Devolution and Aging Policy
Edited by Francis O. Caro, PhD and Robert Mom's, DSW; 2002; New York: The Hawthorn Press; 274 pages; hard cover; $49.95.
Devolution is the current pattern of decentralizing governmental responsibilities for social problems from a federal to state and local arenas. This edited book begins to address the needs of U.S. older adults in this changing social policy environment. The collection of 14 articles (co-published in the Journal of Aging & Social Policy, Vol. 14, No. 3/4, 2002) explores devolution in five areas: implementation of established federal-state programs; innovation within established federal-state programs; the National Alzheimer's Disease federal demonstration to stimulate service development within states; public sector, state, and local initiatives; and private sector initiatives. Although some of the chapters' perspectives clearly lean against devolution, taken together, the book provides a thoughtful dialogue about the current and potential risks and benefits of this policy shift.
Though grounded in a social work and social policy perspective, this book is important and useful for gerontological nurses. It provides a useful historical context of the shifting patterns of elder care from a family obligation to a federal social contract (i.e., 1935 Social Security Act and 1965 Medicare and Medicaid health care amendments) and the current shift to state responsibilities. State to state variability, elder care equity, continuity and consistency of formal elder services, incongruity of a medical disease paradigm with healthy aging and older adult competence, and program effectiveness are some of the embedded issues critical to gerontological nursing. Although this book does not incorporate nursing science or a nursing perspective, it does provide a useful overview of the current social and health policy shifts that may inform nursing. For example, how does nursing science and the profession of nursing inform and provide for the care of well and chronically ill older persons during this policy shift? How might nursing science and nurses influence policy to promote quality of care for older adults during this dynamic, and thus opportune time, for paradigmatic, programmatic, regulatory, and procedural changes?