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In “Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?”, the author suggests making elder care a shared public responsibility not just a family burden. One key policy is de-gendering and formalizing elder care work, as seen in Scandinavian countries like Sweden and Norway. These nations offer public funding, caregiver wages, and support for family caregivers, treating care work as essential, not invisible. This reduces gender inequality and ensures consistent, professional care for older adults (Lloyd-Sherlock, 2021).

Culture deeply influences dementia care. In Nigeria, dementia is often misunderstood and linked to witchcraft or spiritual punishment, which can lead to abuse and social exclusion. Some families seek exorcisms instead of medical care, but education programs are helping shift attitudes (The Guardian, 2024). In contrast, France’s Alzheimer’s villages treat dementia with dignity, letting residents live freely in secure communities, maintaining routines like shopping and walking. This reflects cultural values of autonomy and humane care (The New Yorker, 2020)

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1. One important policy change suggested in Tong’s article is the implementation of publicly mandated long-term insurance programs, this has been adopted by both Germany and Japan. Germany introduced its program in 1994, requiring contributions from employers and employees. Germany’s program provides either professional home care services or cash to pay familial caregivers. Japan followed in 2000 by implementing a similar system, except they did not offer cash payments in fear that it would pressure women into caregiving roles they didn’t want. This policy is important because it ensures fair, professional elder care while reducing the stress on families, and promotes gender equity within these aging societies.

2. From both readings about Dementia care in Nigeria and Brazil, culture deeply influences how dementia is understood and treated. In Nigeria, dementia is often seen as a sign of madness, or even witchcraft, leading to a heavy negative stigma on individuals with dementia. Many people in Nigeria believe it is a punishment for ones wrongdoings in the past, and institutional care is often not thought of so the caregiving usually falls onto the women of the family (P. 146-147). In Brazil, the low education and awareness of dementia causes delays in proper diagnosis(P.53), and just like in Nigeria, the women in Brazil often become the main caregivers, and institutional care is both expensive and culturally resisted. (P. 56-57)

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1. One example of change is ensuring the long-term use of insurance funds that are provided through the government. "Countries vary widely with respect to government funding of long-term care for the elderly. The governments of some countries are very generous, but others are quite parsimonious. Among the most generous governments are those in the Scandinavian countries" (pg. 7) the article then goes to talk about how they make work for those that are consider for elder care, as they can "offer benefits through home-based services provided professional caregivers and forms of cash" (pg 8). This can further assist with low-income families/households, allows for those involved in the field of caregiving to ensure employment opportunities, this could also ensure that every type of social class has the assistance they need, and helps fight against radical disparities within healthcare.

2. Culture has a very pivotal role connected towards the care and treatment of those struggling with dementia. When looking at how health is portrayed in Nigeria, they are known to have a very weak healthcare system and due to this the overall life for them as been low, being 55 years of age. Those in Nigeria have a negative correlation to those with dementia "seeing dementia and aging as intertwined, some Nigerians describe people living with dementia as witches or wizards, or they may believe dementia symptoms are some sort of punishment from a supernatural being" (pg.146) this can further hurt the medical care that is needed for those diagnosed with dementia along with deepening the stigma that surrounds it.

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2. Culture significantly influences how people with dementia are treated and cared for by shaping beliefs, values, and practices related to aging, illness, and family responsibilities. For example, in some cultures, there's a strong emphasis on filial piety, where families are expected to provide care for their elders at home, whereas in others, institutional care is more accepted.

3. Gender plays a significant role in dementia care globally because care work is often viewed as a "feminine" responsibility. Women are disproportionately the primary caregivers for individuals with dementia, whether as family members or professional caregivers. This gendered expectation can lead to women experiencing greater caregiver burden, financial strain, and limited opportunities for personal and professional development. The conclusion of "Long-Term Care for the Elderly Worldwide" discusses how this gender imbalance in care work is a global issue that needs to be addressed through policy changes and societal shifts in attitudes towards caregiving.

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1. In the article, "Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?," the author suggests several economic, policy, and social changes that could improve care for older adults around the globe. Provide at least one example of these changes. Detail the suggested change, which country (or countries) have implemented it, and why it is important.

One change suggested in the article is the use of public long-term care insurance. Germany, for example, started this in 1994. In this system, workers and employers both put money into insurance that helps pay for long-term care. This program lets people get care at home or use the money to pay family members who provide care. This change is important because it helps make sure everyone can get the care they need without putting all the work on families, especially women. It also spreads the cost fairly, so care is not just for the rich.

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

The article explains that gender plays a big role in dementia care because care work is still mostly seen as women’s work. Around the world, women, whether paid or unpaid, are expected to care for people with dementia. This often means women give up jobs or other goals to do this work, which can hurt them later, like in retirement. The article says this is unfair and calls for men to share care work more so that women are not doing more than their fair share.

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Prompt two: The first example is some view caring for elderly especially those with dementia as a burden to society. One example from the MUSE reading is "These three countries use tax dollars to subsidize social care as well as medical care for their elderly populations." Because many aging individuals can no longer work due to various reasons some may push back on the fact that taxes collected from their paychecks are going to care for others. The same article sums it up when they state, "The young in countries such as these would have to be taxed at very high rates to fund robust public long-term care programs, and it is far from certain that the young will want to be taxed in this particular way (Project Muse 11)." There is also the other financial aspect that many governments cannot afford to provide long-term care for gaining citizens its often left to the family to finically support them. The same article gives the example "Because many individuals—particularly women and many people in developing countries—may not be able to save enough to take care of themselves in their old age, and also because many governments may not be able to adequately fund long-term care for their aging populations, families will probably be asked to shoulder an increasingly large measure of the family members’ long term care needs (Project MUSE 22)." This can cause resentment for the aging population because their children are trying to pay for their own kids and life and have to give money to support their parents. There is also this idea that diseases like dementia and the symptoms are part of aging when in actuality they are not. A lot of the complaints about pain or other symptoms are often dismissed because "that part of getting old." In Nigeria the signs are often dismissed by family and friends because they believe that to be a normal part of aging (Cultural views of Dementia in Nigeria 146). Another example is when the article writes, "In addition to seeing dementia and aging as intertwined, some Nigerians describe people living with dementia as witches or wizards, or they may believe dementia symptoms are some sort of punishment from a supernatural being. (Cultural Views of Dementia in Nigeria 146)." Often punishments are done due to one's actions and dementia is a punishment for something evil you have done. This can lead to the person being outcasted and they can become isolated and decline.

Prompt three: Something I've heard a lot of parents say is "I had kids to take care of me when I'm older" which I don't think it right because that shouldn't be a reason to have a child. I think female family members have more of an expectation to take care for elderly family members since females are often seen as the more "nurturing" gender. This goes hand in hand which the stereotype that all nurses are female. The Project muse article even writes, "The point of the novel was that Japanese daughters-in-law could no longer be expected to be the primary caregivers for elderly parents-in-law." The Japanese government didn't even pass something to recognize that females' family members cannot be expected to be the sole caretaker until 2002. Another example is when the same article states "One of the features to note about this professionally delivered home care, mostly by women, is that the careworkers receive low wages so that the agencies that employ them can make a profit (Project MUSE 13). Again, we can see here there is a trend that females are the ones that are generally viewed as the caretakers. In the essay in Brazil, they even mention that daughters or daughters-in-law are expected to give up personal things like studying, education, and work to care for their aging family members (Aging and Dementia in Brazil 55).

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1. Different countries have different economic policies which influence the care quality of elderly patients. Tong writes, “Countries vary widely with respect to government funding of long-term care for the elderly. he governments of some countries are very generous, but others are quite parsimonious” (p. 4), which could not be further from false. Different countries’ politics set economic aid for patients at a widely scaled range. At one end of the scale, countries such as Africa’s (like Niger, Sierra Leone, Burkina Faso, Ethiopia, Mali, Mozambique, and Uganda) struggle financially and with poverty, so they cannot provide almost any support. Meanwhile, Scandinavian countries (like Norway, Denmark, and Sweden) expect all elderly citizens to have their long-term care needs met to the fullest extent. Other countries such as the United States fall somewhere in between with their safety-net approach, having two publicly funded health programs, Medicare and Medicaid. Finally, countries such as Greece, Italy, and Ireland set the expectation that families of the elderly are primarily responsible for their long-term care. These differences set widely apart leave large gaps between quality of health offered to aging patients, proving again the significance of impact brought upon by cultural differences and political/economic policies. This reinstates the importance of advocating for global health.

3. With global aging, gender norms can also be seen as an obstacle with two stereotypes: the ideal worker norm and the ideal care worker norm. The ideal worker norm revolves around the idea that there is no space for workers to take time off while working full time without childbearing or caretaking to be an acceptable excuse of absence. The ideal care worker norm does not have space for caregivers with the “distraction” of family work to withhold hours/labor. These unfair expectations along with the stereotype that women are to be the caretakers of families greatly withhold women from being able to be recognized as ideal workers or caregivers. Tong writes, “The best way to change this inequitable state of afairs, argues Williams, is to make the workplace conform to the family rather than the family to the workplace. he ideal worker would then become someone who has time for both family and work and is able, because of the way the workplace is structured, to care for self and others” (p. 18). It is important to reinstate the importance of balancing family life with work life.

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1. One example of a meaningful economic and policy change discussed in Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It? is the creation of publicly funded long-term care insurance, specifically in Germany and Japan. These programs were designed not only to address the increasing needs of aging populations but also to shift the burden of care away from families, specifically women, in hopes to create a more fair, state-supported standard. I found this example important because it shows how governments can create real change by acknowledging that care work is a public responsibility, not just a private or family matter.

Germany was one of the first countries to implement this kind of policy. In 1994, they launched a mandatory long-term care insurance program funded by contributions from employers, employees, and pensioners. It’s flexible because it allows people to choose between professional services or receiving cash subsidies to support family caregiving. According to the reading, Tong explains, the program offers “benefits either in the form of home-based services provided by professional caregivers or cash subsidies that beneficiaries can use to pay familial caregivers” (Tong, 2009, p. 8). That flexibility respects individual family needs while still recognizing the importance of state support.

Japan followed Germany’s lead, but with an interesting twist that really stuck with me. In 2000, Japan introduced its version of long-term care insurance, but it intentionally did not offer cash payments to families. At first, that surprised me, wouldn’t more financial help be better? But Tong explains the deeper reasoning that many women’s groups in Japan were worried that cash payments would pressure daughters and daughters-in-law into quitting their jobs to become full-time caregivers. According to the reading, “If only services were provided, then professional home-health care employees would provide care, and daughters-in-law and daughters would not feel pressured to abandon their jobs” (Tong, 2009, p. 8). That quote focuses the gender dimension of this issue and how policy can either reinforce or challenge traditional roles.

This change is important in the context of Japan’s rapidly aging population, where over 25% of the population is 65 or older. Instead of assuming that women would provide care for their families. Japan’s example places the responsibility more on the state. I think that’s a powerful shift. It not only lightens the load for individual families but also promotes greater gender equality by not assuming that care work is automatically a woman’s job.

What stands out to me the most is that both Germany and Japan are examples of countries restructuring systems in a way that recognizes the value of care and tries to share that responsibility more fairly. As Tong puts it, “the more committed a country is to the deconstruction of ingrained notions about who should care (women) and who should work (men), the more able it will be to meet the long-term care needs of the elderly and other vulnerable populations fairly” (Tong, 2009, p. 7). That’s such a powerful statement, and it made me think about how long-term care is about more than services. It’s also about social justice.

Other nations could learn a lot from these approaches. First, that care work needs to be recognized and supported by policy, not just expected from families. And second, that real gender equity can only happen when we stop assuming women will do unpaid labor out of duty. Countries like Japan are showing that it’s possible to break that cycle and that policy has the power to reshape cultural expectations.

3. Gender plays a major role in dementia care around the world, especially when it comes to who is expected to provide that care and how society views caregiving. In “Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?”Rosemarie Tong explains that caregiving especially for elderly people with chronic illnesses like dementia which is still overwhelmingly considered “women’s work,” whether it’s done at home by family or professionally in care settings. According to the reading, “Throughout the world, women are still viewed as society’s primary caregivers, and they are expected to make themselves available when family members need long-term care” (Tong, 2009, p. 18). I found this powerful because it shows how deeply these roles are gendered, and how that continues to affect women’s lives today.

One example that stood out to me was from Japan. The country created a public long-term care insurance program in 2000, but unlike Germany, it decided not to offer cash payments for family members to provide care. This decision was driven by women’s organizations, who were afraid that families would pressure daughters-in-law or daughters to quit their jobs to take care of aging relatives. Tong explains, “if only services were provided, then professional home-health care employees would provide care, and daughters-in-law and daughters would not feel pressured to abandon their jobs” (Tong, 2009, p. 8). I thought this was such an eye-opening point—women weren’t just fighting for better pay or more resources, but for the choice to not be the default caregiver at all.

In many other countries, that kind of change hasn’t happened yet. For example, in Italy and other Southern European countries, there are still laws that require family members, starting with spouses and children are expected to take care of their elderly relatives. According to the reading, “While that may sound reasonable on paper, it usually ends up being the women in the family who step into those roles, often without much support or recognition” (Tong, 2009, p. 10).

Even in places like the U.S., where there isn’t a legal requirement for family caregiving, the expectation still falls heavily on women. Tong makes it clear that this has real consequences. According to the reading, “Care work is still too much women’s work… continuing to regard women as society’s primary caregivers and men as society’s primary workers is not good for women or for men” (Tong, 2009, p. 20). That quote stuck with me because it points to how these outdated gender roles hurt everyone, not just the women who are overburdened, but also the men who miss out on developing meaningful caregiving relationships.

Tong argues that the most effective countries are the ones that challenge these traditional gender roles. For example, Denmark and Norway treat caregiving as a collective responsibility, and their systems are designed to support both men and women in combining work and caregiving. According to the reading, “the Danish state… is based on the explicit principle of social inclusion for older people and women of working age, who are relieved of any duty to provide unpaid care work” (Tong, 2009, p. 19). I think that’s such an important reminder that elder care doesn't have to rely on unpaid female labor, it can be structured in more fair and supportive ways.

Overall, this reading made me realize just how much gender still shapes who gives care and how that work is valued. As more people around the world live longer and need dementia care, we can’t keep putting all that responsibility on women, especially when so many are also working, raising families, and trying to build secure lives for themselves. If we want fair and sustainable care systems, we have to rethink what we expect from both women and men.

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1. In the article, "Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?," the author suggests several economic, policy, and social changes that could improve care for older adults around the globe. Provide at least one example of these changes. Detail the suggested change, what country (or countries) have implemented it, and why it is important.

One of the major policy changes Tong suggests is to improve the care for older adults as comprehensive state funded long-term care systems (Tong, pp. 7-16, 2009). She doesn't suggest this as if it is a novel idea but rather how it is similar to what Norway and Denmark have (Tong, pp. 7-16, 2009). The author showcases these models as they provide universal high-quality long-term care, of  course this is due to high taxes and having a strong sense of social responsibility of that culture/society, this also causes more social inclusion to occur (Tong, pp. 7-16, 2009). Tong goes into specific details as in Denmark the country actively supports older adults by relieving family members, specifically women, or the expectation to provide unpaid care, like lets go that's so slay of them (Tong, pp. 7-16, 2009). Denmark also promotes gender equity in caregiving, as they have policies such as mandatory paternity leave so men and husbands alike can take on family responsibilities that usually fall onto women (Tong, pp. 7-16, 2009). These policies and suggested model is significant as it addresses multiple areas of progressiveness and care for a range of ages and women (Tong, pp. 7-16, 2009). As it addresses the growing needs of the older population and the stereotypes of gender care within family units (Tong, pp. 7-16, 2009). This also allows women to gain more freedom as women constantly have to take of the family and have low-paid professions, this also carries over in carrying for he elder care responsibilities so with this model and approach it allows care to be support to th older population without reinforcing gender inequalities, but then this assists with economic opportunities/growth as well (Tong, pp. 7-16, 2009).

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

Internationally, women are often expected to care for their families, so those who are ‘responsible’ are women (Tong, pp. 16-23, 2009). This of course has no expedition for elders with dementia, as it still falls onto women to care for them, that includes both paid and unpaid roles (Tong, pp. 16-23, 2009). This of course is all due to rooted, outdated and traditional gender norms (Tong, 2009). This work, is, unfortunately, not valued in society nor economically, as the amount for labor or respect is low (Tong, pp. 16-23, 2009).  Again this work is viewed as ‘not important’ as you see with the low wages, lack of social support, lack of support from society, and the amount of gender inequality that occurs as again most workers in the field are women who don’t get any recognition, let alone compensation (Tong, pp. 16-23, 2009).  This specifically matters for gender inequality with dementia care, as again globally it is women taking care of elders in this field for little to no pay, no recognition, and at the cost of their lives and aspirations (Tong, pp. 16-23, 2009).  Hence, Tong prescribes making a more even distribution of caregiving amongst men and women with such models and systems that Denmark and Norway have (Tong, pp. 16-23, 2009). Which, just like anything else, gender deeply shapes who provides care for dementia and elderly patients, along with how that care is valued or devalued (Tong, pp. 16-23, 2009). By having those models, systems, and recognition in place as mentioned in the previous answer, it reframes caregiving as a shared human and societal responsibility no matter gender, families or governments (Tong, pp. 16-23, 2009). This of course is perfectly showcased in Stella’s Aging and Dementia in Brazil article as well (Stella, 2019). Stella specifically reported statistics in regards to the issue as they present both issues as what Tong had also revealed (Stella, p.56, 2019;Tong, 2009). For Brazil specifically, daughters and daughters-in-law often provided unpaid dementia care that was costing them their personal and professional goals, alongside this, the emotional distress they endured was on average 60-70% (Stella, pp. 55-57, 2019). Older women who were often the caregivers as well were more prone to abuse as well, not to mention the low resources they would often be given even with being professional ‘paid’ workers (Stella, pp. 55-57, 2019). Again, this also strengthened what Tong was presenting and stating the issues were within a global scope of care for the elderly and dementia care (Stella, 2019; Tong, 2009).

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I would say that each culture influences how people with dementia are treated. In the CNN video, I found it interesting how the Netherlands created a facility specifically for people with dementia, allowing them to live a more normal and independent life. I believe that at this facility, residents can do many of the things they would if they did not have dementia and were not living in a care setting. The video showed that the patients can go shopping, listen to music, and engage in everyday activities. It also mentioned that everyone who works at the facility is specially trained to work with people who have dementia. I would like to note that while the United States does have nursing homes for people with dementia, to my knowledge, they are nothing like the facility featured in the video.

For my second question

I would say that the Restaurant of Mistaken Orders and Hogeway give people with dementia the chance to live their best lives. For example, the Restaurant of Mistaken Orders allows people in Japan who have dementia the opportunity to work. These approaches are important because they show people with dementia that they can still live meaningful lives and that others care about them.

The change the restaurant is creating is showing us that people with dementia can still work and give back to their community, even if they make mistakes. Hogeway shows that it's possible to create a space where people with dementia can live more freely and do everyday things, just like people without dementia.

Other cultures and nations can learn that people with dementia still have value and can contribute to society, as shown by the restaurant. I strongly believe that the United States could adopt the Hogeway model, because it seems that when people go into nursing homes here, they often feel lonely. At Hogeway, it seemed like people were truly living their best lives, even with dementia, like having the option to go shopping and engage in daily activities.

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Questions 1:

In the article Long term care for the elderly, the author talks about how the economic policy changes that should be able to improve care for the elderly people. Japan's long term care insurance system is a large one that is discussed in this article. This is a publicly funded insurance program that requires any citizen of Japan that is 40 or older to pay "premiums". When they reach 65, they become eligible to receive any care that may be needed for a elderly individual such as in home care, hospital care, and physical therapy or rehabilitation therapy. This system is really cool because it focuses on UHC rather than causing any financial crises'. It mkaes long term care way more sustainable and ensure that people have it at hand when needed. I really like how this insurance model allows for elderly people to be able to have institutionalized care as well as at home care allowing for them to age with less stress at hand while they are trying to heal and rest rather than worrying about the bills or what bills they can leave to family and friends after passing.

Question 3:

The article really focuses on the unpaid dementia care that is often done by the family and is gendered towards the women. Nurses, aids, and even doctors are globally/ the vast majority of women who take these roles. It's "Women's work" culturally. This falls on daighters, wives, and women (in-laws) often and goes unrecognized and is an obligation to care for family members who are ill. Taking care of someone when you feel obligated and culturally forced is really straining mentally and physically. While taking care of someone is already hard enough- having that obligation makes it harder than it has to be especially when dealing with someone with dementia which is extremely challenging in itself. The article concudes that sustainable dementia care is crucial and that needs recognition without the borders of men or women who care for the patients. The work is undervalued and invisible and if not addresses, it will continue to be an unfair burden to many women.

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2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

Culture plays a big role on how people with dementia are treated and cared for, as seen in examples from Brazil and Nigeria. To start, the two countries have a similar belief structure on what dementia is. This belief is the belief that the (dementia) symptoms shown in older people is simply just a byproduct of aging. This leads to families not taking those symptoms seriously and dismissing things that should be of concern. Next, some aspects of Nigerian culture paint those with dementia in a negative light, “There is a belief in Nigeria that if a person is known for doing evil things, such as being abusive to their children, stealing, or murdering someone, while they were younger, the person may be punished for his or her wrongdoing by the gods of the land or by God”. This influences the care and treatment that those with dementia receive- with people not wanting to take the proper steps towards keeping those with the condition safe, happy, and healthy because they view the condition as some sort of karma. This leads to how culture in religion also influences the treatment of care they receive- “Some Nigerians believe that praying for persons with dementia will be helpful in making them feel or become better. Some believe that in addition to the care provided for the persons with dementia, prayers and spiritual support from their religious leaders (e.g., pastors, priests) are important parts of caring for a person with dementia”. While people might have good intentions, this is harmful because it perpetuates dementia as something that can be easily “fixed”. People might believe that the person with dementia or their family aren’t praying enough, or their faith isn’t strong enough- causing even further stigma. Finally, both countries have similar viewpoints on the idea of nursing homes and have a strong culture around keeping family close and together. This can affect the person with dementia because those families don’t have as much in-depth education on what dementia is and how to properly take care of someone with the condition, which can harm them in the long run.

4. How are The Restaurant of Mistaken Orders and Hogeway innovative approaches to dementia care? Be specific. Why are these approaches important, what change are they creating? What can other cultures or nations learn from these approaches?

Restaurant: The restaurant of mistaken orders is an innovative approach to dementia care because instead of hiding those with the condition away, it creates a way for them to interact with the world & community around them. This is especially important because it gives them a sense of purpose and belonging when going through such a scary and stressful point in their lives. This is also important for people who have either little knowledge of the condition or those with negative preconceptions. By experiencing this point of view, general comments and sentiments on those with the condition can become better and create an overall better world for them to live in.

Hogeway: The village is also an innovative approach to dementia care because it carves out a space in a society that generally doesn’t work for them. By giving them this safe environment, it allows those affected to live a generally “normal” life and gives them more autonomy than if they were in a home. This is important because it allows for more possibilities for them to carry on with their favorite routines, activities, and even people. It gives the most respect, dignity, and compassion for them and honors the fact that they are a person first before they are a person with dementia.

Something that other cultures and countries can take from this is that these approaches work so well because they are made with the solid belief that those with dementia deserve to have the same quality of life as others without it. The approaches humanize their feelings, thoughts, behaviors, opinions, and actions. These approaches don’t try to hide or fix the condition, but instead find ways to safely navigate the challenges that come with the diagnosis.

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1. In the article “Long Term Care for the Elderly Worldwide: Whose Responsibility Is It?” Rosemarie says that caring for older people shouldn’t just have to end up falling on their families, especially the women in the family that are performing unpaid work to take care of their older relatives. She suggests that government agencies should put more money into help by funding places like more long term facilities. This would include the government paying for well trained caregivers and making sure that if older adults do not want to leave their homes, to be cared for, they do not have to. This would allow their families to lead their own lives and families without having to take care of everything on their own. Another suggestion was that the government should make it mandatory to deduct a small percentage from employees and employers payroll, so that the government is able to help fund these facilities and create more programs. An example of this sort of system takes place in Germany. They created this required long term care insurance program where employees and employers actually pay a little bit with every check. This money goes towards covering the cost for some elderly people home healthcare or if they choose to live in a nursing home. This option would also give financial support to their family members who have openly chosen to care for their older loved ones. Countries include places like Sweden and Denmark who also have government supported elderly care. This makes sure everyone gets the help they deserve, no matter if they can afford it or not. These kinds of changes are important because it does take a ton of pressure off of those families who have to do everything, and it shows the values in the training they put into those caregivers. So, it stops the notion that women can just take care of their older relatives, so that they choose to keep their jobs and they do not have to change their plans to fit in with caring for their family members. It also makes sure that the elderly are getting good, safe, and protective care from actual trained caregivers who know what they are doing. I have seen this far too often in my own family with my elderly family members. Just recently my cousins lost their mother. She had been a bit older and the two sisters took turns with their mother at their houses. It was a toll. They each had children and were married. They each had jobs and plans. I remember after the funeral talking to my cousin. She mentioned that one of the things she was excited about was taking a vacation. This was because they had sacrificed a lot of their personal time, in order to be caregivers.

2. Culture really does play a vital role in how people with dementia are treated because it shapes what families view as right and wrong. In some places, like the United States, taking care of older relatives at home is seen as the right thing to do, because placing them in a nursing home can be seen as ungrateful, disrespectful, and just overall wrong. People could even feel embarrassed and try to hide that their family member has dementia because of the stigma. So families don’t really talk about it or get professional help for them because they feel like they got it. In Nigeria, there is actually not even a real word for dementia in some of the languages that are local to them, people resort to  calling them mad and stupid. They believe it's just all a part of getting old or possibly even punishment for something bad the person did in the past. Because of that, families sometimes try to hide their older relatives who do have dementia so others will not judge them as much. Women in these families usually end up having to do a lot of the caregiving and the reason is because they feel guilty if they don’t take care of them, even though it’s very hard work and they don’t get much help because a lot of the work falls on to them. Brazilian families also prefer to keep their elderly family members at home with them because they feel a strong connection towards them, and nursing homes are usually really expensive and hard to afford for a regular working class family. There’s also not enough well trained healthcare workers or even actual clinics, especially in more remote or poorer towns. People who chose not to get an education may see memory loss as just a normal aging symptom and not realizing it could be something far worse like dementia. Women sometimes have to give up work, school, and any extra time to care for them. Families can get really stressed when dealing with symptoms like agitation, roaming around, or even as bad as hallucinations. Many families don’t know the training or how to get the support they need, making it even harder. Some families often worry about their elderly members being neglected in facilities, because some older people are at risk of being mistreated or abused, especially if they suffer from dementia.

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2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

Nigeria's indigenous languages don't even have a word for dementia. "Although none of the indigenous languages has a word for dementia, derogatory words like ara (mad) and nzuzu (unintelligent/stupid) are used to describe dementia symptoms that are mistakenly attributed to aging in general" (Nwakasi electronic page 2). They don't even have vocabulary for dementia and mischaracterize it as something that is attributed to all older individuals which isn't true.

"[S]ome Nigerians describe people living with dementia as witches or wizards, or they may believe dementia symptoms are some sort of punishment from a supernatural being. There is a belief in Nigeria that if a person is known for doing evil things, such as being abusive to their children, stealing, or murdering someone, while they were younger, the person may be punished for his or her wrongdoing by the gods of the land or by God" (Nwakasi electronic page 2).

Because of all this people with dementia are treated differently than they should be. For example, "These views about dementia may increase the risk of stigmatization (labeling people in a way that make them seem inferior). Stigma is a mark associated with disgrace or bad reputation, and it also can mean an unfair feeling of disapproval people have toward a thing or another person" (Nwakasi electronic page 2). They are stigmatized and aren't treated properly because of this.

People in Brazil also struggle with handling dementia. "In Brazil, specifically, a considerable challenge to diagnosing and treating dementia is a general lack of understanding about the condition and its complexities. Misunderstandings about the differences between age-associated cognitive changes and early dementia are common, even among health professionals" (Aging and Dementia in Brazil electronic page 3). Even Brazil associated early signs of Dementia with common "age-associated cognitive changes".

Brazil also says, "It is important to note that the health care system in Brazil is a public–private mix whereby a person’s ability to pay plays a major role in determining what care is accessible to them" (Aging and Dementia in Brazil electronic page 3).

So, in conclusion different cultures have different languages. Some of these languages don't have words for dementia. The differing levels of stigma around dementia also change with culture. Different cultures have different ways of identifying and treating dementia and different cultures have different ways of paying for dementia health care.

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

"Because many individuals—particularly women and many people in developing countries—may not be able to save enough to take care of themselves in their old age, and also because many governments may not be able to adequately fund long-term care for their aging populations, families will probably be asked to shoulder an increasingly large measure of the family members’ long term care needs (Parker and Dickenson 2001). However, because of weakening family structures worldwide (Pochagina 2003) and emerging intergenerational conflicts over scarce goods and services (Baifeng 2008), many young people may reconsider the extent of their obligations to elderly people" (Long-term Care for the elderly Worldwide: electronic page 13).

This paragraph shows that often women don't make enough money to have someone take care of them when they are older. This paragraph also states that young family members are often tasked with being "responsible" for caring for their older relatives.

"1) retirement income is linked to waged labor, which is itself gendered; 2) nonwaged reproductive labor, performed predominantly by women, is not recognized or counted under state policy as labor; and 3) retirement policy is based on a model of family status as married with male breadwinner (and with marital status as permanent rather than transient)" (Long-term Care for the elderly Worldwide: electronic page 17).

Money plays a factor in who can pay for healthcare when they get old and who can't. Money has historically been gendered against women. Women perform tasks such as childcare, which is very similar to elderly care. Historically neither of these types of labor have been recognized. Women aren't payed for childcare of their own children.

So, typically, mostly young (some older) female individuals, are tasked with taking care of their elderly relatives because it's not seen as that laborious, they practically do it with their own kids anyway, and they are considered to be the most empathetic of their family.

That's how gender plays a role in dementia and general elderly care.

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1. In the article, "Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?," the author suggests several economic, policy, and social changes that could improve care for older adults around the globe. Provide at least one example of these changes. Detail the suggested change, what country (or countries) have implemented it, and why it is important.

One policy change that I found to really standout what the use of publicly mandated long-term care insurance program, that started in 2000. This was made to possibly change social expectations as the responsibility of caring for elderly people in the respective families fell on the shoulders of the generation after them. This put a lot of stress on the younger generation as most people taking care of the elders in their family were working women (Tong, 2009). Unlike in Germany, Japan's program doesn't have cash payments as this is to avoid putting added stress on the daughters and/or daughters-in-law to not leave to the workforces to take care of the older generation and be there caregivers. Instead, the system is meant to offer professional care services, helping to increase professionalism with eldercare and to decrease the expectations for women to serve as caregivers to the older generation. This can shift the reliance of labor for long term care especially for women (Tong, 2009). This is an important model because it shows the culture and level of policy that is restructuring the responsibilities of caregiving and balances the need for care with gender equity and opportunities. Other nations can learn a lot from Japan's work to restructure care and societies expectations that are supported by public policy rather than just the family (Tong, 2009).

2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

When it comes to understanding how culture plays a role in how to understand dementia. In nigeria, dementia is quite misunderstood because of the lack of specific word in indigenous languages for this condition (Nwakasi). Instead, the older generation that show signs of mental decline may be identified with harmful terms such as “ara” (mad) or “nzuzu” (stupid) or even seen as being witches or being punished by a higher being for past mistakes much like karma (Nwakasi). The analysis of this culture creates a stigma and can prevent individuals from getting the care they need. Or even worse relatives with dementia may be hidden by families to avoid shame and keep down the belief that dementia happens when you age and discourage seeking medical treatment (Nwakasi). There is also hesitation for formal long-term care facilities such as nursing homes, which are seen as familial neglect. This leads to caregiving withing the family and it being given by mostly women without care of is they are prepared for it (Nwakasi). This example shows that there is a need for proper education about dementia to combat the harmful stigma to improve care and life for people with dementia through community support and policy changes.

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Germany introduced a mandatory long-term care insurance system in 1994. This program is funded through contributions from both employees and employers. It provides financial support for a range of care services, including both home-based and institutional care. People who qualify can choose between cash benefits allowing family members to provide care or professional services. This system helps reduce the financial burden on families and ensures that all citizens have access to necessary care, regardless of income. Later in 2000 Japan implemented its own long-term care insurance system. “Many Japanese women have entered the paid workforce and do not wish to leave it to provide full-time care for elderly family members.” (Tong). This is so women did not have to stop working to be full time caregivers. It is funded through a combination of user co-payments, government subsidies, and insurance premiums. The Japanese model emphasizes home and community-based care, helping elderly people keep independence for as long as possible. It also includes services like adult daycare, home visits, and caregiver support. “It offers benefits either in the form of home-based services provided by professional caregivers or cash subsidies that beneficiaries can use to pay familial caregivers.” (Tong). These models are important because they shift the responsibility of elder care from individual families to society. By making care more accessible and affordable, they improve the quality of life for older adults and reduce caregiver stress. They also serve as examples for other countries looking to prepare for aging populations through more inclusive and sustainable care systems.

Culture has a strong influence on how people with dementia are treated and cared for. In the article “Cultural Views of Dementia in Niagara” by Candidus Nwakasi, Nwakasi explains how different cultural groups in Niagara understand and respond to dementia differently. Many immigrant families especially from African, Caribbean, and South Asian backgrounds often see dementia symptoms as a normal part of aging, rather than a medical issue. Because of how people may believe it may cause families to delay seeking professional help. In these cultures, it is also common for families to care for loved ones at home instead of using nursing homes, because of the cost. “The older a person gets, the higher the risk of this progressive, cognitive condition, but because Nigeria is a young population with a life expectancy at birth of about 55 years, issues of older adults such as geriatrics and long-term care are not given much attention. In addition, the country’s health care system is very weak, and with the burden of diseases it carries, most health care costs are paid by patients and their families.” (Nwakasi). With how weak the economy is in Niagara it is harder for people to seek medical attention because the cost falls on the patients and their families. Also, with how long the predicted lifespan is it is harder to find long term care for older patients. Language barriers and a lack of culturally resources also make it harder for these families to get the help they need. In the article “Aging and Dementia in Brazil” by Florindo Stella, Jouce Gabriela de Almeida, and Paulo Renato Canineu, the authors show how cultural factors affect dementia care in Brazil. In many areas, people do not have access to doctors who can diagnose or treat dementia. “In Brazil, specifically, a considerable challenge to diagnosing and treating demen- tia is a general lack of understanding about the condition and its complexities.” (Stella, Almeida, and Canineu). With the lack of knowledge doctors have in Brazil it makes it harder to for them to understand it it is dementia or old age. Some families believe memory loss is part of aging, so they do not seek help early. Many rely on family or community support instead of formal healthcare.

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2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

The provided text examines how culture influences the treatment and care of individuals with dementia, with a focus on Nigeria and the United States. It highlights cultural perceptions, language, societal beliefs, and traditional practices that shape responses to dementia. Dementia is a range of symptoms marked by a decline in cognitive abilities, including memory loss, difficulty communicating, impaired reasoning, and trouble with decision-making and problem-solving. People with dementia often forget recent events or familiar faces and may struggle with communication, such as finding the right words or following conversations. Their reasoning and judgment can also be compromised, making decision-making difficult. Problem-solving skills tend to decline as well, which can make managing complex tasks, such as finances or planning outings, overwhelming. These symptoms vary in intensity and tend to worsen over time, increasingly impacting an individual's ability to live independently (Nwakasi, p. 1). In Nigeria, cultural beliefs and societal attitudes play a significant role in how dementia is perceived and managed. Some elders with dementia may be seen as cursed or punished by supernatural forces, leading families to hide their condition or avoid seeking medical help due to stigma or fear. Cultural factors such as the absence of a specific word for dementia, the use of derogatory terms like ara (meaning "mad") and nzuzu (meaning "stupid"), and supernatural attributions significantly influence perceptions and care. For instance, some Nigerians believe that those with dementia are witches or wizards, or that their symptoms are divine punishment. Traditional healing practices, including praying for persons with dementia and spiritual rituals, are often sought alongside or instead of medical treatment, reflecting a blend of cultural and spiritual beliefs. In contrast, in the United States, awareness and medical understanding of dementia are generally higher, with a focus on early diagnosis, medical intervention, and support services. However, cultural diversity within the U.S. also influences perceptions and care, with different communities holding varying beliefs about aging and mental health, which can affect how families respond and seek help. For example, some communities may view dementia as a regular part of aging and therefore avoid seeking medical assistance. In contrast, others may rely heavily on traditional healing practices instead of modern medicine. Another example is the belief that if a person acts wrongly in youth, they will be punished by the gods later in life, which can create stigma. These cultural views often lead to shame, family abandonment, and reluctance to seek help publicly. Overall, in the United States, there's generally greater awareness about dementia, and more efforts are made to educate families and communities about medical explanations, reducing stigma (Tong, p. 6). However, even in the U.S., cultural beliefs and language can influence how care is provided, especially in immigrant communities where traditional beliefs might coexist with Western medical practices.

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

The article, “Long-term Care for the Elderly Worldwide,” examines how gender influences dementia care across different cultures. Traditionally, women have borne the primary responsibility for caring for the elderly, including those with dementia. For example, in Japan, long-term care is often considered a duty of female family members, such as daughters and wives, who are expected to provide emotional support, medical assistance, and daily living help (Tong, p. 1). Similarly, in India, women typically serve as the primary caregivers for elderly relatives, often sacrificing their own careers and personal aspirations to provide essential home-based care, which includes managing medications, assisting with mobility, and coordinating medical appointments. In Nigeria, women are predominantly responsible for community-based care, often balancing these duties with household chores such as cooking and cleaning, which adds to their overall workload (Nwakasi, p. 3). However, increasing workforce participation among women seeking independence is gradually changing these traditional expectations, affecting dementia caregiving strategies globally. This demographic transition is particularly significant given the rising elderly population and the declining number of younger generations, resulting from lower birth rates. Women constitute many dementia caregivers worldwide, influenced by societal gender roles, cultural expectations, and workforce involvement. As women become increasingly active in the workforce across regions such as Latin America, Southeast Asia, Europe, and North America, caregiving roles and formal support systems are likely to evolve. Demographic data also indicate a growing caregiving burden; by 2050, the number of U.S. workers supporting retirees is expected to increase substantially, placing additional strain on families and healthcare systems. Similarly, in some European countries, there will be only two working-age individuals available per elderly person, highlighting the demographic challenge. This shifting landscape has major implications, especially since women, as the primary caregivers, are disproportionately affected psychologically, physically, and economically (Tong, p. 8). Consequently, there is an urgent need for gender-sensitive policies to support caregivers, provide them with adequate resources, and address disparities in dementia care. The Danish government exemplifies this approach by emphasizing social inclusion for older people and women of working age, and by implementing measures such as paid caregiving leave, social services, and community support programs. This strategy highlights the gender dynamics in caregiving, particularly for those with dementia, where women often shoulder a disproportionate burden of unpaid care responsibilities, which can impact their mental health, employment, and financial stability (Tong, p. 16). The text emphasizes the importance of balancing men's roles in paid work and caregiving, arguing that caregiving virtues are vital to societal cohesion and meaningful life (Tong, p. 17). It advocates for creating conditions that enable men to develop as better caregivers and highlights the need for increased male participation in domestic life, alongside encouraging women's continued workforce engagement.

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Brooke Fishback’s Answers to Questions 2 & 3

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Brooke Fishback’s Answers to Questions 2 & 3

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2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

Culture influences everything that we do. From how you are raised, to the type of family structure you were born into, to the type of government you live in. Throughout the articles, the main focus was on dementia patients and how families were to be involved with caring for these members. Depending on the culture you come from, this became different answers. In cultures where family is a core value, members were expected to care for their elderly. An example is in Scandinavia where “Scandinavians pride themselves on their firm adherence to the principle of solidarity according to which they have a collective responsibility to provide care for their most vulnerable members; the very young, the elderly, the disabled, the infirm, and so on”(Tong, 2009 pg.7). Other countries like Mexico fall under this expectation as well. Tong says, “Mexicans recognize taking care of the elderly, sick, and poor as the social responsibility of the family”(Tong, 2009, pg.10). These type of cultures value the relationship with their elders and feel obligated to help them, wether its from how they were raised or how they feel the need to give back to their parents since their parents took care of them as children. This could also lead to guilt toward the children if they are not in a place to care for their parents. This can then lead to the question “if most people worldwide believe that parents or parental figures have primary responsibility for the care of their young children, then why should there be any question about wether adult children have the primary responsibility to care for their elderly parents”(Tong, 2009, pg.16)? In other countries, if a family member can’t care for their elders themselves and have to put them in a nursing home, people make assumptions on the whole family. Nwakasi explains that if putting a loved ones in “nursing homes in Nigeria or putting one’s parents in a nursing home is culturally frowned upon by and unacceptable to many Nigerian families. Largely due to their general respect for elders. Nigerians believe strongly that putting one’s parents in a nursing home is disrespectful”(Nwakasi, pg.147). Many chose to help their parents due to obligation and to not disgrace their family, however it can take a toll on the caregivers as well and impact the care that people with dementia need.

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

Gender plays a big role in caring for the elderly and patients with dementia around the world. Women are generally the ones being forced to take care of their elders due to culture and how the government works. In today’s world, women are still seen as the caregiver in the family. “Nigerian women are more likely than men to become caregivers for their parents or relatives with dementia. They assume the role of caregivers for their parents, and if they are married, in the absence of sisters-in-law, they may also become caregivers for their husbands’ parents with or without dementia” (Nwakasi, pg.147). This could be from the cultural aspect of being obligated to help their families out of respect. One of the reasons why women have to care for their elders is because “many individuals—particularly women and many people in developing countries— may not be able to save enough to take care of themselves in their old age, and also because many governments may not be able to adequately fund long-term care for their aging populations, families will probably be asked to shoulder an increasingly large measure of the family members’ long term care needs”(Tong, 2009, pg.16). Due to the fact that men are also seen as the breadwinners, women are able to provide care when needed. Tong says that women are seen as “society’s primary caregivers and men as society’s primary workers”(Tong, 2009, pg.20). This explains how the culture and society play a role in how gender influences dementia care. In addition, the government plays a role by providing a retirement policy to help with elder care, however your marital status affects the income one gets to be able to provide care. This also impacts women, because when they are forced to become caregivers through obligation, they have to put their lives on hold and “giving up personal interests such as study, professional jobs, and leisure” (Stella, et. al , pg.55-56). If these women have jobs, they leave the workforce and their pay to help their elders. I think most of the world has this same mindset of women being able to drop everything and their desires in order to help others. This influences women’s lives and puts pressure on them to make the decision to help their elders, simply based on cultural aspects and the expectations that come with that.

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1. In the article, "Long-Term Care for the Elderly Worldwide: Whose Responsibility Is It?," the author suggests several economic, policy, and social changes that could improve care for older adults around the globe. Provide at least one example of these changes. Detail the suggested change, what country (or countries) have implemented it, and why it is important.

2. How does culture influence how people with dementia are treated and cared for? Provide specific examples from the readings/media.

3. How does gender play a role in dementia care around the world? (Hint: Think about who is "responsible" for care work and how care work is viewed, as discussed in the conclusion of "Long-Term Care for the Elderly Worldwide.")

4. How are The Restaurant of Mistaken Orders and Hogeway innovative approaches to dementia care? Be specific. Why are these approaches important, what change are they creating? What can other cultures or nations learn from these approaches?