Abstract

1. Needsassessment and the organization of eldercare provision in the modernwelfarestate – a comparativeperspective Morten Balle Hansen, Professor, PhD Department of Political Science, Aalborg University Denmark mbh@dps.aau.dk

2. Abstract • Comparative studies of homecare, eldercare and social care generally indicatethat a largenumber of industrializedcountriesarefacingcommonchallenges. • Thesechallengesarecaused by the demographicaldevelopments of an aging population, changed labormarketconditions and changed familystructures. • At a macro-levelthispresentationanalyzeshowdifferentwelfarestate systems cope with thesechallenges by organizing the provision of eldercare in differentways. • At a micro-leveldifferent systems of needs-assessmentareanalyzed. The pros and cons of thesedifferent systems willbediscussedsincethispresentation isplanned as an introduction to the complexitiesthatareassociated with needassessmentpractice.

3. Outline • Introduction • Some Global Trends • Global (European) variation in organizing eldercare • The Danish (Nordic) Case • Some current issues in needs assessment

4. Some Global Trends • From a purely demographical point of view, since the 1970s, the need for elder service on a global scale has grown and will continue to grow over the next decades • The percentage of the world’s population which is 60 years old or older has increased from 8 % in 1970 to 10% in 2000 and is expected to reach 15 % in 2025 and 22 % in 2050 • Claim: How a society choose to organizeitseldercareincreasinglydeterminesitssuccess in the global economy

5. Global variations in Organizing Eldercare IFamily and state • Traditionally the family has taking care of the elderly • In all countries the family and informal social networks continues to play a significant role • In many countries however – and increasingly in the past decades – the state has taken over a lot of this responsibility – especially in the Northern part of Europe • This is also shown in judicial terms: • In the Nordic countries and the Netherlands the state is legally responsible for taking care of the elderly • In the southern part of Europe the family (defined in various ways) is legally responsible • The change tends to covary with women participation rates in the labor market

6. Global variations in Organizing Eldercare II • Financing eldercare: Who pays? • Taxes (Denmark) • Taxes and user payment: (Other Nordic countries, Austria, etc.) • Insurance (public) and user payment: (Netherlands, Germany, etc.) • Either taxes (low income groups) or private insurance (high income groups) and user payment: (France, USA, etc.) • Family or non-profit (e.g. church) charity organizations

7. Global variations in Organizing Eldercare III • Organizing eldercare: Who controls and organizes the eldercare? • Public: Municipalities (Denmark, other Nordic countries, UK) • Public: Local health boards (Ireland) • Public: representatives for AWBZ (Netherlands) • Public: other kinds of public sector organizing • Public and private: (Belgium and France) • Non-profit organizations or family: (Greece)

8. Global variations in Organizing Eldercare IV • Supply: Who are the primary suppliers of eldercare? • Public municipalities and some private and/or Non-profit providers: (Denmark, other Nordic countries, UK) • Non-profit providers and some private companies: (Netherlands, Germany, Italy, etc.)

9. Summing up on global (European) variations as related to Denmark (Scandinavia) • Financing eldercare: Who pays? • Denmark is unique in the sense that almost all costs are financed by tax payers • Organizing eldercare: Who controls and organizes the eldercare? • Denmark, other Nordic countries and UK relies heavily on local government administration to organize and control • Supply: Who are the primary suppliers of eldercare? • Denmark, other Nordic countries and UK relies on local government supply, but increasingly private providers as well

10. The issues of Needs assessment should be understood in this context of managing eldercare Some Current issues in needs assessment

11. Issues of Needsassessment in Eldercare I • Needs assessment is related to the professional organization of eldercare (in contrast to the family) and thus to administrative issues of efficiency, transparency and equity • Claim: Only relatively large professional organizations (public or private) are able to (and have to) cope with the challenges of needs assessment

12. Issues of Needsassessment in EldercareII • One essential issue in the current Danish context is to make needs assessment more dynamic - how do we avoid that need assessment become a self-fulfilling prophecy? That it constitutes and preserves a certain (low) level of ability • Previous and current systems of Needsassessmenttend to be rigid and unable to support a developmentalperspective in whicheldercarepracticetry to improve the eldersability to takecare of them-selves • This developmentalperspective on eldercarepractice is currentlyhigh on the administrative agenda and alsosupported by professional norms of social workers

13. Issues of Needsassessment in EldercareIII • Transparency: The issue of developmentalperspectivetend to besomewhat in conflict/tension with a tranparencycriteriaaccording to which it shouldbe clear whyspecificelderlypeoplegethelp and othersdon’t • Equity: One criteriaaccording to which it shouldbe transparent thatpeople with the same needsshould have the same services has beenimportant in designingcurrent systems of needassessment. • This criteriatend to behard to sustain in a developmentalperspective.

14. Issues of Needsassessment in EldercareIV • Otherissues: • Standardization: Can weconstruct a universal needsassessmentlanguage (such as ICF)? Shouldwe? For instancewedon’t have a commonlanguage of needsassessmentbetween hospitals and municipalities in the Danish context • Communication: Professional actors (e.g. Nurses, doctors, social workers), the political-administrative system, the elderlyusers and their relatives and the public at large need to communicateaboutelderlyneeds. But a vocabulary of needsasseessment have differentfunctions in differentcontexts. How is thisfactrelated to the idea of af a standardizedcommonlanguage?

15. Thanks for your attention Contact information: Morten Balle Hansen, Professor, PhD Department of Political Science Centre for Organization, Management and Administration Aalborg University Fibigerstræde 1 9220 Aalborg Denmark E-mail: mbh@dps.aau.dk Phone: +45 99402338