in support of the accepted objectives (Kivinen, 1998)). The principle of normalization and integration helps a great deal in shaping the direction that the disability policy takes in different areas of social policy (Heikkilä, 2000). However, the challenge of de-institutionalizing various groups, particularly those that bring together people with learning disabilities, is yet to be dealt with completely. All the special needs of these disabled people have not yet been met in the most desirable manner possible. Japan In Japan, the Health Services for the Elderly Act 1982 is the most important piece of legislation that takes care of the country’s elderly population (Sugisawa, 1994). Since its implementation, the Act has resulted in increased social participation and social support for the elderly population (Sugisawa, 1994). In such a context, various aspects of community engagements among elderly people, for instance, social contacts and marital status do not appear to have statistically significant effects on death, either directly or indirectly. General health checkups are always available for all insured Japanese residents who are above the age of 40. Tatara (1991) adds that the elderly are also offered inpatient care, if need for it arises. Estimates indicate that between 1985 and 1986, the rate of checkups increased from 25.5% to 27.6%, while the number of bed days for the 8.5 million elderly people who were insured was 2.21 million bed days. Japan also boasts of a unique situation, whereby ‘silver employment agencies’ search for employment opportunities for the elderly people. Majority of these senior citizens, who are managers and professionals, get employment in new or troubled organizations that require short-term expertise. In terms of care for the elderly people, the situation in Japan is typical of a worldwide trend, where the traditional model is breaking down. It is being replaced with some other new models of excellent family care, majority of which take the form of a mix of both formal and informal care. In Japan, the traditional patterns have been under strain as a result of economic, demographic and social changes. The city of Tokyo has an elaborate housing plan that takes care of the elderly and disabled residents. The plan ensures that commercial development does not squeeze into housing projects when land costs are high, mainly as a result of commercial developments being offered permits for expensive land. The plan also ensures that there is some cross-subsidization between commerce and housing. This way, housing plans can never be subjected to massive relocations, a scenario that would bring about significant disruptions in the elderly people’s way of life. Singapore Singapore is a small country whose approximate area is 633 square kilometers. Since attaining its full independence in 1965, it was until 1989 that a national policy on the welfare of elderly persons was formulated. In this policy, the four areas of focus included community care, attitudes towards the country’s elderly people, employment of senior citizens in the workforce, and residential care. In this national policy, it is made explicitly clear that it is not the duty of the government to take of the elderly people (Harrison, 1997). The main thrust of the policy was to ensure that there is family responsibility for these people as well as support from the entire community. It was hoped that this would help in spreading the costs of care as well as to bolster all the traditional Singaporean values of filial piety. Since the 1980s, the general feeling among many policymakers and providers of services to the senior citizens has been that traditional gerontological perspectives and theories have failed to address the problem of ‘crisis in social ageing’. This feeling has been proliferated by the continued emphasis on the welfare of the aged people in North America, Europe, and elsewhere. Rapid globalization has compressed both space and time, revolutionizing the way in which the capital accumulation goal is pursued and achieved. Meanwhile, the Singaporean government has for a long time been steadfast in pursuing its non-welfare state philosophy with regard to care for its senior citizens. During the early decades since independence, planning for the elderly people was confined to the sectoral realms and services were regard as a mere extension of the social welfare schemes that were already in place. Indeed, self-regulation has become a prevalent feature in neoliberal economies and Singapore has been no exception. For this reason, Singaporeans are being encouraged to govern themselves by planning for a secure future, with the state’s role being the provision of enough backing to ensure that the subjects’ efforts come to fruition. The country has also been steadfast in providing the disabled people with the right atmosphere of ensuring that they are not discriminated against in terms of both employment and access to social services. However, as Ng (2006 points out, the prevalence of functional disability is much lower compared to the aging and health transition trends. Conclusion In summary, each of the seven countries explored in this literature review has a unique policy framework for the elderly and disabled people. The disability policy and legislation being adopted in the US are based on inclusion, independence, and empowerment. This approach is different from the one used in Sweden, where the government there formulated a political goal of helping all the people with disabilities to live, as much as possible, like everyone else. Similarly, the policies adopted for the elderly people in different countries vary in terms of the extent to which they are explicitly spelt out. Finland, for instance, the principle of normalization and integration has led to a clearly defined social policy. Moreover, there are over 70 national organizations that represent the interests of the disabled people, including those from multiethnic and minority backgrounds. In almost all the countries surveyed, there are concerns over the unaccomplished goal of meeting the special needs of the ageing and the disabled. In these countries, these concerns are being addressed through political plans, policy frameworks, and acts of parliament. All these efforts are best undertaken in the context of clearly set-out underlying philosophical statements. In each of these countries, important lessons can be learned by Australian policymakers and service providers of welfare to the elderly and disabled people. Recommendations 1. There is need for a philosophical basis to be formulated for various policy measures being undertaken to assist the old and disabled people, especially those who live in marginalized communities. 2. The current Disability Services Program should be reviewed so that industry-based initiates are extended to cover the needs of communities with special needs, particularly the Aboriginal and the Torres Strait Islander people. The elderly and ageing from these communities should be helped find employment. This necessitates the creation of an employment agency, such as the one found in Japan, specifically tasked with the role of looking up employment opportunities for these people. 3. The rights of disabled and elderly people should be declared in an act of parliament, in order to create a sense of urgency in the government’s commitment of integrating them into the mainstream society. 4. Mainstream service providers need to work with ethno-specific groups and agencies in order to facilitate the rehabilitation of disabled and ageing people. 5. 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