LONG-TERM CARE FOR OLDER ADULTS IN THE UNITED STATES: SOCIAL JUSTICE, SOCIAL WELFARE, AND SERVICE MODELS

Yıl 2023, Cilt: 23 Sayı: 61, 693 - 729, 25.12.2023

Hazal Swearinger

https://doi.org/10.21560/spcd.vi.1150176

Öz

As a result of longer life expectancies and time spent with chronic diseases, physical and mental difficulties experienced during old age has become widespread. Long-term care models that provide personal care services to older adults experiencing these difficulties have reached critical importance. Long term care services, as a subdomain of social welfare seeking to ensure social justice should address these needs through rights-based framework. This study aimed to establish the relationship between social welfare models and long-term care in the context of the United States (USA). For this purpose, it was discussed how American market-centered liberal welfare model shaped the long-term care system in a historical context with reference to long-term care models, financing, and service delivery. This discussion concluded that the American long-term care system has a market-centered income-testing model and does not adhere to a rights-based social justice framework. As a result, there are significant disparities in both availability of long-term care and quality of services offered. The USA must address the structural inequalities in organization, financing, and provision of long-term care services in order to ensure social justice in the provision of care, while at the same time, new care models should be developed to better integrate emerging technology into care models.

Anahtar Kelimeler

social policies, long term care, aging, United States

AMERİKA BİRLEŞİK DEVLETLERİ'NDE YAŞLILIKTA UZUN SÜRELİ BAKIM: SOSYAL ADALET, SOSYAL REFAH VE HİZMET MODELLERİ

Öz

Uzayan yaşam süreleri ve kronik hastalıklarla geçen sürelerin artması neticesinde yaşlılık süresince deneyimlenen fiziksel ve zihinsel engellilik yaygınlaşmıştır. Bu engelleri yaşayan yaşlı bireylere kişisel bakım hizmetleri sunan uzun süreli bakım modelleri kritik bir öneme ulaşmıştır. Sosyal adaleti sağlamayı hedefleyen sosyal politikalar, yaşlılıkta engellilik yaşayan ve bakıma muhtaç bireylerin bu ihtiyaçlarına uzun süreli bakım hizmetleri aracılığı ile hak temelli bir çerçevede yaklaşmalıdır. Bu çalışma Amerika Birleşik Devletleri (ABD) bağlamında sosyal refah modelleri ve uzun süreli bakım modelleri arasındaki ilişkiyi kurmayı hedeflemiştir. Bu amaçla, Amerikan sosyal refah sisteminin piyasa merkezli liberal refah modeline sahip olmasının uzun süreli bakım sistemini nasıl şekillendirdiğini, uzun süreli bakım modelleri, finansmanı ve hizmet sunumuna değinerek tarihsel bir çerçevede tartışmıştır. Bu tartışma, Amerikan uzun süreli bakım sisteminin piyasa merkezli gelir-testi modeline sahip olduğu ve hak temelli ve sosyal adaleti sağlamayı hedefleyen bir yaklaşım takip etmediği sonucuna ulaşmıştır. Bunun neticesinde uzun süreli bakıma erişimde ve erişilen hizmetin kalitesinde büyük eşitsizliklerle karşılaşılmaktadır. ABD, bu bakımın sunulmasında sosyal adaleti sağlamak için uzun süreli bakım hizmetlerinin organizasyonu, finansmanı ve sunumunda yapısal reformlar yaparak bu alanda yaşanan eşitsizliklere müdahale etmeli, aynı zamanda da gelişen teknolojiyi bakım modellerine daha iyi entegre etmek için uzun süreli bakım modellerini geliştirilmeli ve düzenlenmelidir.

Anahtar Kelimeler

Amerika Birleşik Devletleri, sosyal Politikalar, uzun Süreli Bakım, yaşlanma

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