Cash for long‐term care: Policy debates,visions, and designs on the move

Cash‐for‐care (CfC) schemes have introduced a key transformation in long‐term care policies across Europe since the 1990s. The article explores the extent to which CfC policies have changed over time and into which directions, the ways in which change (if any) has occurred and the forces underlying it. By combining the literature on institutional change with ideational approaches, the article focuses on policy theories and policy designs, on modes of change and factors pushing for change within the CfC policy, and in the long‐term care and neighbouring policy fields. In doing so, we aim to contribute to understanding institutional change and the transformation of an increasingly important sector of the welfare state.     

The turn to optional familialism through the market: Long‐term care,cash‐for‐care,and caregiving policies in Europe

Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care.     

Unemployment and conditional welfare: Exclusion and belonging in immigrant women's discourse on being long‐term dependent on social assistance

Long‐term unemployment with dependency on social assistance in Sweden has increased and is particularly high among foreign‐born persons. The present study explored immigrant recipients' experiences of being welfare reliant. Swedish‐Iraqi women's construction of exclusion and belonging in relation to policies and welfare regulations was scrutinised. The women referred to unemployment with frustration, expressing that it renders dependence on social welfare and enforces adherence to the stipulations of the social services. The individual's mobility and agency are restricted and concerted efforts to obtain employment are futile, which increase the sense of exclusion. However, the entitlement to social assistance also engenders feelings of belonging, of being connected to and cared for by the new country. More research is needed to examine the role that social assistance regulations play in forming feelings of belonging and exclusion. It appears essential that political initiatives be taken to reverse the trend of high unemployment among foreign‐born persons.     

Youth‐oriented active labour market policies and economic crisis: Explaining policy effort in Greece and Portugal

The starting point of this study is the implementation of seemingly similar youth‐oriented labour market policies in Greece and Portugal. Both countries have suffered high youth unemployment rates and have been pressured to restructure their labour market as part of the rescue programmes adopted during the European sovereign debt crisis. Despite convergence in terms of policy trajectories, there is a significant divergence in employment outcomes. In Portugal, youth‐oriented policies were better‐targeted and structured. Their implementation has been more effective and has involved the social partners from the outset of the crisis. In Greece, policy design failures, administrative weaknesses and unfavourable macroeconomic conditions have limited the dynamics of youth‐oriented policies thus increasing youth insecurity. Τhe analysis suggests that convergence in policy content can be compatible with divergence in terms of outcomes.     

Employers' attitudes towards long‐term unemployed people and the role of activation in Switzerland

Over the last few years, most OECD countries have extended their activation policy to new groups of non‐working people, including the long‐term unemployed (LTU). However, it is widely known that employers tend to regard LTU people as potentially problematic persons. This is likely to constitute a major obstacle for long‐term unemployed jobseekers. On the basis of a survey among employers in a Swiss canton (N = 722), this article aims to shed light on the perception employers have of the long‐term unemployed and whether this may matter for their recruitment practices. It also asks what, from the employer point of view, may facilitate access to employment for an LTU person. A key finding is that large companies have a worse image of the long‐term unemployed and are less likely to hire them. Furthermore, independent of company size, a test period or the recommendation of a trustworthy person is seen as the factors most likely to facilitate access to jobs for LTU people.     

Unheard voices,unmapped terrain: Care work in long‐term residential care for older people in Canada and Sweden

Daly T, Szebehely M. Unheard voices, unmapped terrain: care work in long‐term residential care for older people in Canada and Sweden This article aims to contribute to comparative welfare state research by analysing the everyday work life of long‐term care facility workers in Canada and Sweden. The study's empirical base was a survey of fixed and open‐ended questions. The article presents results from a subset of respondents (care aides and assistant nurses) working in facilities in three Canadian provinces (n= 557) and across Sweden (n= 292). The workers' experiences were linked to the broader economic and organisational contexts of residential care in the two jurisdictions. We found a high degree of country‐specific differentiation of work organisation: Canada follows a model of highly differentiated task‐oriented work, whereas Sweden represents an integrated relational care work model. Reflecting differences in the vertical division of labour, the Canadian care aides had more demanding working conditions than their Swedish colleagues. The consequences of these models for care workers, for older people and for their families are discussed.     

Trends in long‐term sickness absence in Sweden 1992–2008: the role of economic conditions,legislation, demography,work environment and alcohol consumption

Lidwall U, Marklund S. Trends in long‐term sickness absence in Sweden 1992–2008: the role of economic conditions, legislation, demography, work environment and alcohol consumption Int J Soc Welfare 2011: 20: 167©179 © 2010 The Author(s), International Journal of Social Welfare © 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. In Sweden, absence from work because of illness or injury has fluctuated considerably over time. This study aimed to identify potentially important factors behind variations in long‐term sickness absence. Aggregated data were used to assess factors correlated with the number of ongoing cases of sickness absence lasting more than 59 days. Trends were analysed using statistics from national social insurance records, labour force surveys and other official statistics. Although specific changes in the degree of generosity in the sickness insurance scheme were important in some cases, the results showed no consistent associations for the study period 1992–2008. Men were generally more sensitive to macroeconomic factors than women. Furthermore, compared with earlier findings, workforce composition had less impact on variations in long‐term sickness absence. Notably, public health indicators such as alcohol sales and working conditions were clearly related to long‐term sick leave during the period under investigation.     

Coping with long–term unemployment: economic security, labour market integration and well–being. Results from a Danish panel study, 1994–1999

On the basis of a Danish panel study of the long–term unemployed 1994–1999, the article challenges core premises underlying labour market reforms, assigning too high a priority to work and work incentives, and too little priority to social protection. Economic hardship has become widespread among long–term unemployed even in Denmark, and this is a more serious threat against well–being than unemployment as such. Generous social security, denounced as 'passive support', enables the unemployed to cope with their situation, and there are no signs of any 'dependency culture'. Incentives in terms of economic hardship may stimulate active job seeking but the panel study reveals that it has no positive effect on subsequent labour market integration.     

Coordination of legislative speech in times of crisis: Youth unemployment and debates on redistributive policies in the Swedish Riksdag, 1994–2014

Parliamentary debates and the discussion on different law proposals are a key part of the process of policy making. We argue in this article that a high economic problem pressure in the region an MP represents will affect the MP’s legislative speechmaking. We also hypothesise that parties tend to coordinate their speakers in parliament to display a cohesive profile in the domain of labour, employment and immigration issues, i.e., in issue areas which reflect redistributive policies that are highly salient for almost all parties. We evaluate our expectations based on an analysis of Swedish parliamentary debates on labour, employment and immigration policy during the period between 1994 and 2014. The findings show that parliamentary parties coordinate speechmaking: Those MPs who represent economically troubled districts are less likely to appear in plenary debates, as well as MPs who deviate programmatically from the party line.     

Older Persons’ Views on Using Cash‐for‐Care Allowances at the Crossroads of Gender,Socio‐economic Status and Care Needs in Vienna

The article aims to contribute to understanding social inequalities resulting from familization (or de‐familization) tendencies among cash‐for‐care beneficiaries in a Conservative welfare state. It highlights justifications for choices in accessing and using care in a cash‐for‐care scheme from the perspective of care recipients aged 80 years and older in Vienna. Along key dimensions characterizing care recipients’ experiences, we identify four different user groups, which reflect recipients’ individual characteristics, particularly gender, socio‐economic status (SES), and care needs, and the respective care arrangement. The groups are dubbed: (1) the self‐confident; (2) the illiterate; (3) the dependent; and (4) the lonely. Narrative interviews with 15 frail older people were held in 2014 and analyzed using the framework analysis method. Results show that familiarity with support structures associates with higher SES, while those who depend on others for acquiring information or organizing care express ambivalence in choosing between formal and informal care. Engagement in deciding which care type to use is limited among people of lower SES or with complex care needs, but own experience as informal caregiver for a family member increases care recipients’ long‐term care (LTC) system literacy. Gender differences among care recipients were limited, yet middle‐class female recipients often expressed normative claims for family care from female relatives. We conclude that unconditional care allowance schemes may reinforce existing gender relations, particularly among informal caregivers, as well as underpin socio‐economic differences among LTC users in old‐age. Results also partly question the assumptions of choice and empowerment implicit in many cash‐for‐care schemes.