Dissertations / Theses: 'Aged care policy'

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De, Bellis Anita Marie, and anita debellis@flinders edu au. "Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility." Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.

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This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care. Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care. Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'. The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision. The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice. There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation. If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.

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Venturato, Lorraine V. "A practice divided: Registered nurses' experience of policy and reform in residential aged care." Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/36785/1/36785_Digitised%20Thesis.pdf.

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With the increase in the percentage of the population aged over 65 years, there is increased pressure on the health care system and the nursing profession to provide quality, cost effective care to meet this growing demand for aged care services. As a result, residential aged care services in Australia have undergone a period of extensive reform, including policy and funding changes, impacting on all areas of practice. This demand for high quality, cost effective aged care requires both the involvement of committed professionals and the development and implementation of appropriate plans and policy. This study explores the experiences of registered nurses in residential aged care facilities and how these experiences are shaped by government aged care policy and reform. By posing the research questions: How do registered nurses experience everyday practice in residential aged care? and What influence have policy and reform processes had on registered nurses' experience of their everyday practice? this study aims to further develop understanding of aged care practice and the contextual factors that define it. Thus, the purpose of this study is to challenge registered nurses to reflect on their role in residential aged care (what they do), and through examination of policy and reform (why they do it), explore nursing practices and options for service delivery aimed at creating a care environment of excellence for older Australians. The qualitative research methodology designed for this study is based on a critical hermeneutics approach informed by the works of Gadamer and Habermas. Such an approach recognises the historical, contextual and linguistic basis for interpretation and critique. While Gadamer provides direction for the study to reveal an understanding of registered nurses' experiences, Habermas provides insight into the role of critique in understanding the contextual conditions of such experience. Ultimately, this study seeks to make explicit the cultural and political meanings that operate to establish meaning and context in residential aged care in Australia. Fourteen (14) registered nurses practising in both public and charitable residential aged care facilities were interviewed as part of this study. Registered nurses from high, low and mixed care facilities were interviewed in-depth. Journal notes provided insight into assumptions and prejudices involved in interpretation and facilitated the critical examination of practice experiences within the residential aged care context. Findings suggest that residential aged care is a complex and challenging environment, full of tensions, contradictions and frustrations for registered nurses employed within the system. Three aspects of the experiences of aged care practice are revealed in this study: Searching for Value; Dealing with Change; and Dividing Practice. The search for value reveals the tensions registered nurses experience in seeking to reconcile those aspects of practice that construct meaning and value in their everyday practice with dominant social and professional values that fail to acknowledge the value of ageing and aged care. Dealing with change is an everyday aspect of practice for registered nurses as they struggle to redefine their roles and responsibilities within a changing environment. This struggle highlights the tensions that exist between traditional nursing roles and their expanding managerial responsibilities. Registered nurses also identified conflicts in caring as a result of their changing roles, which have resulted in a division of practice. These conflicts in caring contribute to the tensions experienced between registered nurses and other stakeholders in residential aged care in relation to everyday practice and quality of care. Findings indicate that aged care policy and reform have a significant impact on the experiences of registered nurses in residential aged care and contribute to the tensions, challenges and frustrations facing nurses in their everyday practice. These findings indicate that aged care policy and reform processes are integral in the restructuring of practice in residential aged care. This analysis illuminates the ways in which aged care policy constructs the tensions and evident contradictions within registered nurses' roles. Based on these findings, recommendations for practice and further research encourage cooperation between government, service providers and the nursing profession to assist registered nurses to reconcile past, present and future practices in order to redefine practice and meaning in residential aged care.

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Liu, Sherry T. "Behavioral, Policy, and Environmental Approaches to Obesity Prevention in Preschool-Aged Children." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1395108013.

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Hansen, Annissa Margaret. "Shaping aged care work through technology: A senior manager affordance perspective." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/208914/1/Annissa_Hansen_Thesis.pdf.

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This research identifies the affordances of technology in aged care from the perspectives of senior managers. Interviews with Executives and Directors in a large aged care provider, an aged care industry body, and an aged care technology developer revealed the numerous ways in which technology shapes the aged care work environment. The findings suggest that government, aged care organisations, and technology providers need to balance the efficiencies of technology adoption with the humanistic nature of aged care work.

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Leung, Man-fuk Edward. "An analysis of policy on residential nursing care for the elderly in Hong Kong." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13236222.

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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.

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Hampson, R. "Setting policy in concrete: the impact of the built environment on older people who live in residential aged care facilities." University of Melbourne, 2008. http://repository.unimelb.edu.au/10187/3425.

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Residents of residential aged care facilities live out the last days of their lives in an institutional environment. These facilities can potentially liberate and/or constrain. The voice of actual residents has been little explored to date. Critical gerontology, which underpins the study, demands that researchers endeavour to understand the lived experience of the older person.
This thesis focuses on the impact of the built environment on older people (without dementia) who live in residential aged care facilities. Based on original research undertaken in Victoria and some of the latest thinking from Australia and overseas the study was undertaken using mixed methods. The research involved a review of the literature, in depth small group interviews with residents, staff, family and carers, and surveys and a best practice forum with architects and managers.
The research identified and explored the key areas of concern for each of these stakeholders, considering how residential aged care services could do more to improve the quality of life for residents through the built environment. Three key areas emerged from the study. Firstly, the journey the residents make in their time in the RACF and how the built environment impacts on their quality of life in place and over time. Secondly, the ‘frames of reference’ the key informants to the study hold are explored and how they can impact on the design process. Finally, by analysing the data collected and placing the resident at the centre, a model is proposed which holds potential and significance in relation to the development of RACFs in the future

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O'Reilly, Maria Therese. "Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/40314/1/Maria_O%27Reilly_Thesis.pdf.

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Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

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Summers, Michael. "Great expectations : a policy case study of four case management programs in one organisation /." Connect to thesis, 2007. http://repository.unimelb.edu.au/10187/2182.

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Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)

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Ding, Hua, and 丁華. "In the trend of "socializing social welfare" policy: a study on service quality and social capital in thesociety-run home for the aged in Beijing, China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B39558952.

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Martins, Aline Blaya. "Atenção primária à saúde voltada às necessidades das pessoas idosas : da política à evidência." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/143803.

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A população mundial vem envelhecendo, diante dessa premissa a Organização Mundial de Saúde (OMS), bem como, o Ministério da Saúde (MS) do Brasil, vem buscando adaptar-se a esta realidade através de políticas públicas capazes de promover o envelhecimento ativo e da atenção à saúde adaptada às necessidades da população idosa. A OMS propôs a adequação da Atenção Primária à Saúde (APS) às necessidades dos idosos. O Brasil, por sua vez, segue as orientações da OMS, dentro da linha de cuidado voltada para a saúde dos idosos, na Estratégia de Saúde da Família e dentro da Política de Atenção à Saúde da Pessoa Idosa. No entanto, ainda não há evidências quanto à avaliação da adequação destas políticas e de sua relação com a forma como os idosos percebem sua saúde geral e bucal. Desta forma, esta pesquisa teve como objetivo verificar a extensão do cuidado em saúde que é acessado por idosos moradores de dois distritos de Porto Alegre/RS, em relação ao preconizado para efetividade da Atenção Primária à Saúde, e realizar um censo das unidades de saúde de APS dos mesmos distritos a fim de estabelecer uma relação entre os dados empíricos levantados e: i) Políticas de Saúde relacionadas com a Atenção Primária à Saúde voltadas às necessidades das pessoas idosas, ii) autoavaliação de saúde geral e iii) percepção de saúde bucal. A metodologia do estudo contou com um estudo teórico realizado através de um levantamento de documentos, um estudo epidemiológico de base populacional de delineamento transversal e um censo de unidades de saúde. Os resultados deste estudo apontam para uma realidade distinta entre o que as Políticas voltadas para os idosos preconizam e o que é oferecido para os idosos. Foram observadas limitações em relação ao acesso, longitudinalidade, integralidade e qualidade do cuidado. Além disso, foi possível observar que em relação à autoavaliação de saúde os resultados mostraram associações entre a avaliação positiva da saúde e fatores psicossociais (sintomatologia depressiva), características pessoais (nº de morbidades) e ambientais (orientação do serviço para a APS). Já em relação à percepção de saúde bucal, os resultados apontaram associação com determinantes primários (satisfação com último atendimento odontológico, resiliência e renda suficiente para as necessidades da família), comportamentos em saúde (hábito tabágico) e condições de saúde bucal (número de dentes e presença de restos radiculares). A conclusão que se chegou a partir de tais resultados é que há uma necessidade premente de ampliação do acesso e qualificação do cuidado para que a Atenção Primária disponibilizada para os idosos que vivem nos distritos Lomba do Pinheiro e Partenon em Porto Alegre possa ser realmente considerada adequada às necessidades dos idosos. Além disso, é necessário que se leve em consideração o papel da Atenção Primária a saúde na avaliação da sua própria saúde e na percepção de saúde bucal por parte de idosos.
The world population is aging. In response to those trends the World Health Organization (WHO), as well as the Brazilian Ministry of Health (MH), are aiming at tackling such matters through public policies that promote active aging through health care adapted to the needs of the elderly population. The WHO has proposed an Age-friendly Primary Health Care (PHC) that lies in accordance with the needs of the elderly. In Brazil, the WHO guidelines are followed within older people care provision, in the Family Health Strategy, and within the National Health Policy for the Elderly Person. However, there is still no evidence concerning the assessment of adequacy of these policies and its association with how older people perceive their general and oral health. Thus, this study aimed to verify the extension towards primary health care provided by health services accessed by older persons living in two sanitary districts of Porto Alegre/RS in relation with the recommendation in terms of effectiveness of primary health care. In addition, a census of the primary health care services of the two sanitary districts was carried out forming, along with the epidemiological survey, the basis of the empirical data that allowed establish a relationship with: i) Health Policies related to Primary Health Care and targeting on the needs of older persons, ii) self-rated health and iii) self-perceived oral health. The methodology included: theoretical study made by a documental research, a cross-sectional population-based epidemiological study and a health PHC services census. The results of this study show a distinct reality between what policies targeting older persons recommend and what is actually provided, limitations in terms of access, longitudinally, comprehensiveness and quality of care were observed. Furthermore, it was observed that positive self-rated health was associated with psychosocial factors (depressive symptomatology), personal characteristics (number of morbidities) and environmental characteristics (orientation towards PHC Attributes). Self-perceived oral health was associated with primary determinants of health (satisfaction with prior dental appointment, resilience and income that was enough to meet family needs), 17 health behaviors (smoking habit) and oral health status (number of teeth and of root remnants). Concluding, there is an urgent need to increase access and to qualify care so that Primary Health Care services made available for older people, at least for those who live in the Lomba do Pinheiro and Partenon sanitary districts of Porto Alegre/RS, reach its goals of providing adequate and resolutive care that is adequate to the needs of the elderly. Furthermore, it is necessary to take into account the role of Primary Health Care on the rate of health and perception of oral health by the elderly. Still, advances in relation to equity and quality of care in respect to primary health care professionals continued education attainment were observed.

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Ibrahim, Rahimah. "Technicalities of ageing in place : a case study of the integration of residential care services through the use of information technology (IT) in the changing context of care." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16484/.

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Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.

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Ibrahim, Rahimah. "Technicalities of ageing in place : a case study of the integration of residential care services through the use of information technology (IT) in the changing context of care." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16484/1/Rahimah_Ibrahim_Thesis.pdf.

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Abstract:

Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.

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Rosomoff, Sara Stephanie. "Promote the General Welfare: A Political Economy Analysis of Medicare & Medicaid." Miami University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=miami1574263717055768.

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15

Orgill, Marsha Sarah. "Challenges facing the implementation of community and home-based early childhood development programmes for vulnerable children aged 0-4 years in the Western Cape and Eastern Cape, South Africa." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/3709.

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This thesis examined the challenges facing the public sector implementation of community and home based early childhood development (ECD) programmes for vulnerable children aged 0-4 years in the Western Cape and Eastern Cape, South Africa. A qualitative case-study approach was used. The unit of analysis was the Department of Social Development (DoSD) as they are the public sector funders of non-profit organizations (NPOs) who deliver these services. The thesis included a literature review, a policy document review, and the collection and analysis of six interviews with officials involved in implementation of the National Integrated Plan for Early Childhood Development 2005–2010 (NIP for ECD). The data was organised using organizational coding and conceptually ordered displays, and analysed using the 5-C protocol of implementation as the overarching conceptual framework. The findings of the study showed that the main challenges facing the DoSD in the implementation of community and home-based ECD are: (1) Human resources that are stretched to capacity at the provincial and district level, primarily social workers who are unable to manage current services; (2) inadequate line item funding to scale up the provision of services in order to fulfill the mandate of the NIP for ECD (2005); (3) a shortage of NPOs to scale up services, current service providers already suffer with their own capacity constraints; (4) a lack of norms and standards for funding community and home-based ECD; (5) the social sector currently prioritizes centre-based ECD (in terms of funding and training) over community and home-based ECD. Another critical shortcoming is a lack of information regarding provision of services and a lack of South African evidence based research to assist implementers in making rationing decisions at the provincial level. Officials at the DoSD however display commitment to, and recognize the need to, support community and home-based ECD. The officials are however limited in doing so due to capacity constraints.

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Oliveira, Tatiane Almeida de. "Assistência domiciliar no SUS: reflexões sobre o acesso aos serviços com base nas condições de saneamento básico da população idosa." Universidade Federal de Juiz de Fora, 2013. https://repositorio.ufjf.br/jspui/handle/ufjf/927.

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FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Introdução: o contexto familiar tem um papel importante no processo de envelhecimento, e nos casos em que o idoso é dependente, surge a figura de um cuidador. Uma possibilidade de atendimento ao idoso frágil e de apoio aos seus cuidadores informais é a Assistência Domiciliar (AD). Algumas possíveis vantagens desse modelo são: a melhoria da qualidade de vida e da satisfação dos usuários, o estímulo aos vínculos familiares e profissionais, a redução dos custos gerais, a desospitalização, o aumento da segurança, o trabalho multiprofissional, e a mudança no padrão de atendimento cartesiano do sistema de saúde vigente. Entretanto, as condições sanitárias dos domicílios muitas vezes são incompatíveis para a implantação da AD de acordo com as exigências da resolução da ANVISA nº11 de 01/2006. Dessa forma, este trabalho propõe analisar o acesso da população idosa aos serviços de assistência domiciliar no setor público com base nas condições de saneamento e moradia, e propor uma delimitação para as áreas de abrangência de Equipes Multidisciplinares de Assistência Domiciliar (EMAD) para o município de Juiz de Fora (MG). Metodologia: este estudo utilizou os resultados do censo de 2010 e os dados sobre a cobertura de serviços de saúde pelo município. Foi criada uma variável nominal dicotômica que representou as exigências mínimas para implantação do Serviço de Assistência Domiciliar (SAD) pelo arcabouço legal (domicílios adequados e inadequados). Foram consideradas as características socioeconômicas e demográficas dos indivíduos, as condições de saneamento e moradia e a cobertura por serviços de saúde. A partir disso, realizou-se uma análise bivariada entre a condição domiciliar para AD e as demais variáveis, além de uma distribuição territorial dos resultados por meio de geoprocessamento dos dados. Resultados: as condições domiciliares inadequadas para AD representaram 15,1% de todos os domicílios com idosos e estavam associadas às cores de pele preta e parda, sexo masculino, idade maior que 90 anos, incapacidade funcional básica, baixa renda e baixo nível de instrução. A proporção de domicílios adequados foi maior nas regiões centrais, bem como a oferta de serviços hospitalares. A cobertura pela Estratégia de Saúde da Família foi maior nas regiões de periferia. A divisão territorial proposta para EMAD manteve as características dos grupos populacionais que compunham as áreas de abrangência. Conclusão: Apesar dos princípios e diretrizes dos SAD ressaltarem a ampliação do acesso, este ainda é condicionado por condições sanitárias e de moradias precárias para a população idosa. Para que a AD seja inserida efetivamente no contexto público de saúde, deve-se primar pela intersetorialidade por meio da melhoria das condições básicas de saneamento e moradia, das desigualdades socioeconômicas e do acesso aos diversos níveis de serviços de saúde, com a finalidade de oferecer um atendimento integral e universal pelo SUS.
Introduction: the family background has an important role in the aging process, and in cases where the elderly are dependent, appears the figure of a caregiver. One possibility to take care of the fragile elderly and to support their informal caregivers is Home Care (HC). Some possible advantages of this model are: the improvement of the quality of life and the satisfaction of the users, the stimulus to family and professional bonds, the reduction of overhead costs, dehospitalization, the increase in security, multiprofessional work, and the change in the pattern of cartesian care in the current health system. However, the homes sanitary conditions are often incompatible for the deployment of HC in accordance with the requirements of resolution of ANVISA no. 11 of 01/2006. In this way, this study suggests to analyze the access of elderly population to the services of home care in the public sector on the basis of the conditions of sanitation and housing, and propose a definition for the areas of coverage of Multidisciplinary Team of Home care (MTHC) for the city of Juiz de Fora (MG). Methodology: this study used the results of the 2010 census and the data on the coverage of health services by the municipality. It was created a nominal variable dichotomous that represented the minimum requirements for the implementation of the Home Care Services (HCS) according to the legal framework (households appropriate and inappropriate). It was considered the socioeconomic and demographic characteristics of individuals, the conditions of sanitation and housing and the coverage by health services. From this, it was performed a bivariate analysis of the home conditions for HC and the other variables, in addition to a territorial distribution of the results by means of geoprocessing. Results: the home conditions unsuitable for HC accounted for 15.1 % of all households with elderly and were associated with the colors of the black and mulatto, male sex, age greater than 90 years, basic functional incapacity, low income and low level of education. The proportion of households suitable was greater in the central regions, as well as the provision of hospital services. The coverage by the Family Health Strategy was greater in regions of the periphery. The territorial division proposal for MTHC maintained the characteristics of population groups that comprised the areas of coverage. Conclusion: although the principles and guidelines of HCS emphasized the expansion of access, this is still conditioned by sanitary conditions and substandard housing for the elderly population. For that the HC is inserted effectively in the context of public health, we must prioritize intersectoriality by means of improving the basic conditions of sanitation and housing, socio-economic inequalities and access to various levels of health services, in order to offer a comprehensive and universal care by Unified Health System.

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Erlandsson, Sara. "Hjälp för att bevara eller förändra? : Åldersrelaterade diskurser om omsorg, stöd och service." Doctoral thesis, Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-102584.

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This thesis analyses the categorisation of adult persons who need help to cope in everyday life as either older persons or persons with a disability. Despite the development of social services in the Scandinavian countries being guided by the principles of universalism and equality, adults in need of care have different rights to support depending on their current age and at which age disability occurs. This thesis aims to explore how age-based differences in access to care, support and service are legitimised. In the thesis, the concept of help is used to refer to care, support and service. Using a discourse analytic approach, Swedish elderly and disability policies and websites through which providers of help market their services were examined. The analysis, inspired by the theoretical framework of governmentality, draws attention to how users of help and helpers are constituted in two age-related discourses on help. The first discourse, help to maintain, is used mainly in relation to older persons. In this discourse older persons are constituted as subjects in need of safety, comfort and company while the helpers are represented as caring and knowing. The second discourse, help to change, constitutes younger persons with a disability as citizens in becoming. Help aims to improve the situation for younger help users in varying ways: the opportunity to fully determine the tasks performed by helpers is essential to users of personal assistance whereas personal development as regards both practical and social skills is the key to change for persons with an intellectual or mental disability. While help for younger persons is represented as a means to enhance the individual’s self-determination and ability to participate in society, help for older persons is represented as aiming to maintain past patterns of life, not aspiring towards change or improvement. It is argued that these representations support a lower ambition for eldercare than for disability services.

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Bonwell, Patricia Brown. "COHORT MEMBERSHIP, DENTAL INSURANCE AND UTILIZATION OF DENTAL SERVICES IN ADULTS AGE 47 AND OVER RECEIVING DENTAL CARE AT VIRGINIA COMMONWEALTH UNIVERSITY’S SCHOOL OF DENTISTRY." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2823.

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This cross-sectional, non-experimental study evaluates associations between cohort membership, type of dental coverage, and utilization of dental services in all patients age 47 and over who received dental care at Virginia Commonwealth University’s (VCU) School of Dentistry in 2011. Structural Lag Theory poses that society’s institutions lag behind the actuality of a healthy and capable older adult population. The two dynamisms of the Structural Lag Theory were used for this study. The Dynamism of Changing Lives is represented by Cohort differences. Cohort differences include cohort size, people living longer and retaining more of their natural teeth along with different attitudes toward dental care. This dynamism impacts the Dynamism of Structural Change, represented by the institutions of dental coverage and utilization of dental services. Cohort membership is an independent variable. The dependent variable, utilization, is defined as Financial-Total amount spent and Procedural-Routine adult dental prophylaxis. Dental coverage, a dichotomous variable, is used as an independent and dependent variable. Descriptive statistics revealed employer provided dental coverage is the most prevalent type of dental coverage. However, when considered a payment source, out of pocket funding is the primary source of payment for dental services. Using Chi-square and logistic regression, examination of Cohorts (1-Greatest Generation, 2-Silent Generation, 3-Baby Boomer Generation) revealed that Cohort 2 had more dental coverage than Cohort 1, and Cohort 3 had more dental coverage than Cohort 2. Using logistic regression, Cohort 2 showed the highest level of Procedural utilization. Evaluating Financial utilization, multiple regression models showed Cohort 1 utilized more than Cohort 2 and Cohort 2 utilized more than Cohort 3. Those with dental coverage spend more on dental services, fees for routine adult dental prophylaxis make up the majority of the total amount spent, and those with dental coverage utilize more dental services when defined as total amount spent. Because they have experienced different social, political, economic, and technological changes at different times in their life course, the receipt of dental services by new cohorts of older people differs from previous ones. Findings from this study confirm that there is a structural lag in Medicare policy and its coverage of dental services.

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Zhang, Min H. "The Effect of Change in Medi-Cal Dental Coverage on Dental Care Utilization Among Medi-Cal Beneficiaries." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6045.

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One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 (22% in 2017 vs. 12% in 2013) for the overall population. However, the magnitude of increase differs in different age groups and ethnic groups. More statistically significant findings show greater utilization rates among beneficiaries of 19-64 than 65-74 and 75+ years old. Also, more significant findings show lower utilization among Black than White, Hispanic or Asian beneficiaries. The partial restoration significantly reduced the dental related ER visits among Medi-Cal beneficiaries from 2015 to 2017. However, the reduction is largely seen in beneficiaries of 19-64 years old in the ethnic groups of White and Black with reductions of 20 and 15 visits per 1,000 enrollees respectively in 2017 comparing to 2013. The dental related ER visits were lower for Hispanics and Asians, and remained very low among those 65 years old and above. In addition, the partial restoration resulted in increases in participation of dental care providers in the Medi-Cal program.

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20

Jones, Russell. "The relationship between post-traumatic stress symptoms severity, coping style, perceived social support, extent of service experience, age, and gender within the Western Cape police service." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/50179.

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Thesis (MA) -- University of Stellenbosch, 2004.
ENGLISH ABSTRACT: The effects that a traumatic event can have on an individual and the high crime rate in South Africa (SA) were grounds for this two-phase study investigating Posttraumatic Stress Disorder (PTSD) symptom severity within the South African Police Service (SAPS). Two aims of the study were to investigate the relationship of six variables with the outcome variable (PTSD symptom severity) and to construct a regression model that could be used to predict levels ofPTSD symptom severity amongst SAPS members. A third aim was to construct a current list of duty-related stressors that SAPS members face. Phase one comprised 19 officers compiling a duty-related stress list that would form the basis of the stressor questionnaire in phase two. Phase two comprised 97 officers in 12 stations in the West Metropol completing a battery of questionnaires, including the PTSD Symptom Scale: Self-Report Version (Foa, Riggs, Dancu, & Rothbaum, 1993), the Ways of Coping Questionnaire (Folkman & Lazarus, 1988), the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988), an extent of service experience questionnaire, and the duty-related stress list. The results from the regression model showed perceived social support to have significant beneficial effects on PTSD symptom severity as did emotion-focused coping. Problem-focused coping was found to exacerbate PTSD symptom severity. Regression model 1 and regression model 2 were found to not significantly predict the outcome variable and the model of best fit was suggested.
AFRIKAANSE OPSOMMING: Die uitwerking wat 'n traumatiese gebeurtenis op 'n individu kan he en die hoe misdaadsyfer in Suid-Afrika (SA) was die beweegredes agter 'n tweefasige studie na die ernstigheid van die simptome van posttraumatiese stresversteuring (PTSV) in die Suid- Afrikaanse Polisiediens (SAPD). Die doel van die studie was om die verwantskap van ses veranderlikes met die uitkomsveranderlike te ondersoek en om 'n regressiemodel te skep wat gebruik kan word om die vlak van ernstigheid van PTSV-simptome by SAPD-Iede te voorspel. 'n Derde doel was om 'n bygewerkte lys van die werksverwante stressors wat SAPD-Iede in die gesig staar, saam te stel. In fase een het 19 polisiebeamptes 'n werksverwante streslys saamgestel wat as grondslag vir die stressorvraelys van fase twee gedien het. Fase twee het die voltooiing van 'n reeks vraelyste deur 97 beamptes van 12 stasies in die Wes-Metropool behels. Vraelyste het die volgende ingesluit: die PTSVsirnptoomskaal: self-aanmeldingsweergawe (Foa, Riggs, Daneu & Rothbaum, 1993), die maniere-van-hantering-vraelys (Folkman & Lazarus, 1998), die multidimensionele skaal van waargenome sosiale ondersteuning (Zimet, Dahlem, Zimet & Farley, 1998), 'n vraelys oor die mate van dienservaring, en die stresvraelys. Die uitslae van die regressiemodel het getoon dat waargenome sosiale ondersteuning, asook emosioneelgefokusde hantering, 'n betekenisvolle voordelige uitwerking op die ernstigheid van PTSV -sirnptome het. Daar is gevind dat probleemgefokusde hantering die ernstigheid van PTSV-simptome vererger. Regressiemodel 1 en die gewysigde regressiemodel 2 het nie die uitkomsveranderlike betekenisvol voorspel nie en die model wat die meeste van pas was, is aanbeveel.

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Olaison, Anna. "Negotiating needs : Processing older persons as home care recipients in gerontological social work practices." Doctoral thesis, Linköpings universitet, NISAL - Nationella institutet för forskning om äldre och åldrande, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-15968.

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The study concerns the needs assessment processes that older persons undergo to gain access to home care. The participation of older persons, their relatives and municipal care managers was studied from a communicative perspective. The assessment meetings functions as formal problem-solving events. The older persons´ accounts are negotiated discursively in interaction. Various storylines are used by the older persons and their relatives whether they view home care as an intrusion, as a complement or as a right. In case of divergent opinions the older person has the final say as prescribed by the Swedish social service act. One conclusion is that the role of relatives is not defined and a family perspective is not present. In the study the institutional structure of the assessment process was also analyzed. Older persons are processed into clients; their needs are fitted within the framework of documentation and institutional categories. In the transfer of talk to text all the particulars are not reflected and two types of documentation was identified; a fact-oriented objective language or an event-oriented personal language. Care management models and a managerialist thinking has influenced the assessment process by bureaucratisation of older people trough people processing, which is in contradiction to the individual-centric perspective prescribed by the law. The introduction of care management models in gerontological social work has lead to an embedded contradiction and constitutes a welfare political dilemma. Improved communicative methods are needed in order to achieve a holistic assessment situation.
Studien tar sin utgångspunkt i de bedömningsprocesser äldre personer genomgår för att få tillgång till hjälp i hemmet. Bedömningsprocessen där äldre, deras anhö-riga och kommunala behovsbedömare deltog studerades ur ett kommunikativt perspektiv. Interaktionen vid behovsbedömningssamtalet fungerar som en pro-blemlösningsprocess. Den äldre personens redogörelse för behov förhandlas diskursivt i interaktionen och tre olika berättelselinjer identifierades, baserade på om de sökande betraktar hemtjänsten som ett intrång, som ett komplement och stöd eller som en rättighet. När olika åsikter uttrycks har de äldre sista ordet i enlighet med Socialtjänstlagens föreskrifter. En slutsats är att de anhörigas roll i behovsbedömningsprocessen inte är definierad och att ett familjeperspektiv sak-nas. I studien analyserades också bedömningsprocessens institutionella struktur. De äldre behovssökande processas till att bli klienter, deras behov anpassas till dokumentationens ramverk och kategoriseras i enlighet med institutionella kate-gorier. I transfereringen av tal till text redovisas inte samtliga element i samtalet. Två typer av utredningstext identifierades, den faktaorienterade och den händelse-orienterade. I studien diskuteras det marknadsekonomiska tänkande som kommit att påverka bedömningsprocessen genom byråkratisering vilket står i motsatsställ-ning till det individcentrerade perspektiv som lagen förespråkar. Introduktionen av marknadsmodeller i det gerontologiska sociala arbetet har medfört en inbyggd motsättning och utgör ett välfärdspolitiskt dilemma. Förbättrade kommunikativa metoder behövs för att uppnå en holistisk bedömningsprocess.

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22

Zavřelová, Gabriela. "Důchodová reforma v České republice(souvislost rodinné a důchodové politiky)." Master's thesis, Vysoká škola ekonomická v Praze, 2010. http://www.nusl.cz/ntk/nusl-75334.

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My diploma thesis will deal with the topic of unusual proposal of pension reform, which is based on the connection of the old-age-benefit and the number of brought children. Through the analysis of demographic development I try to show the dependency of today's pay-as-you-go pension system to number of persons gainfully employed with respect to the number of pensioners. Authors of the Children PAYG concept are noting of connection between family and pension policy and argue that the reason of unfriendly demographic structure and decreasing birth rate is right pension system. According to them this pension system make free riders who are described like people without own children. This fact should be considered in order to the claim to old age pension. In analytic part of this work will be researched individual variants of Children PAYG system. This part will be aimed at its positives and negatives especially. In conclusion of this work I'll propose a possible variant of this pension system which could resolve troubles of financial tenability, is in respect to deserts and at the same time would be equitable for as much people as possible.

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23

Lam, Mei-yee, and 林美儀. "Community support facilities planning for an aging population in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31259716.

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Marquez, Christine Garrido. "As políticas multissetoriais e integradas do Banco Mundial no Brasil: a infância como capital humano do futuro." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/7361.

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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
This research integrates the project of Public Policy and Education of Children in Goiás: history, concepts, projects and practices developed by the Center of Studies and Research of Childhood and its Education in Different Contexts (NEPIEC) which is inserted in the research line: Education, Teaching Professionalization, Educational Work of the Postgraduate Program in the School of Education of the Federal University of Goiás. Propositions of multisectoral policies and integrated development of Early Childhood of the World Bank for developing countries have been investigated, which involve interconnected actions in education, health, nutrition, social protection (child protection and social assistance) and basic sanitation, in order to understand how this process has been set up in Brazil as of the 1990s. A documentary and literature research was carried out and we propose as reference of analysis historical and dialectical materialism. The starting point being a survey called State of the Art on the studied subject, in order to map out the academic and scientific production in the field, to enable a look at the production, observing the evolution of research, its features, focus and gaps. Presenting the multiple aspects of the organizational structure of the World Bank and its development policy propositions on Early Childhood supported in the six Education Sectoral Documents and the eight publications produced from 1974 to 2014 by the International Organization, which were formulated to instruct the political debate with governments, development partners and civil society in developing countries, including Brazil. The strategic entry points of investment have been analyzed, classified into four themes based on: 1) programs based on Early Childhood Development Centers focusing on school readiness; 2) residential programs based on behavioral change in relation to health, nutrition and child care; 3) communication / media campaigns aimed at families with young children on child health, nutrition and overall development; and, 4) conditional cash transfer for families with small children. It is concluded that the World Bank since its inception in 1944, besides project financing, policy-making, technical assistance to governments, also plays an important role in the meeting, synthesis and dissemination of knowledge about the specific development issues covering its extensive practice area, including the development of Early Childhood, services in the area and around the world. Since the seventies, the World Bank references the relevance of the adoption of multisectoral and integrated programs designed for Early Childhood, with the theoretical support based on the political theory of human capital, which seeks the reproduction and accumulation of capital, as opposed to a project that aims to guarantee full rights the children in Brazil.
Esta pesquisa integra o projeto Políticas Públicas e Educação da Infância em Goiás: história, concepções, projetos e práticas, desenvolvido pelo Núcleo de Estudos e Pesquisas da Infância e sua Educação em Diferentes Contextos (NEPIEC) e está inserida na Linha de Pesquisa: Formação, Profissionalização Docente, Traballho Educativo do Programa de Pós-Graduação em Educação da Faculdade de Educação da Universidade Federal de Goiás. Investigamos as proposições de políticas multissetoriais e integradas de Desenvolvimento da Primeira Infância do Banco Mundial para os países em desenvolvimento, os quais envolvem ações interligadas no campo da educação, saúde, nutrição, proteção social (proteção à criança e assistência social) e de saneamento básico, a fim de compreender como este processo tem se configurado no Brasil, a partir dos anos de 1990. Foi realizada uma pesquisa documental e bibliográfica e propomos como referencial de análise o materialismo histórico e dialético. A metodologia de pesquisa abrange a constituição do Estado da Arte acerca da temática em estudo, com o propósito de mapearmos as produções acadêmicas e científicas na área, possibilitando um olhar sobre a produção, observando a evolução das pesquisas, suas características, foco e as lacunas existentes. Apresentamos os múltiplos aspectos da estrutura organizacional do Banco Mundial e as suas proposições políticas de Desenvolvimento da Primeira Infância apoiadas nos seis Documentos Setoriais de Educação e nas oito publicações produzidas no período de 1974 a 2014 pela referida Organização Internacional sobre a temática, as quais foram formuladas para instruir o debate político com governos, parceiros de desenvolvimento e a sociedade civil dos países em desenvolvimento, inclusive com o Brasil. Analisamos os pontos de entrada estratégicos de investimento, classificados em quatro eixos temáticos baseados em: 1) programas baseados em Centros de Desenvolvimento da Primeira Infância com foco na prontidão escolar; 2) programas domiciliares baseados na mudança de comportamento em relação à saúde, à nutrição e aos cuidados parentais; 3) campanhas de comunicação/mídia destinadas a família com crianças pequenas sobre saúde infantil, nutrição e desenvolvimento global; e, 4) transferência condicionada de renda para famílias com crianças pequenas. Com base na pesquisa realizada, conclui-se que o Banco Mundial desde sua criação, em 1944, além do financiamento de projetos, formulação de políticas, da assistência técnica a governos, desempenha um papel relevante na reunião, síntese e disseminação do conhecimento sobre os temas específicos de desenvolvimento que abrangem sua extensa área de atuação, inclusive sobre o desenvolvimento da primeira infância e serviços na área em todo o mundo. Desde os anos setenta, o Banco Mundial referencia a relevância da adoção de programas multissetoriais e integrados dirigidos à primeira infância, tendo como base de sustentação teórica das políticas a teoria do capital humano, que busca a reprodução e a acumulação do capital, em contraposição a um projeto que objetive a garantia dos direitos plenos da criança no Brasil.

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Zhang, He-yi, and 張禾宜. "The Study of Kaohsiung Municipal Government Aged Population Care Policy." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/9ceens.

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碩士
國立中山大學
高階公共政策碩士班
95
According to the definition given by World Health Organization (WHO), if a country’s percentage of people who are older than 65 years old is greater than 7% of total population, it is an aging society. Based on the forecast statistics for the aged population from the Ministry of Interior, Taiwan’s aged population will rise to 14% in 2010 and will be over 20% in 2030. The fast growth of the aged population is a common social phenomenon around the world. Indeed, how to take care of the aged is an important issue, especially in Taiwan. Purpose: This research aims to understand problems of aging population, such as employment, medical care, care of the aged, long-term care, long-term family support, leisure, and education. The result of the study might serve as a reference for Kaohsiung city government in making caring policies for the aged population. Material and method: This study is conducted through deep interview and questionnaire. The content focused on Kaohsiung city government’s caring policies for the aged population. 170 subjects received interview and questionnaire. 150 cases were obtained, 20 being excluded due to incomplete data. Result: (1) 34.7% of the Kaohsiung residents do not have the concept of the care of the aged and only 20% of the 50-to-60-year-old residents’ plan their later life. (2) 30% of the Kaohsiung residents’ first choice is living with their children and their next choice is living in the community (26%). The third choice is living in private nursing centers (18.7%). (3) 60.6% of old people are not willing to live in nursing centers. Discussion: In Taiwan traditional culture, people believe that the best life of the aged is living with children, playing with grand-children, and then died by nature. From the result of this study, Kaohsiung city government’s caring policies for the aged population will achieve the goal to create a high-quality and peaceful environment.

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Moran, Shane, University of Western Sydney, and Faculty of Health. "China's aged care crisis : problems, resources, solutions." 2000. http://handle.uws.edu.au:8081/1959.7/23015.

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China is currently facing what I expect to be its most significant challenge to date - a crisis in the care of its rapidly ageing population. The causes of this crisis are complex and multi-faceted and its implications far-reaching from the social, economic and political perspectives. This thesis examines the causes and consequences of the impending aged care crisis in China, with a particular focus on the urban elderly. In addition to extensive interviews with government officials, a sample of 2,000 retires and their children were surveyed in Shanghai as part of my research. My findings from the Research Survey and Questionnaire, together with my observations from site visits to numerous aged care crisis and the associated problems. Of primary concern is the fact that the Chinese government does not have in place an appropriate aged care structure nor a strategy to implement systems to cope with the impending crisis. I conclude that it is imperative the Chinese government recognises both the immediacy and scale of the crisis and acts accordingly. Failure to do so may result in both significant social unrest and severe economic consequences. Recommendations are offered for consideration by the Chinese government in an effort to manage the impending aged care crisis in China.
Doctor of Philosophy (PhD)

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Wang, Jiun-Yue, and 王君月. "The Implementation Evaluation of the Long-Term Care Policy in Aged Society：A Case Study of Home Care Service in New Taipei City." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/00075603900253048888.

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碩士
世新大學
行政管理學研究所(含博、碩專班)
100
The problem of aging population is getting more and more serious and has become one of the major global concerns. In order to reduce the impacts caused by aging society, government in Taiwan has proposed many social welfare policies. One of the policies is “Long Term Care”, in which, “home care” is the most commonly used service among the senior and the handicapped. Therefore, our study investigated the current status of “home care service” and subsequently evaluated the government policy through qualitative research, in-depth interview, and literature review. The purpose of this study is to tap into the insight and perception of related staff’s toward “home care service” and to analyze problems and difficulties that staff might face when carrying out the service. I also compared the difference of home care service before and after Taiwan County being promoted to New Taipei City. Based on the research findings, agencies and affiliated institutions responsible for carrying out the service has followed government’s regulations and rules in terms of task procedure, task content, financial management, and manpower allocation. According to the data drawn from interviewing related staff, home care service has indeed provided the senior and the handicapped with great help. Problems and difficulties with home care service mainly come from two major areas, namely “task content and procedure” and “manpower allocation”. After Taipei Country was promoted to New Taipei City, no significant change or difference was found in home care service. Based on the analysis of this study, I advanced some suggestions for future development of home care service and further researches. Hopefully, it will trigger more scholars to conduct more researches in the same field.

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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning / Brian James Fleming." Thesis, 2003. http://hdl.handle.net/2440/22062.

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Tilly, Jane Annette. "Are consumer-directed home and community services appropriate for older persons?" 2001. http://books.google.com/books?id=IjBYAAAAMAAJ.

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Ghani, Zartashia. "Cost-effectiveness analysis of an mHealth application (SMART4MD) and analysis of the effect of dialysis treatments on labor market outcomes : Health technology assessment of two treatment methods." Licentiate thesis, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-20587.

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Health Technology Assessment is an important factor for decision making in the healthcare sector in Sweden. It helps to curtail the rising costs associated with the healthcare sector and aids in the efficient allocation of scarce public health resources. This thesis investigates the cost-effectiveness and the effectiveness in general of two health technologies, addressing the following research objectives: i) assessing the cost-effectiveness of mobile health (mHealth) interventions designed for older adults diagnosed with mild cognitive impairment, and ii) assessing the effectiveness of peritoneal dialysis (PD) treatment on labor market outcomes in comparison with institutional hemodialysis (IHD) treatment in Swedish settings. Study I and Study II are related to the first research objective. In Study I, we summarized and critically assessed the current evidence on the cost-effectiveness of mHealth interventions focusing on older adults; we found some evidence supporting the cost-effectiveness of these interventions. In Study II, we conducted a within-trial cost-effectiveness analysis of the software application Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) from a healthcare perspective for a period of six months. A total of 345 Swedish dyads (MCI patient and informal caregiver) participated in this study. For a short time period of six months, we found that SMART4MD is not cost-effective for MCI patients (statistically insignificant); however, a trend was observed that indicated that it might be cost-effective for informal caregivers, although results remained statistically insignificant (p > 0.05). Study III is related to the second research objective. In Study III, we investigated the effect of PD on labor market outcomes (employment rate, work income, and disability pension) in comparison to IHD. We found that PD is associated with a treatment advantage over IHD in terms of increased employment, work income, and reduced disability pension in the Swedish population after controlling for non-random selection for the treatment.

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Huang, Wan-Fen, and 黃婉芬. "A Comparative Study on the Policy of Child Care in the Age of Low Fertility Between Taiwan and Japan." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/49719223204244548237.

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碩士
國立暨南國際大學
比較教育學系
97
Abstract According to OECD report, a country can only totally replace among generation, only if each women fertility rate has to be up to more than 2.1 people. However, the economy growth, the accumulation of wealth, the emergence of urbanization, and a new line of the doctrines of women, which make global fertility rate at unprecedentedly low level. Falling population of children phenomenon is very common among developed countries. The birth rate in Taiwan had already declined to “1.24“ in 2003, which imply Taiwan has to face the impact of falling population of children. It will have a negative effect on the education industry and national overall development. Therefore, our government agenda has regarded this issue as potential crisis to national security and add it into “National security report”. In Japan, the lowest birth rate of 1.57 was in 1989. Japanese government began alert, thus actively exploring the factors of decline population year by year, and proposed countermeasures to meet the child care needs for parents in order to raise the birth rate. To address falling population of children issues, this paper aims at Taiwanese and Japanese child care policy analysis since 1989. There are four points to indicate: Firstly, the child care policy development of Taiwan and Japan; secondly, analysis on the parent's demand for child care in Taiwan and Japan; thirdly, discussion between Taiwan and Japan in the light of child care policy toward falling population of children; fourthly, developing feasible proposals for future reform and development in term of child care policy to Taiwanese authorities. There are five suggestions base on the analysis of this dissertation. First, the government should set up a sound consultation system to child care access. Next, the government should develop systematic policy to child care industry and set up an administration or a department to be responsible for child care policy. Third, the government should set up a multi-dimensional, convenient and easy child care system to parents or guardians. Fourth, the government should integrate education between carers and teachers and guarantee a good welfare to child carers and teachers. Last, the government should set up administrative and monitoring system to all child care providers, increase social welfare benefit budget to child care industry gradually as well as promote the family value.

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Alemayehu, Berhanu. "The lifetime distribution of health care costs." 2001. http://books.google.com/books?id=sCxYAAAAMAAJ.

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Splavcová, Hana. "Podmínky vzdělávání dvouletých dětí v mateřských školách." Master's thesis, 2015. http://www.nusl.cz/ntk/nusl-335364.

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This thesis deals with actual topic in the Czech Republic - pre-school education of children younger than three years in kindergartens. With regards to social, health educational and family policies development, education and care of children under three years of age have shifted to kindergartens. The aims of this thesis are to describe recent changes concerning family, current state of pre-school education system in the Czech Republic with regard to children younger than three years of age needs and analyze and specific these needs by a contemporary young child. On such substantial data base we would like to define specific conditions of pre-school education of such young children. To follow the aims, an inquiry was conducted to examine whether or not the needs of children younger than three years are fulfilled at some kindergartens. Following that, the inquiry outputs from individual school have been compared to one another and to a model of an optimal praxis of a pre-school institution. Based on this thesis outcomes it is obvious that pre-school education of children of age up to three years in kindergartens is possible. In further detail, to maintain current quality of pre- school education also in case of inclusion of such children into kindergartens it is necessary to adopt specific legal...

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Namakando-Phiri, Anne. "A phenomenological study of ageing amongst the older persons in Zambia." Thesis, 2004. http://hdl.handle.net/10500/1924.

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A study entitled `Phenomenological study of ageing amongst the older persons in Zambia' was undertaken with the purpose of gaining an understanding of the ageing phenomenon within the Zambian context and provide frameworks that could be used by policy-makers and health professionals to formulate guidelines or interventions relevant to the lived experiences of older persons and the meaning attached to ageing or being old, and consequently maintain or improve the quality of life of older persons of Zambia. The objectives of the study were to describe (1) the lived experiences of the older persons of Zambia, and (2) the meaning they attached to ageing or being old within the Zambian context. A transcendental phenomenological design within the qualitative naturalistic approach was used to guide the research process and to assist the researcher to reach the purpose and objectives of the study. Focus group and in-depth individual interviews were conducted to generate data from twenty-seven (27) informants. Fifteen (15) informants participated in the focus group interviews and twelve (12) in in-depth individual interviews. In total, 24 in-depth individual interviews were conducted in term of two interviews per informants, and two focus group interviews. Data collection covered a period of three months. Coliazzi (1978) and Giorgi (1985) techniques for qualitative data analysis were used and verbatim excerpts form the transcribed interviews were used to support the themes that emerged from data and to provide a richer picture of the situation. Three frameworks derived from the findings of this study: (1) framework of the lived experiences of older persons of Zambia, (2) framework of the meaning of ageing or being old and (3) framework for understanding ageing within the Zambian context. The researcher believed that these frameworks would make a meaningful contribution toward the understanding and the development of policies and interventions that would assist in enhancing or maintaining the quality of life of older people of Zambia. The main findings of the results of this study indicated three most significant dimensions of the lived experiences of the older persons (health, socio-economic and psychosocial) that need to be taken into account when planning for any programs or interventions aimed at maintaining or improving the quality of life of older persons of Zambia. These interventions and programs should also address the negative feelings or meanings attached to the above experiences. The main findings of the results of this study also showed that the meaning of being old or ageing in Zambia does not depend on the health, socio-economic and psychosocial living experiences of the older person but it depends largely on the inner values of the older persons, such as spiritual, emotional and cultural beliefs. This means that maintaining or improving the quality of life of older persons in Zambia would require comprehensive programs or interventions that should take into account the health, socio-economic, psychosocial, spiritual, emotional and cultural needs of the older people.
Health Studies
D. Litt. et Phil. (Health Studies)

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Mabela, Constance Sarah. "Mental well-being among the unemployed : the role of government intervention." Thesis, 2012. http://hdl.handle.net/10500/11877.

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The purpose of this study was to determine the impact of unemployment on the mental well-being of the South African working age population. The implication of exploring this relationship is to indicate the importance of good mental health among persons who are not employed. The present study also aimed atinvestigating the role that government can play in mitigating the impact of unemployment on mental health. This part of the research assessed the effectiveness of government’s social security system. The current study employs a mixed research design whereby both quantitative and qualitative methods of data analysis are used. The relationship between unemployment, mental well-being and government intervention is investigated using a cohort group in which the mental health of persons not employed, aged between 15 and 64 years, are followed over the period, 2004 to 2008. The results are presented using two types of data. First, secondary data from Statistics South Africa’s General Household Survey (GHS) were used to measure the impact of unemployment on mental health and to ascertain the impact of government social assistance on affected individuals’ mental well-being. Secondly, in order to explore individual perceptions around government intervention, the research employed a qualitative phenomenological design. This involved conducting semi-structured personal interviews with four unemployed women residing in Gauteng. The results showed that incidences of self-reported mental health illnesses were most likely to be found among individuals who were not employed as compared to those that were employed. This finding proved to be consistent using both descriptive and multivariate statistics which included predictive models. In terms of government intervention, positive mental well-being was shown to be positively related to access of social welfare services (in the form of social grants). This finding was true for all the years of reporting (i.e., 2004 to 2008). In conclusion, although unemployment was found to have a negative impact of mental well-being, government intervention was shown to positively mitigate this impact, thereby giving hope to an otherwise hopeless situation. Unemployment and its impact on mental well-beingalso proved to be a complex subject, requiring multidisciplinary intervening strategies to solving it.
Psychology
D. Litt. et Phil. (Psychology)

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LÍSKOVCOVÁ, Ilona. "Analýza potřeby služeb pro děti do tří let věku v regionu České Budějovice." Doctoral thesis, 2011. http://www.nusl.cz/ntk/nusl-54526.

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The research was divided into two parts and mapped the current situation in the region of Czech Republic and Česke Budějovice in terms of care services for children under three years of age and respondents' oppinions related to these services, including relations with age, residence, education and reflection on starting work earlier than three years of a child. Statistical analysis was aimed at assessing dependency factors and the subsequent search of categories and where was a significant difference. It was a quantitative research. Object of inquiry was set 716 selected respondents, namely parents of children under the age of three from the Region of České Budějovice.

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Wolniewicz-Slomka, Klaudia. "Projektowanie i implementacja polityki rodzinnej na poziomie lokalnym i krajowym na przykładzie ustawy o opiece nad dziećmi w wieku do lat 3." Doctoral thesis, 2018. https://depotuw.ceon.pl/handle/item/3038.

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Abstract:

Polityka rodzinna w Polsce zmieniła się znacząco od czasu transformacji ustrojowej w 1989 roku. Początkowo koncentrowała się głównie na pomocy finansowej skierowanej do najbardziej potrzebujących rodzin, ale z czasem państwo zaczęło coraz bardziej angażować się we wsparcie rodziny na różnych etapach jej powstawania i rozwoju: m.in. zmodyfikowano system opieki nad dziećmi w wieku do lat 3, wprowadzono dłuższe urlopy macierzyńskie, oraz program wsparcia młodych par w zakupie ich pierwszego mieszkania. W ostatnich latach, opieka nad najmłodszymi dziećmi stała się ważnym elementem polityki rodzinnej państwa, o czym świadczy wprowadzenie Ustawy z dnia 4 lutego 2011 roku o opiece nad dziećmi w wieku do lat 3 i towarzyszącego jej rządowego programu „Maluch”, którego celem było finansowanie nowych i utrzymanie istniejących miejsc opieki. Biorąc pod uwagę liczne zmiany w tym zakresie, interesującym wydaje się przyjrzenie się procesom projektowania i wdrażania polityki rodzinnej w Polsce na poziomie krajowym i lokalnym na przykładzie jednego z jej narzędzi – opieki nad najmłodszym dzieckiem, co autorka uczyniła przedmiotem rozprawy doktorskiej. W tym celu przeanalizowała teorię projektowania i implementacji, i podjęła próbę jej uporządkowania, oraz dokonała studium przypadku, które objęło działania na centralnym i lokalnym poziomie tworzenia polityki. Praca mieści się w nurcie badawczym określanym jako policy analysis, ale nie obejmuje etapu ewaluacji polityki publicznej oraz w podejściu neoinstytucjonalnym, które zakłada, że instytucje społeczne są efektem interakcji formalnych zasad, nieformalnych wzorów działania i decyzji społecznych aktorów. W pracy sformułowano główną tezę badawczą, która zakładała, że w procesie projektowania oraz wdrażania Ustawy o opiece nad dziećmi w wieku do lat 3 ujawnia się wielopoziomowość polskiej polityki rodzinnej, a te dwa etapy są obecne zarówno na poziomie centralnym, jak i lokalnym. Tezę główną rozwijało pięć tez szczegółowych, do których przyporządkowano pytania badawcze. Odpowiedzi na te pytania znalazły się we wszystkich pięciu rozdziałach pracy, z których dwa pierwsze miały charakter teoretyczny, a pozostałe trzy – empiryczny. W pierwszym z nich autorka, po pierwsze, zaprezentowała, jakie relacje zachodzą między polityką rodzinną a polityką publiczną, a więc politykami, które od dawna wpływają na rodzinę, oraz po drugie, dokonując m.in. przeglądu celów polityk rodzinnych, różnorodności i zmienności ich modeli zarysowała kontekst zmian w opiece nad najmłodszymi dziećmi, czemu służył przegląd literatury. W kolejnym, również opartym na tej samej metodologii rozdziale, zawarła przegląd koncepcji badania projektowania i implementacji polityki publicznej oraz zaprezentowała koncepcję badań własnych. W trzeciej części rozprawy doktorskiej, skupiła się na przebiegu procesu projektowania i implementacji ustawy na poziomie krajowym, czemu służyła własna jakościowa analiz programów wyborczych i stenogramów debat parlamentarnych. Czwartą część pracy poświęciła debacie prasowej na temat polityki rodzinnej, która miała miejsce w latach 2010-2015. W tym celu przeanalizowała pod względem ilościowym i jakościowym artykuły prasowe opublikowane w tym czasie w pięciu tytułach prasowych o zasięgu krajowym – dwóch dziennikach i trzech tygodnikach. W ostatnim rozdziale przyjrzała się projektowaniu i implementacji na poziomie lokalnym polityki opieki nad najmłodszym dzieckiem w dwóch, celowo dobranych miastach – Płocku i Ostrołęce. Przeprowadzone przez autorkę badanie terenowe objęło analizę dokumentów urzędowych, treści zawartych na stronach internetowych miast, indywidualne wywiady pogłębione oraz niesystematyczną obserwację bezpośrednią.
Family policy in Poland has gone through many changes since the political transformation that took place in the country in 1989. In the first years of the new regime, state intervention was limited, and focused mainly on financial support to families in need. With time, the Polish state became much more active in supporting families: it developed childcare services for children under the age of three, introduced longer maternity leaves, and assisted young people in buying their first apartment. In recent years, childcare services addressed to children under the age of three have become an important element of the Government’s family policy, and new legislation was introduced to regulate it: the Act of 4 February 2011 on care for children under the age of three along with a new governmental program titled “Maluch”, aimed at financing new childcare institutions and maintaining those that already existed. With these extensive changes in mind, it was interesting to analyze how family policy was being created and implemented in Poland, especially in the field of childcare services for the youngest. This was the main aim of this dissertation. On its way to answering this question, the research analyzed different theories of creating and implementing public policies and presented the case study, focused on creating and implementing policy at the national and local levels in Poland. The research was done from the policy analysis perspective, but did not include evaluation stage of formulating public policy. Also, it was inspired by the neo-institutional theory according to which social institutions are being created as a result of interactions between formal rules, informal acting patterns and decisions made by the social actors. According to the main thesis of this work, the processes of creating and implementing family policy in Poland take place at various levels, both national and local. The main thesis was developed into five detailed thesis statements to which the research questions were assigned to. Answers to the research questions were presented in all five chapters of the thesis. The dissertation consists of two theoretical chapters and three empirical chapters. The first chapter, based on literature review, defined relations between family policy and public policy – two types of policies that deal with family issues. It presented various models and developments in family policy, which constituted the background for an analysis of changes in the care system for children under the age of three. The second chapter was an overview of theoretical approaches to the creation and implementation of public policy. The research concept and design were also presented in this chapter. The three empirical chapters presented the results of three different studies conducted in the frame of this research: the process of creation of family policy at the national level in Poland, press debate that accompanied the creation of family policy and creation and implementation of family policy at the local level. The third chapter analyzed the process of creation the childcare policy and was based on the analysis of elections programmes and transcripts of parliamentarian sessions. The fourth chapter presented an quantitative and qualitative analysis of press articles that were published in two dailies and three weeklies during the time of the creation and implementation of the Act – between 2010 and 2015. Finally, the last chapter showed the results of analyses conducted in two cities – Płock and Ostrołęka, based on desk research, in-depth interviews and unsystematic direct observation.

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Dissertations / Theses on the topic 'Aged care policy'

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