Needs assessment and the organization of eldercare provision in the modern welfare state – a comparative perspective
Morten Balle Hansen, Professor, PhD
Department of Political Science,
Aalborg University Denmark mbh@dps.aau.dk
No. 1

Abstract
Comparative studies of home care, eldercare and social care generally indicate that a large number of industrialized countries are facing common challenges.
These challenges are caused by the demographical developments of an aging population, changed labor market conditions and changed family structures.
At a macro-level this presentation analyzes how different welfare state systems cope with these challenges by organizing the provision of eldercare in different ways.
At a micro-level different systems of needs-assessment are analyzed. The pros and cons of these different systems will be discussed since this presentation is planned as an introduction to the complexities that are associated with need assessment practice.
No. 2

1. Introduction
2. Some Global Trends
3. Global (European) variation in organizing eldercare
4. The Danish (Nordic) Case
5. Some current issues in needs assessment
No. 3

• From a purely demographical point of view, since the 1970s, the need for elder service on a global scale has grown and will continue to grow over the next decades
• The percentage of the world’s population which is 60 years old or older has increased from 8 % in 1970 to 10% in 2000 and is expected to reach 15 % in 2025 and 22 % in 2050
• Claim: How a society choose to organize its eldercare increasingly determines its success in the global economy
No. 4

Global variations in Organizing Eldercare I
Family and state
• Traditionally the family has taking care of the elderly
• In all countries the family and informal social networks continues to play a significant role
• In many countries however – and increasingly in the past decades – the state has taken over a lot of this responsibility – especially in the Northern part of Europe
• This is also shown in judicial terms:
• In the Nordic countries and the Netherlands the state is legally responsible for taking care of the elderly
• In the southern part of Europe the family (defined in various ways) is legally responsible
• The change tends to covary with women participation rates in the labor market
No. 5

Global variations in Organizing Eldercare II
Financing eldercare: Who pays?
• Taxes (Denmark)
• Taxes and user payment: (Other Nordic countries, Austria, etc.)
• Insurance (public) and user payment: (Netherlands, Germany, etc.)
• Either taxes (low income groups) or private insurance (high income groups) and user payment: (France, USA, etc.)
• Family or non-profit (e.g. church) charity organizations
No. 6

Global variations in Organizing Eldercare III
Organizing eldercare: Who controls and organizes the eldercare?
• Public: Municipalities (Denmark, other Nordic countries, UK)
• Public: Local health boards (Ireland)
• Public: representatives for AWBZ (Netherlands)
• Public: other kinds of public sector organizing
• Public and private: (Belgium and France)
• Non-profit organizations or family: (Greece)
No. 7

Global variations in Organizing Eldercare IV
Supply: Who are the primary suppliers of eldercare?
• Public municipalities and some private and/or Non-profit providers: (Denmark, other Nordic countries, UK)
• Non-profit providers and some private companies:
(Netherlands, Germany, Italy, etc.)
No. 8

Summing up on global (European) variations as related to Denmark (Scandinavia)
Financing eldercare: Who pays?
• Denmark is unique in the sense that almost all costs are financed by tax payers
Organizing eldercare: Who controls and organizes the eldercare?
• Denmark, other Nordic countries and UK relies heavily on local government administration to organize and control
Supply: Who are the primary suppliers of eldercare?
• Denmark, other Nordic countries and UK relies on local government supply, but increasingly private providers as well
No. 9

The issues of Needs assessment should be understood in this context of managing eldercare
SOME CURRENT ISSUES IN NEEDS
ASSESSMENT
No. 10

Issues of Needs assessment in Eldercare I
Needs assessment is related to the professional organization of eldercare (in contrast to the family) and thus to administrative issues of efficiency, transparency and equity
Claim: Only relatively large professional organizations (public or private) are able to (and have to) cope with the challenges of needs assessment
No. 11

Issues of Needs assessment in Eldercare II
One essential issue in the current Danish context is to make needs assessment more dynamic - how do we avoid that need assessment become a self-fulfilling prophecy? That it constitutes and preserves a certain (low) level of ability
Previous and current systems of Needs assessment tend to be rigid and unable to support a developmental perspective in which eldercare practice try to improve the elders ability to take care of them-selves
This developmental perspective on eldercare practice is currently high on the administrative agenda and also supported by professional norms of social workers
No. 12

Issues of Needs assessment in Eldercare III
Transparency: The issue of developmental perspective tend to be somewhat in conflict/tension with a tranparency criteria according to which it should be clear why specific elderly people get help and others don’t
Equity: One criteria according to which it should be transparent that people with the same needs should have the same services has been important in designing current systems of need assessment.
This criteria tend to be hard to sustain in a developmental perspective.
No. 13

Issues of Needs assessment in Eldercare IV
Other issues:
• Standardization: Can we construct a universal needs assessment language (such as ICF)? Should we? For instance we don’t have a common language of needs assessment between hospitals and municipalities in the Danish context
• Communication: Professional actors (e.g. Nurses, doctors, social workers), the political-administrative system, the elderly users and their relatives and the public at large need to communicate about elderly needs. But a vocabulary of needs asseessment have different functions in different contexts. How is this fact related to the idea of af a standardized common language?
No. 14

Thanks for your attention
Contact information:
Morten Balle Hansen,
Professor, PhD
Department of Political Science
Centre for Organization, Management and
Administration
Aalborg University
Fibigerstræde 1
9220 Aalborg
Denmark
E-mail: mbh@dps.aau.dk
Phone: +45
99402338
No. 15