Monday 10th September
Private and public provision of elder care: Can we find an equitable balance?
It is common to encounter the view that “family caregiving” is both prominent and societally important, is both beneficial and costly, and also that its future is threatened by demographic change and constraints on public resources. It is also common to encounter the view that the problematic aspects of family caregiving provide a rationale for new, or improved, or at least expanded, collective roles in the provision and support of elder care.
In virtually all of the more-developed countries of the world, a system of publicly-provided care coexists with various patterns of family-provided care. This remains true even in countries that have gone far towards universality in their public long-term care (LTC) systems, among them Germany, Japan, and Korea.
I will compare selected features of these countries’ LTC systems, and will also include comparisons to the U.S., a country with no single, or at least no systematic, “system” of publicly-supported LTC services, as well as to selected additional countries.
A comparison of how these countries’ systems are designed, and how they work in practice, will lead to broader considerations of program design, with implications for how these systems might work in principle. I consider a number of key actors in this program-design problem, including today’s elders, today’s younger population, people distinguished by their family situation, and the present versus the future populations.
Even the nominally “universal” public systems currently in existence depart from complete universality through their use of various rationing devices, and each such device has the potential to alter the mix of family- and publicly-provided services. Another important design issue is the degree to which we adopt program features that support “family caregiving” rather than “family caregivers.”
With the numerous interests—sometimes complementary, and sometimes competing—represented by the various actors as well as the numerous program-design features in use, mixed systems of family- and publicly-provided elder care seem to be inevitable. However, the equity implications of different program-design decisions differ in important ways.
Douglas Wolf is a demographer, policy analyst, and gerontological researcher who studies the economic, demographic, and social aspects of aging, disability, and long-term care. Wolf’s professional experience includes an appointment as an economist in the Office of Income Security Policy in the U.S. Department of Health, Education and Welfare (now DHHS), several years at the Urban Institute culminating in a position as Director of its Population Studies Center, and several years at Syracuse University, where he is currently Professor of Public Administration and International Affairs, Gerald B. Cramer Professor of Aging Studies, and Associate Director of the University’s Aging Studies Institute. Wolf also spent two years as a Research Scholar at the International Institute for Applied Systems Analysis in Laxenburg, Austria where he worked with its Population Program.
Tuesday, 11th September
Toward ‘fit-for-purpose’ policy on long-term care in sub-Saharan Africa? Key challenges, approaches and opportunities.
Sub-Saharan African (SSA) countries have expressed a global-level commitment to the development of sustainable and equitable long-term care systems – and, thus, to ensuring the rights of, and equitable conditions for carers, and access to person-centered and integrated care for all who need it. The pursuit of these imperatives demands an expansion of organized LTC provision and support services — especially given evidence, albeit limited, of major faults in current family-based LTC provision, and inequities in the organized LTC provision that is expanding in response to rising need. Yet, policy- and scientific debate on forging required LTC systems for SSA countries remains in its infancy – and no fit-for-purpose policy architecture exists.
This plenary talk seeks to offer an analysis of the nature- and key drivers of the policy impasse, and of particular approaches that are needed to overcome it. The presentation, first, locates specific gaps in the extent to, and ways in which existing regional and national policy frames on aging or care address the key LTC imperatives. Drawing on a ‘thinking and working politically’ approach, the analysis then identifies (i) a set of political factors that act as likely key ‘blockers’ to addressing the policy gaps and (ii) foci and promising entry points for research and advocacy to address the blocks. Reflections on implications for North-South and South-South collaboration on LTC are concluded in the talk.
Dr. Isabella Aboderin is a Senior Research Scientist and Head of the Aging and Development Unit at the African Population and Health Research Center (APHRC) in Nairobi, Kenya. She holds additional positions as a Visiting Associate Professor of Gerontology at the University of Southampton, UK and as an Extraordinary Professor at North West University, South Africa.
Among other roles, Isabella serves as Regional Chair for Africa of the International Association of Gerontology and Geriatrics (IAGG); Technical Advisor to the Global Commission on Aging in Developing Countries; Member of the African Commission on Human and People’s Rights Working Group on the Rights of Older Persons, Global Ambassador for HelpAge International and Trustee on the board of the United Nations International Institute on Ageing (INIA) and, incoming, the Population Reference Bureau (PRB).