Maria Angeles Tortosa

The effects of rationing home-help services in Spain and Sweden: a comparative analysis

In both Spain and Sweden the most important public support for older people that is provided in their own homes are home-help services. In Sweden, these programmes were expanded in years of economic growth but recently have radically declined. Spain still strives to expand them in spite of financial problems. Both countries ration these services but in different ways. Spain provides relatively few hours of help with household tasks, primarily to poor old people. At present, one to two per cent of the 65-plus population is covered. Local government is still trying to reach more people to relieve pressure on limited institutional care. Sweden continues to cut down the service from the present coverage of nine per cent of the 65-plus population. It is focusing on the oldest and frailest people of all social classes who live alone. It is gradually being transformed into home health care. Institutional care has not been cut back to the same degree. Spain uses strict needs assessments and eligibility criteria to target clients. Sweden has sharpened its needs assessments and raised fees to discourage users with lesser needs.

Nursing home vouchers in Spain: the Valencian experience

The main purpose of this paper is to evaluate the innovative nursing home voucher scheme that was introduced by the Valencia Autonomous Region of Spain in the early 1990s to implement targets laid down by the national plan for the development of older peoples services. The article begins with a review of the evolution of Spanish social services, and especially the nursing home sector, and then summarises the genesis, objectives and characteristics of the voucher scheme. The main part of the paper reports a performance analysis and economic evaluation of the programme. On the basis of detailed information over four years, it is concluded that nursing home vouchers have contributed to the increased supply of publicly-financed rooms, have promoted equality of access to the service, and have increased user choice. It is also shown, however, that while vouchers can lead to an increase in the quality of inputs, they increase utilisation and expenditure. In the absence of the monitoring or reporting data that would be required, it is not possible to determine whether the scheme has increased efficiency, in the sense of improving the quality of life of frail older people at reasonable and containable cost.

Diversification of old-age care services for older people: Trade-offs between coverage, diversification and targeting in European countries

Information on public services for older people is often limited to institutional care and Home Help/ Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services in many countries are supplemented — or substituted — by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems, and day care. In this study the authors use various data sources to provide information on all or most of these types of support for Denmark, Norway, Sweden, Germany, England, Spain, and Israel, concluding with a closer scrutiny of Swedish service profiles. When all types of support are considered, service coverage in these countries is approximately 50–100% higher than for the two major types alone. Data suggest some degree of targeting, at least in countries with higher coverage rates for services. Coverage is estimated as a percentage of a specific age group which uses a service. In countries with lower coverage rates, users may demand or get what is available, with little differentiation between client needs. When user rates are high, there is also a greater overlap between family care and public services. In countries with lower coverage rates, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people more effectively than the choice between nothing, Home Help or institutional care, but minor services also may be used as an inexpensive substitute for full support.

La soledad de las personas mayores en España y Suecia: contexto y cultura

OBJECTIVES Older people in Spain and other Southern European countries are reported to feel lonelier than the older people in the North of Europe. Data from the 1970s and onwards consistently show this. The present study explores feelings of loneliness as a product of both cultural and situational determining factors, by comparing survey data for Spain and Sweden. MATERIAL AND METHOD Data derived from several national surveys of the older people in Spain and Sweden with questions about loneliness. For closer analysis we use the Spanish 2006 Encuesta de Condiciones de Vida (Living conditions Questionnaire), and the Swedish 2002-2003 Survey of Living Conditions. RESULTS On average, 24% of older people in Spain and 10% of elderly Swedish people expressed sentiments of loneliness in the surveys used here (2006 and 2002-03 respectively). Living arrangements and perceived health are related with factors of loneliness in both countries, although levels differ. For example, people in good health who live alone are five times more likely to feel lonely in Spain (45%) than in Sweden (9%) and two-three times more likely when living alone in poor health (82% and 32% respectively). People in good health who live with their spouse/partner only are equally unlikely in both Spain and Sweden to express loneliness (4-5%). It often seems--when it occurs--to be due to caring for a spouse/partner, or problems in the relationship. CONCLUSIONS Results highlight the importance of contextual features--health and living arrangements--and cultural expectations in interpreting reported loneliness.

Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region

Spanish long term care is in danger, therefore we propose a change in the nursing home funding sys¬tem. We use as an example the extremely complex nursing home financing system of Valencian Region. In this region, there are many funding mechanisms: two types of public subsidies, two different acces¬sibility plans, a voucher scheme and a cash benefit approach related to residential service. We evaluate these methods through the quasi-market theory. We find that these approaches have negative impact on equity, efficiency and freedom of choice and we propose a new, homogeneous financing method for all nursing homes through voucher.