Labour Markets,Care Regimes and Foreign Care Worker Policies in East Asia

This article analyzes the politics of foreign care worker policies in Japan, Korea and Taiwan. In the face of socio‐demographic challenges, these countries have responded differently to the increasing demand for hiring foreign care workers, creating distinct policies with respect to the origins of the foreign care workforce, the size of the foreign care workforce in the labour market, and job specifications. In this article, I argue that the interaction of female employment patterns, the public provision (or lack) of social care, and labour market policies in the care service sector determines the diverging political pathways of foreign care worker policies in these three countries over the past two decades.     

Marketisation policies in different contexts: Consequences for home‐care workers in Germany,Japan and Sweden

Market‐oriented restructurings of long‐term care policies contribute significantly to the aggravation of care workers’ situations. This article focuses on the effects of broader long‐term care policy developments on market‐oriented reforms. Germany, Japan and Sweden are three countries that have introduced market‐oriented reforms into home‐based care provision embedded in distinct long‐term care policy developments. Conceptually, this article draws on comparative research on care to define the institutional dimensions of long‐term care policies. Empirically, the research is based on policy analyses, as well as on national statistics and a comparative research project on home‐care workers in the aforementioned countries. The findings reveal the mediating impact of the extension and decline of long‐term public care support and the corresponding development of the care infrastructure on both the restructuring of care work and the assessments of the care workers themselves.     

Deregulation,workplace, and women: Nurses in private health care in India

The paper examines the growth of private health care in India in the context of its regulatory provisions and questions the work and employment conditions of female care workers (nurses) employed there. Nurses constitute 80% of the total workers in each nursing home/hospital. In the wake of increased demand for private health care since mid‐1990s, insertion of technology and investment is inducing transformation of nursing homes into multi‐ and super‐speciality hospitals resulting in changes in work organization of nurses. This has led to demand for larger numbers of workers. Employers gain by the segmentation in the nursing labor market, paying low wages. Workers face widespread social discrimination, long working hours, and high work intensity. The deplorable situation of a significant section of workers employed in this sector indicates state failure to control the private health sector. Lack of effective standards of work impacts nature of work of the workforce employed in various levels in the healthcare system.     

The Challenge of the Care Workforce: Recent Trends and Emerging problems

This paper examines the paid care workforce in community services in Australia. Focusing on people employed in direct service delivery roles, I use unpublished data from the Censuses of 1996 and 2001 to document some important characteristics of the care workforce in community services, in which a large minority of care workers are employed in this country. International research has established that paid care workers suffer considerable labour market disadvantage. The paper presents evidence of deinstitutionalisation, deprofessionalisation, functional underemployment, and relatively poor pay for care workers in community service industries, which suggests that problems identified in other English‐speaking countries are also evident in Australia. I conclude by discussing the policy implications of these trends, and by raising some questions for workforce planning.     

Older Women Doing Home Care: Exploitation or Ideal Job?

The increased need for both personal assistance workers and meaningful employment opportunities for older workers results in growing numbers of older home care aides. This study examined lifetime financial security and perceived advantages of older age in this field through interviews with 31 older home care aides. Study participants experienced high levels of financial insecurity and perceived older workers as particularly well suited to the home care job. The consequences of this low-wage, low-status work are explored along with implications for social workers to advocate for improved conditions for these workers providing essential care to frail elders.     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Same same but different? Comparing institutional performance in the long-term care systems of Japan and South Korea

Responding to a rapidly aging population, Japan and South Korea introduced social insurance-based long-term care systems (LTCSs) in 2000 and 2008, respectively. Korea studied and took up key features of Japan's system while evolving along its own trajectory in line with its healthcare system. The aim of the present study is to unpack the broad category of ‘social insurance’ to explore how distinct system inputs and designs in Korea and Japan related to outcomes in performance measured in terms of coverage, quality of care, and sustainability. In doing so, the study serves as an important starting point for advancing a new stream of social policy research on the comparative performance of LTCSs. Our findings demonstrate that despite adopting a common system type, differences in implementation of the social insurance model (particularly in terms of financing and governance) contributed to divergent performance, with Japan outperforming Korea on most indicators during the observed period. This bears contrary implications for policymaking in the two countries: Whereas Japanese policymakers are faced with the challenge of promoting quality while containing spending, in Korea greater investment is required to strengthen the workforce and build up community care.     

Migrant Care Work Going Dutch? The Emergence of a Live‐in Migrant Care Market and the Restructuring of the Dutch Long‐term Care System

In recent years, a live‐in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long‐term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live‐in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash‐for‐care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. Our findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change.     

The Development of Korea's New Long-Term Care Service Infrastructure and Its Results: Focusing on the Market-Friendly Policy Used for Expansion of the Numbers of Service Providers and Personal Care Workers

One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.     

Family Policies in Germany and France: The Role of Enterprises and Social Partners

Although France and Germany are commonly classified as Bismarckian welfare regimes, they differ significantly in terms of family policy. For a long time, social and family policy in (West) Germany was focused on the male-breadwinner model of married couples. This was based on the expectation that women, in particular married women with children, would withdraw from the labour market permanently, or at least temporarily. Whereas care by mothers was massively subsidized by state family policy, the expansion of the childcare infrastructure was neglected and progressed only very slowly compared to the situation in many other countries of Europe. France, on the contrary, is one of the European countries where childcare services are particularly widespread, giving mothers the option to combine paid work and motherhood. Nevertheless, significant changes are happening in both countries. Concern over the demographic trends and low birth rates (in particular in Germany) have refocused attention on family policy in recent years. In Germany, it has now become a key field of debate and policy, and new actors have appeared on the scene. This article proposes to compare the latest developments in both countries, highlighting the contribution of enterprises and social partners to work–life balance, re-analysing the different types of familialism characterizing both countries.     

Social care and migration policy in Australia: Emerging intersections?

Migrants are important both as providers and users of paid care services in Australia, yet migration has rarely featured in Australian strategies to grow and sustain the paid care workforce. Correspondingly, Australia is rarely mentioned in the international scholarship on care and migration that has burgeoned since the 1990s. This article shows the ways that service providers, consumer advocates, unions and scholars have begun to bring migration into debates about workforce growth in two of Australia's most significant areas of paid care: aged care and childcare. Drawing on submissions to national enquiries in both areas, we identify the actors who have sought to adjust Australia's migration settings to respond to growing demand for care, and explain the rationales – which differ between the sectors – underlying their advocacy for change.     

Cash for care and care employment: (Missing) debates and realities

The introduction of cash‐for‐care (CfC) schemes in different European countries over the last years has responded to a plurality of strategies aimed at attending the rising demand and increasing costs of the long‐term care needs of an ageing population. The specific system of care provision in each country shaped the response given to those challenges, as well as the room for manoeuvre for policymakers when trying to transform the domain of care into a sphere where markets may play a larger role, partly relieving families, and also the state, from these responsibilities. Policy debates and scholarly analyses largely overlooked the contribution of these schemes to the creation and shaping of employment. This article provides a comparative analysis of how CfC‐based policies entail—alongside the regulation of informal care—a(n implicit or explicit) connection with care employment and may contribute to structuring employment relations in this sector. It looks jointly at the specific features of CfC and at the institutional context—welfare regime—in which they are embedded in order to assess the extent to which these schemes contributed (generally unintendedly) to a transformation of the care employment size and features in seven European countries.     

Active Ageing Index in Korea – Comparison with China and EU countries

The evidence‐based policymaking relies on the use and robustness of the available data. Many conceptual and operational difficulties restrict this process, not least in making use of evidence to identify policy priorities. The Active Ageing Index (AAI), developed originally for the 28 European Union countries, offers a strong motivation in this respect. This paper reports on the development of the AAI for Korea, a country where speed and level of population aging is among the highest in the world. Drawing on the comparative analysis of the AAI results for Korea, China, and European countries, we find that Korea's AAI (35.3) is higher than the average of the AAI for all EU countries (33.9) but lower than China (37.3). Fitting Korea into the overall ranking with the EU countries and China (ranked 7), Korea is ranked 11, just behind Germany (10). The AAI results in Korea show that the employment domain performs extremely well compared with the EU countries, but other domains, especially “Social participation” and “Independent, healthy and secure living,” are achieving less favorable outcomes. High employment among the current cohorts of older workers in Korea can be attributed largely to the constraints of low pension income status.     

The Effects of Marketization of Long-term Care Services for Older Adults in Korea

To cope with the rapid increase in aging population, the South Korean government introduced new long-term care insurance in 2008 by using the market forces and mechanisms of competition and choice. The study explored the effect of the marketization of long-term care (LTC) services on the provision of services under the Korean long-term care insurance (LTCI) system. By adopting qualitative semi-structured in-depth interview methods, the experiences of 17 home visiting service provider managers were examined. The study results suggest that the marketization of LTC services faces several challenges. Some of the stakeholders in the field, such as home visiting service providers, care workers, and older clients, appear to employ unlawful activities or unprincipled behaviors to maximize their individual interests. The results also suggest that the unprincipled behavior, unlawful activities, and financial problems that service providers face contribute to low quality care services. Future studies should explore these issues using larger samples of service users and providers.     

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash P, Shih Y.‐C. Introducing social insurance for long‐term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long‐term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform. Key Practitioner Message: ?Emphasizes the importance of policy learning from other environments; ?Highlights the need for a strong regulatory and provider infrastructure for delivering long‐term care services; ?Emphasizes the need for training, support, and appropriate regulation of the long‐term care workforce.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.     

Public health care in the balance: exploring popular support for health care systems in the European Union

Which factors explain intra‐ and inter‐country variations in levels of public support for national health care systems within the European Union, and why? We propose that public opinion towards public health care is dependent on (1) the type of welfare state regime to which the various European welfare states belong, (2) typical features of the national care system and (3) individual social and demographic characteristics, which are related to self‐interest or morality oriented motives. To assess the explanatory power of these factors, data from the Eurobarometer survey series are analysed. Support for public health care appears to be particularly positively related to social‐democratic attributes of welfare states, whereas support drops with increasing degrees of liberalism and conservatism. Further, support for public health care proves to be associated with wider coverage and public funding of national care services. We also find higher levels of support in countries with scarce social services for children and the elderly, and larger proportions of female (part‐time) employment. Lastly, with respect to individual characteristics, we find remarkably little evidence for self‐interest oriented motives affecting the preference for solidary health care arrangements.     

Organization and Supply of Long‐term Care Services for the Elderly: A Bird's‐eye View of Old and New EU Member States

This article provides an overview of the organization of formal long‐term care (LTC) systems for the elderly in ten old and 11 new EU member states (MS). Generally, we find that the main responsibility for regulating LTC services is centralized in half of these countries, whereas in the remaining countries, this responsibility is typically shared between authorities at the central level and those at the regional or local levels in both institutional and home‐based care. Responsibilities for planning LTC capacities are jointly met by central and non‐central authorities in most countries. Access to publicly financed services is rarely means tested, and most countries have implemented legal entitlements conditional on needs. In virtually all countries, access to institutional care is subject to cost sharing, which also applies to home‐based care in most countries. The relative importance of institutional LTC relative to home‐based LTC services differs significantly across Europe. Although old MS appear to be experiencing some degree of convergence, institutional capacity levels still span a wide range. Considerable diversity may also be observed in the national public–private mix in the provision of LTC services. Lastly, free choice between public and private providers exists in the vast majority of these countries. This overview provides vital insights into the differences and similarities in the organization of LTC systems across Europe, especially between old and new MS, while also contributing valuable insight into previously neglected topics, thus broadening the knowledge base of international experience for mutual learning.     

Public investment in care services in Turkey: Promoting employment & gender inclusive growth

Recent policy debates on macroeconomic tools to counteract the prolonged global economic recession point to the potential of fiscal policies with appropriate sectoral targets for simultaneously boosting effective demand while alleviating inequalities through employment generation. This paper contributes to the debate by pointing to the social care services sector –in particular early childhood education and care (ECEC) — as an effective target of fiscal spending for robust employment generation and gender inclusive growth. We use a macro-micro simulation model to examine the aggregate and gender employment impact of increasing public expenditures on ECEC services, an underdeveloped sector in Turkey versus physical infrastructure and construction, a common target of stimulatory spending. Our methodological approach combines input-output analysis on aggregate employment effects with a statistical microsimulation approach to assess distributional outcomes. We find that an expansion of ECEC services creates not only significantly more jobs but also does so in a more gender-equitable and fiscally sustainable way than the a construction boom.