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Due to population aging, the need for home care has increased. This leads not only to staff shortages, but also to planning challenges for care organizations. Rescheduling home visits places a strain on everyone involved in care provision. Above all, it is a difficulty for care-service users and their relatives that the only way of getting information about changes in care visits is to call the care organization. These additional phonecalls add to the stress ofcare workers. This paper presents an ICT service that allows home-care service users to request the arrival time for a care worker’s next visit using a voice-based approach. The voice-supported service, ‘notification of care workers’ arrival time’, uses two-stage data processing to predict the time of the visit the closer it gets. In the first step, staff-scheduling data is used; in the second step, the data is enriched with the individual care worker’s current movement data. This approach was tested in a pilot in 2021 and validated using data for 174 care-service users and 26 care workers. Improvements for future research aresuggested.

"An infinite number of fitness apps are available on various app stores. However, hardly any of them are fitted to the needs and requirements of care-dependent peo-ple. This paper investigates the effectiveness of a customised fitness-app prototype for increasing physical activity in home care service users. Home care service users from Austria and Italy were randomly assigned to two groups. In total, 216 partici-pants were involved in the field trial, 104 received a tablet with the fitness app and an activity tracker (treatment group), 112 did not (control group). Regularity of physical activity, frequency of fitness exercises and walking behaviour were self- reported by participants at baseline, after 4 months and after 8 months. In addition, the frequency of using the prototype was assessed based on the fitness app's logged usage data. We estimated multilevel mixed-effects ordered logistic models to examine the effects of the intervention. After 4 months, the intervention increased the home care users’ probability of agreeing strongly with being physically active on a regular basis by 28 percentage points (p< 0.001; 95% CI: 0.20, 0.36) and their probability of reporting to exercise more than once a week by 45 percentage points (p< 0.001; 95% CI: 0.32, 0.57). Walking behaviour was not affected on group- level but improved for frequent users of the activity tracker. Frequent and regular users of the fitness app benefited most and effects persisted until the end of the 8 months controlled trial. Tailoring a fitness-app prototype to the needs of care-dependent people has the potential to support people with functional limitations to engage in a more active lifestyle. Future research is encouraged to seek further insights into how new technologies can sup-port physical activities in people with long-term care needs."

Purpose The Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) can be used to assess long-term care-related quality of life (LTC-QoL) of adult informal carers of persons using LTC services. The ASCOT-Carer instrument has been translated into several languages, but preference weights reflecting the relative importance of different outcome states are only available for England so far. In this paper, we estimated preference weights for the German version of the ASCOT-Carer for Austria and investigated the value people place on different QoL-outcome states. Methods We used data from a best–worst scaling (BWS) experiment and estimated a scale-adjusted multinomial logit (S-MNL) model to elicit preference weights for the ASCOT-Carer domain-levels. Data were collected using an online survey of the Austrian general population (n = 1001). Results Top levels in the domains of ‘Space and time to be yourself’, ‘Occupation’ and ‘Control over daily life’ were perceived as providing the highest utility, and states with high needs in the same domains seen as particularly undesirable. ‘Personal safety’ was the only domain where levels were roughly equidistant. In all other domains, the difference between the top two levels (‘ideal state’ and ‘no needs’) was very small. Conclusion The paper provides preference weights for the German version of ASCOT-Carer to be used in Austrian populations. Furthermore, the results give insight into which LTC-QoL-outcomes are seen as particularly (un)desirable, and may therefore help to better tailor services directed at informal carers and the persons they care for.

The Adult Social Care Outcomes Toolkit four response‐level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face‐to‐face interview survey of older people receiving publicly funded home care services, which was conducted in 2016–2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi‐square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well‐being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ‐5D‐3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.

ZusammenfassungFitness-Apps gibt es viele. Auf die Bedürfnisse älterer Menschen sind nur wenige zugeschnitten. Dieser Beitrag stellt den Innovationsprozess vor, der die Entwicklung des app-basierten Bewegungsprogramms für älterer Menschen „Fit-mit-ILSE“ geleitet hat. Von der Idee bis zum Prototyp werden jene Schritte beschrieben, die zu richtungsweisenden Impulsen durch potenzielle Nutzer*innen für die Entwicklung von „Fit-mit-ILSE“ führten.

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures quality-of-life (QoL) outcomes of long-term care (LTC) service provision. Country-specificpreference weights are required to calculate ASCOT scores. ASCOT has been translated into German, but lacks preference weights for German-speaking countries. Objectives: This paper aims to establish Austrian preference weights for the German version of the ASCOT service user measure, using best-worst scaling (BWS). Methods: Data were collected using an online BWS-experiment from a general population sample (n=1,000) of Austrian adults. We use a scale-adjusted multinomiallogit model (S-MNL) accounting for positioning effects to estimate preference weights. Results: Austrians value the top attribute-levels in the ASCOT domains 'being meaningfully occupied during the day' and 'having control over daily life' most highly,whereas high needs were the least preferred in the domains 'dignity' and 'social participation'. From a methods perspective, we found significant positioning effectsonly for 'best' choices, with statements at the top of a list being picked more often than those further down in the list. Factors related to survey completion (self-assessed understanding of the tasks and survey completion time) were shown to have the greatest effect on individual choice consistency. Discussion:The paper provides Austrian preference weights for the German version of ASCOT for service users. The weights also provide insight into how Austriansvalue different LTC-QoL states. Future research may investigate how values for different LTC-QoL states differ between socioeconomic groups.

Purpose: Traditionally, researchers have relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using internet-based methods. Different methods of data collection may be a source of variation in the results. In this study, we compare the preferences for the Adult Social Care Outcomes Toolkit (ASCOT) service user measure elicited using best-worst scaling (BWS) via a face-to-face interview and an online survey.\ud Methods: Data were collected from a representative sample of the general population in England. The respondents (face-to-face: n=500; online: n=1,001) completed a survey, which included the BWS experiment involving the ASCOT measure. Each respondent received eight best-worst scenarios and made four choices (best, second best, worst, second worst) in each scenario. Multinomial logit regressions were undertaken to analyse the data taking into account differences in the characteristics of the two samples and the repeated nature of the data.\ud Results: We initially found a number of small significant differences in preferences between the two methods across all ASCOT domains. These differences were substantially reduced – from 15 to five out of 30 coefficients being different at the 5% level – and remained small in value after controlling for differences in observable and unobservable characteristics of the two samples.\ud Conclusions: This comparison demonstrates that face-to-face and internet surveys may lead to fairly similar preferences for social care-related quality of life when differences in sample characteristics are controlled for. With or without a constant sampling frame, studies should carefully design the BWS exercise and provide similar levels of clarification to participants in each survey to minimise the amount of error variance in the choice process.

There is evidence that training for strength and balance prevents decline in physical function in old age when the training is personally instructed. It is an open question whether interventions that deliver training via up-to-date technologies can achieve long-term effects. This study examined the effects of an 8-month fitness training program delivered via information and communication technology (ICT) on lower-body strength and balance in female home care users (n = 72) aged 75 years on average. For statistical analysis, the test group was divided into two subgroups, one who used the program at least 8 times per month (n = 26) and another one who used the program less often (n = 17) compared with a control group that received no exercise program (n = 29). It was found that regular ICT-exercisers exhibited positive effects over time on lower-body strength and balance compared to a decrease in both indicators in irregular exercisers and the control group. The authors see potential in offering exercise programs to people of advanced age via ICT to counteract physical decline in old age.

European countries have developed a range of long-term care (LTC) policy responses to support the increasing share of older people. However, little is known about the effectiveness of LTC services and benefits, particularly their impact on older peoples’ quality of life (QoL). This paper investigates the role of personal, care service and environmental characteristics on the effects of home care services on QoL across England, Finland and Austria. We used data from surveys conducted in England, Finland and Austria. In total, 811 older adults were included in the analysis. OLS regression including main effects and country-specific interactions was used to explore variation in gains in long-term care service-related quality-of-life (LTC-QoL). Explanatory variables were derived from the production of welfare framework and comprised home care service user socio-demographics, needs indicators, social support and environmental variables and characteristics of home care service provision. In all three countries, LTC-QoL gains increased with needs, indicating that home care services perform well, with additional gains declining the higher the needs. Also, better process quality contributed to LTC-QoL improvements in all three countries. In addition, the availability of informal care, social contact, financial household situation and living alone, were associated with changes in LTC-QoL only in one or two of the countries. Home care services increased service users’ QoL in all three European countries. The increase in QoL, however, varied across the countries. The results also provide insights into the benefits and limits of home care service provision and areas for future improvements. JEL: I31, I38, J14

Purpose The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal carers’ quality of life (QoL). Translations of the ASCOT-Carer into other languages are useful for national and cross-national studies. The aim of this paper was to report on the translation and cultural adaptation of the original English ASCOT-Carer into German, to assess its content validity and to test for its construct validity (convergent and discriminative/known-group validity). Methods Translation and cultural adaptation followed the ISPOR TCA guidelines. As part of the translation and adaptation process, five cognitive debriefing interviews with informal carers were used for evaluating linguistic and content validity. In addition, a sample of 344 informal carers of older adults, who received home care services in Austria, was used for hypothesis testing as suggested by the COSMIN checklist to assess convergent and discriminative/known-group validity as part of construct validity. Results Cognitive interviews provided evidence that questions and response options of the German ASCOT-Carer were understood as intended. Associations between ASCOT-Carer scores/domains and related outcome measures (convergent validity) and expected groups of informal carers and the care service users they care for (discriminative validity) supported construct validity of the translated instrument. Conclusion The German ASCOT-Carer instrument meets the required standards for content and construct validity which supports its usefulness for (cross-)national studies on LTC-service-related QoL-outcomes in informal carers. Research is encouraged to assess further measurement properties of the translated instrument.

This study developed Finnish preference weights for the seven-attribute Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer) and investigated survey fatigue and learning in best-worst scaling (BWS) experiments. An online survey that included a BWS experiment using the ASCOT-Carer was completed by a sample from the general population in Finland. A block of eight BWS profiles describing different states from the ASCOT-Carer were randomly assigned to each respondent, who consecutively made four choices (best, worst, second best and second worst) per profile. The analysis panel data had 32,160 choices made by 1005 respondents. A scale multinomial logit (S-MNL) model was used to estimate preference weights for 28 ASCOT-Carer attribute levels. Fatigue and learning effects were examined as scale heterogeneity. Several specifications of the generalised MNL model were employed to ensure the stability of the preference estimates. The most and least-valued states were the top and bottom levels of the control over daily life attribute. The preference weights were not on a cardinal scale. We observed the position effect of the attributes on preferences associated with the best or second-best choices. A learning effect was found. The established preference weights can be used in evaluations of the effects of long-term care services and interventions on the quality of life of service users and caregivers. The learning effect implies a need to develop study designs that ensure equal consideration to all profiles (choice tasks) in a sequential choice experiment.

To address the challenges of aging societies, various information and communication technology (ICT)-based systems for older people have been developed in recent years. Currently, the evaluation of these so-called active and assisted living (AAL) systems usually focuses on the analyses of usability and acceptance, while some also assess their impact. Little is known about the actual take-up of these assistive technologies. This paper presents a framework for measuring the take-up by analyzing the actual usage of AAL systems. This evaluation framework covers detailed information regarding the entire process including usage data logging, data preparation, and usage data analysis. We applied the framework on the AAL prototype CARIMO for measuring its take-up during an eight-month field trial in Austria and Italy. The framework was designed to guide systematic, comparable, and reproducible usage data evaluation in the AAL field, however, the general applicability of the framework has yet to be validated.

Background: There is increasing interest in assessing the effects of interventions on older people, people with long-term conditions and their informal carers for use in economic evaluation. The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) is a measure that specifically assesses the impact of social care services on informal carers. To date, the ASCOT-Carer has not been preference-weighted. Objectives: To estimate preference-based index values for the English version of the ASCOT-Carer from the general population in England. Methods: The ASCOT-Carer consists of 7 domains, each reflecting aspects of social care-related quality of life in informal carers. Preferences for the ASCOT-Carer social care-related quality of life states were estimated using a best–worst scaling exercise in an online survey. The survey was administered to a sample of the general adult population in England (n = 1000). Participants were asked to put themselves into the hypothetical state of being an informal carer and indicate which attribute they thought was the best (first and second) and worst (first and second) from a profile list of 7 attributes reflecting the 7 domains, each ranging at a different level (1-4). Multinomial logit regression was used to analyze the data and estimate preference weights for the ASCOT-Carer measure. Results: The most valued aspect by English participants was the "occupation" attribute at its highest level. Results further showed participants rated having no control over their daily life as the lowest attribute-level of all those presented. The position of the 7 attributes influenced participants’ best and worst choices, and there was evidence of both scale and taste heterogeneity on preferences. Conclusion: This study has established a set of preference-based index values for the ASCOT-Carer in England derived from the best–worst scaling exercise that can be used for economic evaluation of interventions on older individuals and their informal carers.

Sarkopenie, ubersetzt die Fleischarmut (griech. sarka = Fleisch, penia = Mangel, Armut), meint den altersbedingten und normalen Verlust an Skelettmuskelmasse, sofern keine Erkrankung oder eine strenge Diat als Ursachen vorliegen. Bei einem uber der Alters- und Geschlechtsnorm liegenden Verlust der Muskelmasse kommt es jedoch zu einem deutlichen Verlust der Funktionskapazitat des Herzkreislauf- und Stoffwechselsystems, was sich im Alltag in einer Abnahme der Kraftfahigkeit und Reduzierung der Gehgeschwindigkeit ausern kann.

This article examines whether providing informal eldercare to an older dependent person predicts employees' intentions to change jobs or exit the labor market and, if so, which particular aspects of both caregiving (e.g. time demands, physical/cognitive care burden) and their current work environment shape these intentions. We used data from a sample of 471 caring and 431 noncaring employees in Austria and split the analyses by gender. We found different aspects of informal caregiving to be associated with the intention to change jobs and with the anticipated labor market withdrawal of male and female workers. A time-based conflict between informal eldercare and paid work was significantly and positively related to the intended job change of female workers but not of their male counterparts. Flexible work arrangements were found to facilitate the attachment of female workers to their jobs and the labor market. Intentions to exit the labor market of male workers appeared to be triggered by a physical care burden rather than time demands. Copyright © 2012 John Wiley & Sons, Ltd. HIGHLIGHTS We studied the effects of providing informal eldercare on the turnover intention of men and women in a group of workers who were also the main carers providing support to a dependent older person with substantial care needs. The intention of male and female workers to change jobs and exit the labor market is shaped by the different characteristics of informal caregiving. Time-based conflicts between informal care and paid work are associated with a higher relative risk of anticipating job changes for female workers. Flextime facilitates the job and labor market attachment of female workers with eldercare responsibilities. The intensity of personal care provided to an older relative is significantly positively related to male workers' relative risk of anticipated labor market exit. Care to an older person in need of supervision makes the labor market exit of female workers less likely, lending thus support to the idea of the respite effect of work.

Voluntary work provides a major source of labor for many nonprofit organizations. Consequences of volunteers and paid staff working alongside each other in nonprofits are well documented. This article contributes to this strand of literature and investigates whether the presence of volunteer work influences paid employees' wages in nonprofit organizations. We estimated a multilevel wage equation accounting for personal characteristics of workers and characteristics of nonprofits. The analysis revealed that nonprofit organizations engaging volunteers pay lower wages to their employees. Our findings contribute to the understanding of wage-setting behavior of nonprofits and improve the methodological approach of empirical research in this field.

Background: quality ratings of care homes are used by decision makers in the absence of direct information about outcomes. However, there is little evidence about the relationship between regulators' ratings of homes and residents' quality of life outcomes. Objectives: to capture social care-related quality of life (SCRQoL) outcomes for residents and investigate the relationship between outcomes and regulator quality ratings of homes. Methods: data were collected for 366 residents of 83 English care homes for older people inspected during 2008. Outcomes were measured using the Adult Social Care Outcomes Toolkit (ASCOT). Multivariate multilevel modelling was used to investigate the relationship between quality of life outcomes and star ratings of homes, controlling for resident and home characteristics. Results: care homes were delivering substantial gains in SCRQoL, but were more successful in delivering ‘basic’ (e.g. personal cleanliness) than higher-order domains (e.g. social participation). Outcomes were associated with quality ratings of residential homes but not of nursing homes. Conclusions: the approach to providing quality ratings by the regulator in England is currently under review. Future quality indicators need to demonstrate their relationship with quality of life outcomes if they are to be a reliable guide to commissioners and private individuals purchasing care.

BACKGROUND: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation.METHODS: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study.RESULTS: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website ( http://www.pssru.ac.uk/ascot ).CONCLUSIONS: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation.

Aging societies are confronted by a growing need for adequate and reliable long-term care (LTC). Against the background of limited financial resources, measurement of LTC outcomes has attracted increasing interest. This chapter discusses how conventional and behavioral economic approaches contribute to our understanding of LTC outcomes and how LTC outcomes can be measured. A production-centered approach is used to identify final LTC outcomes that indicate the impact of LTC on care recipients’ and carers’ quality of life (QoL). Conventional economic approaches assume rational, utility-maximizing individuals as well as perfect markets and suggest that it is possible to measure LTC outcomes indirectly, using revealed-preference approaches, with preferences inferred from care recipients’ choices. However, behavioral economics holds that revealed preferences are not a reliable starting point for measuring QoL gains from LTC services. At the same time, behavioral economists also caution against taking self-assessments of QoL outcomes and stated-preference approaches in economic evaluation at face value. Whichever approach is being followed to measure LTC outcomes, at least three issues need to be addressed: specifying LTC outcome domains, eliciting preferences for these domains, and measuring the impact of LTC on QoL.

In Austria, health and social care are organized in separate systems, which themselves are fragmented and display substantial degrees of fiscal as well as parafiscal federalism. While a major part of healthcare funding is based on contributions to mandatory social health insurance, social care is not part of the country’s Bismarckian tradition and remains essentially tax-funded. As a consequence, health care, on the one hand, and social care, on the other hand, are characterized by different degrees and flavors of federalism. The federal government as well as the country’s provinces take responsibilities in health and social care. Self-governed social health insurance is a more visible player in health care, where its regional bodies determine financing and delivery in outpatient and rehabilitative care.

Objectives. In light of an aging workforce, reconciling informal eldercare and paid work becomes increasingly pertinent.This article investigates the association between informal eldercare and work-related strain and tests for both the 'competing demands' and 'expansion' hypotheses. Methods. The sample of 938 Austrian employees consisted of employees caring for older relatives and a control group of employees without eldercare obligations. We ran a Tobit regression model on work-related strain with different measures of informal eldercare as explanatory variables and controls for both personal and workplace characteristics. Results. Accounting for different characteristics of eldercare within one estimation model revealed that informal eldercare was associated with work-related strain in 2 ways, that is, it increased with both care hours and subjective care burden. However, after controlling for these burdensome attributes of eldercare, the carer status as such was found to be negatively associated with work-related strain. In addition and independently of care commitments, work-related factors, such as advanced skills and job motivation, reduced work-related strain. Discussion. This article lends support to both the 'competing demands' and the 'expansion' hypotheses. Commitment to eldercare can enhance work-related outcomes but entails work-related problems if care burden and time demands of eldercare are substantial. Thus, workers with eldercare responsibilities cannot be considered less productive from the outset. An individual assessment of their situation, considering the care and work setting, is required. Findings from this study support the design of workplace initiatives to uphold workers' productivity in general and bring specific attention to policies alleviating workers' eldercare burden.

With a universal long-term care (LTC) allowance programme, subsidized LTC services for dependent persons and a new programme coping with migrant care work in private households, Austria today is one of the European Union (EU) countries addressing the issue of LTC in a substantial manner. In 2006, Austria spent slightly less than 1 per cent of its GDP on care for elderly people alone, ranking the country fourth in the EU-25, behind Sweden (2.4 per cent), Denmark (1.7 per cent) and Norway (1.6 per cent) (Eurostat, 2010).

This article examines whether providing informal eldercare to an older dependent person predicts employees' intentions to change jobs or exit the labor market and, if so, which particular aspects of both caregiving (e.g. time demands, physical/cognitive care burden) and their current work environment shape these intentions. We used data from a sample of 471 caring and 431 noncaring employees in Austria and split the analyses by gender. We found different aspects of informal caregiving to be associated with the intention to change jobs and with the anticipated labor market withdrawal of male and female workers. A time-based conflict between informal eldercare and paid work was significantly and positively related to the intended job change of female workers but not of their male counterparts. Flexible work arrangements were found to facilitate the attachment of female workers to their jobs and the labor market. Intentions to exit the labor market of male workers appeared to be triggered by a physical care burden rather than time demands.We studied the effects of providing informal eldercare on the turnover intention of men and women in a group of workers who were also the main carers providing support to a dependent older person with substantial care needs. The intention of male and female workers to change jobs and exit the labor market is shaped by the different characteristics of informal caregiving. Time-based conflicts between informal care and paid work are associated with a higher relative risk of anticipating job changes for female workers. Flextime facilitates the job and labor market attachment of female workers with eldercare responsibilities. The intensity of personal care provided to an older relative is significantly positively related to male workers' relative risk of anticipated labor market exit. Care to an older person in need of supervision makes the labor market exit of female workers less likely, lending thus support to the idea of the respite effect of work.

Eine wesentliche Leistung moderner Wohlfahrtsstaaten besteht darin, die Lebensbedingungen benachteiligter Personen oder Personengruppen durch vielfaltige Angebote der Beratung, Betreuung, Behandlung oder Pflege zu verbessern. Solche sozialen Dienstleistungen werden zunehmend auf Sozialmarkten angeboten und nachgefragt. Sozialmarkte werden wegen der spezifischen Eigenschaften des Gutes, der Angebots- und der Nachfrageseite in vielen Landern staatlich reguliert. Sie lassen sich zudem als gemischte Markte (“mixed markets”) klassifizieren, da auf ihnen offentliche und private Anbieterlnnen prasent sind. Vor diesem Hintergrund werden Sozialmarkte auch als „Quasi-Markte“1 bezeichnet.