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Beyond the logic of promoting independent living of older adults

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Since the early 2000s, ageing in place (AIP) has emerged as a new aged care policy paradigm around the world, evidenced by a sharp increase in the number of AIP… Click to show full abstract

Since the early 2000s, ageing in place (AIP) has emerged as a new aged care policy paradigm around the world, evidenced by a sharp increase in the number of AIP articles, as in the Vasunilashorn et al.1 review. As a policy tool for public accountability, most AIP programs aim to tackle public resource depletion by encouraging older adults to continue living independently in their home or neighbourhood without dependence on public facilities. For example, as the WHO Center for Health Development2 remarks, ‘aging in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home’. However, it is quite often the case that older adults living alone or without assistance in AIP programs end up with accompanying comorbidities such as anxiety or depression. To address these issues, the literature has turned the ecological concept of the early AIP model into remedial models such as socialgerontological, gerontechnological, environmentalgerontological, and normalcygerontological, among others. The motives inherent in the revisions in terms of social interaction (e.g. Schulz et al.3), gerontechnology (e.g. Micera et al.4), contextual environmental elements of place (e.g. Golant5) and comfort zone and/or mastery zone at home (e.g. Hanson6) are to manage comorbidities by promoting the autonomy of older adults who age in place. This allows them to selfcare for longer periods of time without moving to a nursing home. Despite these remedies, AIP programs are still in the predicament of being stuck between the different expectations and demands of governments, older adults, and other stakeholders. They do not achieve the desired results due to older people experiencing a variety of comorbidities caused by health decline, housing inaccessibility and/or unaffordability/insufficiency of homecare support, particularly those older adults with limited income or activities of daily living (ADL). Management of comorbidities may reduce adverse outcomes but may also precipitate them, for not only are none of the revised AIP models onesizefitsall, but they may also conflict with each other. For example, although gerontechnology, like using the internet, allows older adults to socialise with their remote family members or friends, bringing higher levels of mental wellbeing and information explosion, it may simultaneously pose threats to their physical health or comfort through internet addiction. Therefore, as long as the logic of alleviating public spending by managing comorbidities through learning independent living and selfcare skills remains, this predicament will not disappear. It is time to reexamine the latest AIP programs exploring beyond the traditional logic. In China, conflict resolution resorts to a dynamic and nonlinear approach, rather than one that is static and straightforward. Or it is a balancing act or process between the interests of different stakeholders. Thus, these Special Feature articles highlight the different logics of AIP in China. Zhang and Chan,7 in their paper entitled ‘PublicPrivatePartnership in Care Provision for AgeinginPlace: A Comparative Study in Guangdong, China’, document the development and strategy behind the Chinese PublicPrivatePartnership (PPP) ventures in AIP aged care. An effective PPP in the literature usually refers to a mutually beneficial collaboration, a more equitable investment, or a solution to financing costly infrastructure projects. This paper highlights special reference to the Chinese experience in PPP with similar ventures, but different purposes. The three Chinese cases illustrate that governments are not necessarily cash poor because they participated in construction of the three PPP ventures and provide substantial and stable financial support for the daily operation to ensure care provision for all eligible frail older adults and are also not necessarily equitable for their private partners. The ultimate purpose of the three Chinese PPP ventures is to contribute to serving the most unfortunate and improving the quality of care received by older adults. Wang et al.8 have written a highly inspiring article entitled ‘Path toward Home: Exploring Pathways to the Development of a Sense of Home in Residential Care Settings in China’. The authors elaborate on how different residents have different experiences of ‘home’, with data from six facilities. Their results propose that not only is the general care and support provided in a standard older

Keywords: aip programs; older adults; care; home; independent living

Journal Title: Australasian Journal on Ageing
Year Published: 2023

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