Policy programs and service delivery models for older adults and their caregivers: Comparing three provinces and two states
Despite an increase in prevalence of complex chronic conditions and dementia, long‐term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with supp...
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| Published in | Health & social care in the community Vol. 30; no. 6; pp. e4264 - e4279 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Hindawi Limited
01.11.2022
John Wiley and Sons Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Despite an increase in prevalence of complex chronic conditions and dementia, long‐term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY. |
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| AbstractList | Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts 'patch' health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess 'goodness of fit'. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY. Despite an increase in prevalence of complex chronic conditions and dementia, long‐term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY. Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts 'patch' health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess 'goodness of fit'. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY.Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts 'patch' health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess 'goodness of fit'. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY. |
| Author | Peckham, Allie Saragosa, Marianne Marchildon, Greg Shaw, James Bornstein, Stephen McGrail, Kimberlyn Morris, Madeline Young, Yuchi King, Madeline Roerig, Monika Papenkov, Maksim V. |
| AuthorAffiliation | 3 Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada 2 North American Observatory on Health Systems and Policies Toronto Ontario Canada 4 Department of Physical Therapy, Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada 10 School of Arts and Sciences, Department of Economics State University of New York at Albany Albany New York USA 5 Department of Political Science Memorial University St. John's Newfoundland and Labrador Canada 1 Edson College of Nursing and Health Innovation Arizona State University Phoenix Arizona USA 7 Centre for Health Services and Policy Research, School of Population and Public Health University of British Columbia Vancouver British Columbia Canada 9 School of Public Health, Department of Health Policy, Management & Behavior State University of New York at Albany Albany New York USA 6 Community Health and Humanities, Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada 8 |
| AuthorAffiliation_xml | – name: 9 School of Public Health, Department of Health Policy, Management & Behavior State University of New York at Albany Albany New York USA – name: 1 Edson College of Nursing and Health Innovation Arizona State University Phoenix Arizona USA – name: 8 College of Nursing and Health Sciences University of Vermont Burlington Vermont USA – name: 5 Department of Political Science Memorial University St. John's Newfoundland and Labrador Canada – name: 10 School of Arts and Sciences, Department of Economics State University of New York at Albany Albany New York USA – name: 7 Centre for Health Services and Policy Research, School of Population and Public Health University of British Columbia Vancouver British Columbia Canada – name: 2 North American Observatory on Health Systems and Policies Toronto Ontario Canada – name: 4 Department of Physical Therapy, Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada – name: 6 Community Health and Humanities, Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada – name: 3 Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada |
| Author_xml | – sequence: 1 givenname: Allie orcidid: 0000-0001-6199-6903 surname: Peckham fullname: Peckham, Allie email: allie.peckham@asu.edu organization: North American Observatory on Health Systems and Policies – sequence: 2 givenname: Marianne surname: Saragosa fullname: Saragosa, Marianne organization: North American Observatory on Health Systems and Policies – sequence: 3 givenname: Madeline surname: King fullname: King, Madeline organization: University of Toronto – sequence: 4 givenname: Monika orcidid: 0000-0002-9117-0368 surname: Roerig fullname: Roerig, Monika email: monika.roerig@utoronto.ca organization: University of Toronto – sequence: 5 givenname: James surname: Shaw fullname: Shaw, James organization: University of Toronto – sequence: 6 givenname: Stephen surname: Bornstein fullname: Bornstein, Stephen organization: Memorial University – sequence: 7 givenname: Kimberlyn surname: McGrail fullname: McGrail, Kimberlyn organization: University of British Columbia – sequence: 8 givenname: Madeline surname: Morris fullname: Morris, Madeline organization: University of Vermont – sequence: 9 givenname: Yuchi surname: Young fullname: Young, Yuchi organization: State University of New York at Albany – sequence: 10 givenname: Maksim V. surname: Papenkov fullname: Papenkov, Maksim V. organization: State University of New York at Albany – sequence: 11 givenname: Greg orcidid: 0000-0003-4898-2392 surname: Marchildon fullname: Marchildon, Greg email: greg.marchildon@utoronto.ca organization: University of Toronto |
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| Copyright | 2022 The Authors. in the Community published by John Wiley & Sons Ltd. 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd. 2022. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | comparative analysis incrementalism policy layering older adults policy analysis comparative policy dementia |
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| SubjectTerms | Aged Canada Caregivers Chronic Disease Chronic illnesses comparative analysis comparative policy Dementia Dementia - therapy Friendship Goodness of fit Health services Humans incrementalism Infrastructure Morality older adults Older people Original Policy policy analysis policy layering Provinces Segmentation Unpaid |
| Title | Policy programs and service delivery models for older adults and their caregivers: Comparing three provinces and two states |
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