The delivery of social care to older adults in the UK faces major challenges. Growth in the numbers of oldest old, together with the prevalence of age-related diseases, will lead to substantial increases in demand for care. Meeting this demand requires a suitable policy response that provides adequate supplies of labour, both paid and unpaid, and appropriate capital resources: the highly undesirable alternative is escalating levels of unmet need. Whether new technology will mitigate this outcome remains unclear. The political economy of these issues is immensely challenging, which requires a holistic approach covering funding, capital and paid and unpaid care.

Long-term care (LTC) is an increasingly crucial part of Canada’s healthcare system, particularly in Atlantic Canada, which has some of the highest current proportions and future projections of adults over the age of 65 nationwide. Most of the direct care within LTC homes is provided by care aides, yet little is known about this critical workforce. In this study, we explore cross-sectional data from 1,338 care aides from the four Atlantic provinces, which were collected through the Atlantic Research Collaboration on Long-term Care (ARC LTC). Overall, we find that these workers are primarily middle-aged women with almost a decade of experience in the sector. While care aides in the region appear to like their work, their commitment is undermined by significant personal and professional strain, with over half at high risk of burnout, nearly a third reporting below-average mental health scores, and one-in-three considering quitting their job.

The present article has a twofold objective. First, it proposes the Long-Term Care Coordination Index (LTC-CoIn), an analytical tool designed to systematically evaluate the scope of intergovernmental and intersectoral coordination mechanisms in long-term care (LTC) systems, applicable to any territorially complex country. Second, it applies this index to analyse the governance of the Spanish LTC system (SAAD) from its creation in 2006 to the present day. The methodology adopts a mixed-methods approach grounded in historical neo-institutionalism, combining documentary analysis and 16 semi-structured interviews with public decision-makers at the state, regional, and municipal levels, as well as sector experts, with the systematic ordinal scoring of the LTC-CoIn indicators through the triangulation of this qualitative evidence. The findings reveal a significant asymmetry between the two dimensions of coordination: while intergovernmental mechanisms show a moderate degree of development, intersectoral integration between health and social services remains an unresolved structural challenge, with critical deficits in integrated information systems, referral protocols, and interprofessional training. Beyond the Spanish case, the LTC-CoIn provides a replicable analytical framework for synchronic and diachronic comparative studies across different federal and multilevel systems

Recent advances in disaster countermeasures have reduced the number of direct deaths; however, population aging and medical progress have resulted in an increase in the number of individuals with chronic diseases and disabilities, rendering them vulnerable to secondary health effects caused by disrupted care and environmental changes during disasters. Public support systems for disaster-related health impacts are systematically established only in Japan and the USA. Although compensation schemes for disaster-related deaths have been progressively expanded, comprehensive support for survivors who require long-term medical and social care owing to indirect, post-disaster health effects remains insufficiently developed. After the Great East Japan earthquake, increases in stroke hospitalizations, depression, and cognitive decline were observed, while international cases, such as the post-earthquake cancer incidence in Nepal, highlight global relevance. Thus, the definition of “disaster-related sequelae” and the establishment of comprehensive medical and social support systems, including compensation, continuity of care, and preventive education, are urgently needed.

Over the past decades, many Western countries have struggled to meet increasing long-term-care (LTC) demands owing to population ageing. Long-term-care systems had to implement austerity measures, while family sizes have shrunk. This potentially places more pressure on adult children who might struggle to meet their parents’ care needs, even when they are willing and able to support them. However, it is unclear to what extent LTC policies impact on care-giving patterns of adult children. This asks for a comparison of filial care-giving across time periods. Therefore, the present study investigates to what extent the relationship between filial care-giving and characteristics of adult children, their siblings and their parents has changed between 2001 and 2023. To this end, data from two ancillary studies of the Longitudinal Aging Study Amsterdam (LASA) were used, providing information about Dutch older adults’ health and support by their adult children. From the 2001 study, data from 220 parents and 830 children were included, and data from 115 parents and 288 children were included from the 2023 study. Results indicate that parents’ and siblings’ characteristics had overall comparable associations with filial care-giving in 2001 and 2023. However, the gender gap between adult sons’ and daughters’ care-giving has diminished over time. These findings suggest that, despite LTC changes, characteristics of parents, adult children and siblings played a similar role in filial care-giving, but a cultural shift towards more egalitarian distribution of care responsibilities between men and women emerged.

The Covid-19 pandemic introduced new challenges for the long-term care (LTC) sector and changed how staff provided care to residents and families. For example, in Canada, LTC staff were required to implement social contact restrictions, while also supporting ‘virtual’ resident and family communication, with video conference visits becoming a primary strategy for this. The objective of this study was to explore Canadian LTC staff members’ experiences supporting virtual communication between residents and family members during the first year of the Covid-19 pandemic. A total of eight LTC staff with experience supporting or coordinating videoconference visits during this time were interviewed about their experiences. Interview data were analyzed using reflexive thematic analysis. Results revealed an overarching theme of holding it together – working with the imperfect to support resident and family communication – which encompassed four key subthemes: accepting distanced communication as a new normal, tolerating the discomfort of new roles, needing to rely on each other in difficult circumstances, and disconnect between policy and on-the-ground experience. The social contact policies that were introduced during the Covid-19 pandemic had never been tested over such a long duration of time. This study provides insight into the challenges of adapting some of these policies within LTC and may be valuable to ongoing planning for future outbreaks, epidemics, and pandemics, especially when considered alongside resident and family experiences.

A growing ageing population in Taiwan poses serious challenges to care-giving services, especially for the Indigenous population, who experience health disparities and insufficient care-giving resources. The Taiwan government implemented universal long-term care (LTC) services in the early 2000s, aiming to alleviate LTC resource disparities in rural regions, including major Indigenous areas. However, empirical research on LTC generally suggests that gaps and challenges remain between policy implementation goals and Indigenous cultural values that may undermine the effectiveness of implementation. This article investigates this problem by asking: Why do implementation challenges persist for LTC services for Indigenous older adults in rural Taiwan? The study employs a multi-method case study of adult foster care (AFC) to investigate this question with a decolonizing perspective. This research selected AFC facilities as study sites because of their strengths in home settings and cultural embeddedness. Empirical data include participant observation (n = 500 hours) at five AFC facilities across five rural Indigenous villages of Taiwan, supplemental interviews (n = 4), and public legal and regulatory documents, analysed through thematic coding. The findings underscore inherent tensions between LTC policy and Indigenous cultural values in Taiwan around safety, scientific metrics of care and market competition that persisted even in an LTC model that emphasizes cultural embeddedness and local community (i.e. AFC). These government priorities contradict the values of Indigenous care that emphasize belonging and solidarity. Centring cultural context and creating communal participatory spaces is one crucial solution to prevent incompatibilities and hegemony in service towards Indigenous older adults.

Universalism has long been the cornerstone of long-term care (LTC) provision in Nordic welfare states. However, population ageing has led to a decline in public care services, prompting some service users to seek support from alternative sources, such as privately financed and informal care. This raises concerns about increasing inequities between those with access to financial and social resources and those without. We take a novel approach to examine whether reductions in public care have exacerbated inequities in a central care outcome: Social Care-Related Quality of Life (SCRQoL), assessed via the Adult Social Care Outcomes Toolkit (ASCOT). Drawing on comprehensive registry and survey data, we explore the relationship between service users’ social and financial resources and their SCRQoL. Specifically, we investigate whether disparities in SCRQoL between service users with and without resources have grown over time. Our findings reveal limited evidence for social and financial resources contributing to service users’ SCRQoL and no evidence of increasing inequity over time. These findings suggest that service users do not mobilize financial assets or family networks to compensate for retrenchment in public services. Instead, our results underline that physical functioning and social participation are crucial for sustaining SCRQoL. As pressure on public LTC services is expected to intensify over the next two decades, resource-related disparities in SCRQoL may become more pronounced, meaning that preserving and enhancing older adults’ functioning and SCRQoL through preventive strategies and reablement interventions should remain a key policy priority.

The article analyses the impact of COVID-19 on health and long-term care systems, as well as institutional resilience by applying indicators of preparedness, agility and robustness. The study shows how the weakness of intergovernmental and cross-sectorial coordination instruments, and the particularities of the Spanish health and long-term care sectors, hindered the initial response to the challenges presented by the pandemic. However, after the first tragic wave of the disease, the intensification of cooperation mechanisms between health and social services authorities, as well as the free initiative of long-term care facility managers, corrected these initial errors and reversed the long-term care facilities’ extremely fragile situation.

Personal money management is an important part of a self-determined life. When assistance needs increase, many care recipients require help with bills, purchases, paperwork or budget planning. Third-party money management (TPMM) is thus a prevalent care-giving task in long-term care (LTC), essential to care recipients’ wellbeing and financial security. However, research on this phenomenon is scarce, scattered over time and research locations, and lacks consistent terminology. This article sheds light on the under-explored topic of TPMM for care-dependent people. It explores the scope and characteristics of TPMM, develops dimensions to characterize practices and mechanisms of TPMM and identifies aspects of good TPMM practice to balance personal autonomy and support by care-giving. In this scoping review (PRISMA-ScR), we analysed 35 scientific and non-scientific publications, retrieved from multiple databases and via citation searching. We found reports on various TPMM practices ranging from occasional help to official substitute decision-making. To grasp the complexity of support arrangements, we synthesized four dimensions, by which TPMM practices can be characterized: (1) degree of formalization, (2) degree of collaboration, (3) type of care provision and (4) degree of digitalization. We furthermore identified six aspects constituting good practices of TPMM, from collaborative decision-making to adequate fintech design. Future key research areas include the collection of comprehensive data on money management assistance needs and related care tasks, an exploration of TPMM issues in formal care settings, the role and responsibility of financial institutions, (digital) solutions to support TPMM, and detailed insights into the support needs of informal (financial) care-givers.

People with dementia have complex needs and priorities that change along the condition’s trajectory. Attending to these needs requires person-centred long-term care and support to be sensitized to the experiences and subjective realities of people with dementia. Regulators assessing the quality of care and support are important change agents in the health system. Research on regulatory assessments of care and support at home is, however, scarce. This qualitative research aimed to gain insight into the experiences of people with dementia receiving person-centred care and support at home, and to explore how regulators assess the quality of care and support provided in clients’ homes. Using the emotional touchpoint method, we found that people with dementia often experience a tension between wanting to maintain a sense of agency and having to accept increasing dependence on others. Using interviews and document analysis, we identified that regulators found it difficult to include the knowledge gained from clients’ experiences of care and support in their assessments. In regulatory assessments, objective risks are prioritized and assessment criteria are based on a largely positivistic epistemology, favouring measurable criteria. This results in regulators assessing observable or documentable aspects of care that do not acknowledge the necessary nuances and emotional aspects that are most important to people with dementia. We conclude that alternative approaches to regulatory assessments are necessary to evaluate person-centred long-term care and support in a way that reflects the experiences and needs of people with dementia and promotes person-centred practices.

Rising long-term care (LTC) costs and population ageing have shaped LTC policies, emphasizing ‘ageing in place’. This may have changed the composition of the care networks as well as the wellbeing of older adults living at home. This study examines changes in the prevalence of care networks (no care, partner care, informal care, publicly provided formal care and privately paid care) and the associations between care networks and psychological wellbeing across three decades (1992–2022) of LTC policy and societal changes. Using 5,496 observations from 3,999 participants in the Longitudinal Aging Study Amsterdam, multi-level regression analyses were conducted, controlling for age, sex, partner status and physical and cognitive functioning. Findings show that, since 2012, formal care and no care usage increased, while use of partner, informal and privately paid care declined. Formal care users reported more depressive symptoms, with the gap between formal and no care users widening in 2012 and 2022. In conclusion, our study highlights the robustness of associations between care networks and wellbeing over time. Formal care, however, is increasingly negatively related to wellbeing, underscoring the need for improved formal care provision and a deeper understanding of its broader impact on wellbeing.

Many older adults living in a seniors’ residence (SR), especially those living with dementia, will have to be relocated in long-term care (LTC) despite the negative impact of these care transitions on physical and psychological well-being. Using a living lab methodology and focus group methods, a care approach was co-developed in collaboration with a SR and public home care services, to promote aging-in-place and delay relocations in LTC. Outcomes were assessed using Interrupted Time Series Analysis. Integrating best practices like staff training, care reorganization, personalized care based on the residents’ life stories, and stronger collaborations with the home care services, this approach allowed older adults with higher assistance needs to remain within their home. Relocations to LTC were delayed by approximately 3 months. Ultimately, aging-in-place was found to be relevant in providing evolving care to older adults living in a SR, though further studies are needed to document its financial impact.

This study analyzed medium-to-long-term trends in long-term care insurance expenditures in Katsurao Village, which underwent complete evacuation following the Fukushima Daiichi Nuclear Power Plant accident, to elucidate the disaster’s impact on care needs. Long-term care insurance expenditure data of Katsurao Village from 2010 to 2023 were analyzed. Per capita long-term care expenditure was calculated by dividing the total long-term care insurance benefits by the population aged ≥65 years and compared to national averages. In 2016, when evacuation orders were largely lifted, per capita long-term care insurance expenditure reached JPY 562,970, approximately three times pre-disaster levels (JPY 197,461 in 2010). Although expenditures gradually decreased thereafter, they remained high at JPY 415,884 in 2023. Evacuation due to nuclear disaster leads to sustained increases in long-term care burden.