Andrew E. Scharlach

Since Taiwan’s age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country’s 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, performance, and outcome of the AFC program. A 53-item questionnaire was developed based on the World Health Organization (WHO) guideline, including mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). There was a “great difference” found among scores between facilitators and experts for “inter-exchange experience with local and international cities” (40%) and “monitor and revise indicators” (37%) in mechanisms and processes, “evaluate performance of indicators and action plans” (37%) in outcome evaluations, and “interaction between government and community” (46%) and “interaction between civil organization and senior society” (39%) in resource integration. Clearly, facilitators showed overly optimistic assessments in AFC mechanisms and processes, outcome evaluation, and resource integration. The results showed disconnect between experts’ expectations versus actual practice conducted by facilitators. Implications of these findings are to integrate top down expectations with the realities of bottom up practice to design more realistic evaluations; continue to educate stakeholders about design, implementation and evaluation; and further integrate resources from government, civil organizations, and community.

Since Taiwan’s age-friendly city (AFC) program was launched in 2012, the federal government has provided various resources to the country’s 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. In order to examine similarities and differences in the perspectives of local program facilitators and expert team members, a 53-item questionnaire was developed based on the WHO guide. The questionnaire assessed AFC mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). Local authority program facilitators were found to score higher than expert team members with regard to a number of AFC mechanisms and processes, including “organized education/training program”, “establish commitment for officers” and “assess impact and outcome.” Program facilitators also scored higher on outcome evaluation items such as “inter-exchange experience with local and international cities” (40%), “monitor and revise indicators” (37%), and “evaluate performance of indicators and action plans” (37%), and resource integration items such as “interact between government and community” (46%) and “interact between civil organization and senior society” (39%). Clearly, local program facilitators and expert consultants differ substantially in their assessments of AFC mechanisms and processes, outcome evaluation, and resource integration. These findings point to the need for greater awareness of differing perspectives among key stakeholders, and intentional efforts to promote collaboration among them.

Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village’s 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents’ explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need. Member resource inputs were not found to be as salient for Village leaders’ perceptions of sustainability as was anticipated given the Village model’s emphasis on consumer involvement. Despite the lack of longitudinal prospective data, study findings suggest potential limitations of consumer-driven organizational models such as Villages, including the need for a more stable resource base.

This study demonstrates the use of a social return on investment (SROI) approach in estimating the financial and social value created by volunteer-assisted community-based aging services. An expanded value added statement (EVAS) analysis found that the total value of outputs produced by the Concierge Club of San Diego substantially exceeded the cost of the program, after considering likely secondary and tertiary benefits for a range of affected stakeholders—including elderly service recipients, family members, volunteers, and societal institutions. Additional research is needed regarding the direct and indirect costs and benefits of volunteer support services for vulnerable older adults and their families.

Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components.

This article explores the potential role of the Village model, a social initiative that emphasizes member involvement and service access, in helping communities to become more age-friendly. A survey of 86.3% of operational Villages examined activities designed to help members access a variety of supports and services consistent with the World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities program model, as well as other potential contributions to community age friendliness. Analysis revealed that 85.5% of Villages provided assistance with at least six of the eight WHO domains, but only 10.1% implemented features of all eight; more than one-third were engaged in direct or indirect efforts to improve community physical or social infrastructures or improve community attitudes toward older persons. These findings suggest that Villages and other social organizations may have untapped potential for enhancing their members’ ability to age in place consistent with the goals of age-friendly initiatives while also promoting constructive changes in the overall community.

Synthesising the social capital and ageing-friendly communities literature, this paper describes how efforts to make communities more ageing-friendly can promote social inclusion among older adults. Making existing communities more ageing-friendly involves physical and social infrastructure changes that enable older adults to pursue lifelong activities, meet their basic needs, maintain significant relationships, participate in the community in personally and socially meaningful ways, and develop new interests and sources of fulfilment. Such efforts can enhance bonding, bridging and linking capital, and thereby promote social inclusion. The authors discuss the link between ageing-friendly communities and social inclusion, and provide examples of programmes with potential to change existing communities into ones that promote the social inclusion of older adults.

This chapter discusses the government's role in providing long-term care (LTC) for the elderly. It begins by considering the context of a long-term care policy in the United States, including LTC settings and financing, before turning to a discussion of the economic costs and risks associated with LTC. More precisely, it examines the disparities in care needs and related costs, with emphasis on Medicaid, and how public reimbursement and regulatory policies have contributed to these disparities. The chapter also outlines the causes of the increasing economic risk and responsibility for LTC assumed by older adults and their families before concluding with proposed policy solutions to ensure a more equitable distribution of LTC costs and burdens.