Aging and Social Policy: Contrasting Western Europe and the United States

In this essay, three generic issues that underlie our implicit social policy toward older adults and their families are considered: What is the proper division of responsibility for impaired elderly between family members and the state? Is age a morally relevant variable when allocating the resources of society? What should be the balance of competing demands between and among different generations? These issues are considered by contrasting the implicit and explicit policies of the United States with those of several Western European nations (Sweden, West Germany, Austria, and the Netherlands). Suggestions for a family-centered policy on aging are offered. In addition, indications for the appropriate blend of age and need as entitlement criteria are presented.

Life on the Edge: Patterns of Formal and Informal Help to Older Adults in the United States and Sweden

Objectives Our objective in this study was to compare assistance received by individuals in the United States and Sweden with characteristics associated with low, moderate, or high 1-year placement risk in the United States. Methods We used longitudinal nationally representative data from 4,579 participants aged 75 years and older in the 1992 and 1993 waves of the Medicare Current Beneficiary Survey (MCBS) and cross-sectional data from 1,379 individuals aged 75 years and older in the Swedish Aging at Home (AH) national survey for comparative purposes. We developed a logistic regression equation using U.S. data to identify individuals with 3 levels (low, moderate, or high) of predicted 1-year institutional placement risk. Groups with the same characteristics were identified in the Swedish sample and compared on formal and informal assistance received. Results Formal service utilization was higher in Swedish sample, whereas informal service use is lower overall. Individuals with characteristics associated with high placement risk received more formal and less informal assistance in Sweden relative to the United States. Discussion Differences suggest formal services supplement informal support in the United States and that formal and informal services are complementary in Sweden.