The withdrawal of the welfare state: Elderly care in Sweden in the 1990s

In Sweden, clear changes in the care of the elderly have occurred during the 1990s, with fewer people being provided public care, although greater efforts are now directed towards those most in need of help. Elderly people are cared for increasingly in other ways: by the family, by means of market-provided care, and by voluntary and informal means. Differences between municipalities are considerable. A comparative study was conducted in eight Swedish municipalities, four of them characterized by extensive reorganization of home-help services, and the other four constituting a reference group where such changes had not occurred. The aim was to examine processes of setting local priorities and adjustments in a period of marked structural change. Interviews with local politicians, administrators, professionals, and union representatives, and with the elderly themselves, were the main sources of data. The process of determining the extent and content of home care services in the municipalities was found to be a complex process, one involving a number of partly interdependent factors. Restructuring was found to be greatest in the context of a traditionally strong reliance on home-help services, rather than in the context of institutionalized care, where administrative decision-making and a medical and rehabilitative perspective dominated.     

Housing problems experienced by recipients of child welfare services

This study uses data on the experiences of families involved with child welfare services to examine the nature of housing problems and needs among these families and whether housing status affects case outcomes. First, the article describes the housing difficulties faced by two distinct child welfare service populations: families receiving voluntary in-home services and families with children in court-ordered out-of-home care. Second, the study demonstrates the relationship between housing problems and the likelihood of family reunification for children in out-of-home care. The findings have implications for the delivery of child welfare services and the provision of housing assistance to low-income families with children.     

Scandinavian Contrasts and Norwegian Variations in Special Housing for Older People

De-institutionalization is a general trend for Scandinavian long-term care over the last decades. Denmark and Sweden have taken this trend a step further than Norway has, as Denmark suspended institutional care altogether in 1987 and Sweden in 1992. Since then, residential care has been provided to individuals in special housing in various forms. This housing is in principle “independent housing,” where residents are tenants and are provided services according to needs and not sites. This article concentrates on the Norwegian variations to this system, as this is the only country of the 3 that still provides residential care under 2 “regimes,” an institutional care regime and an assisted housing regime. Is assisted housing essentially different from institutional care, or is it better described as old wine in new bottles? The latter may be the case for Sweden, whereas Denmark stands out as having the most housing-oriented care model. Institutional care (i.e., nursing homes) still dominates in Norway, where assisted housing is merely a minor supplement to institutional care in most municipalities. The article explores the reasons for these trends and, in particular, the reasons for the Norwegian resistance to assisted housing as an alternative form of residential care.     

Coordinating co-production in complex network settings

This article draws together the concepts of network management and co-production with complexity sciences. So far, these approaches have rarely been connected in research literature. We suggest that this conceptual framework offers new insights for analyzing the challenges of co-production in complex network settings in the local public services. The aim of the article is to find out how complex network structures meet the co-production process in the context of social and health care services. The empirical part of the article presents a Finnish case study of a multiprofessional service network producing social and health care services for youth. Here, the clients, in this case children and young people with a need for social services, often need multiple services from different service providers simultaneously. Our research findings suggest that the outcomes of the service process are not only dependent on the client's needs, but rather on organizational and professional interests. Our research gives new insights for the discussion on co-production; when it is applied as an intended policy to improve and deliver public services, the complexity of interaction among the street-level workers and the detached professional frameworks should be kept in mind.     

'Behave yourself!' Examining meanings assigned to children with socio-emotional difficulties

Day-care, the context of this research, is a significant service in Finland because every child under compulsory school age (7 years) has the right to municipal day-care once the parental allowance period ends. Finnish day-care is generally organised by municipalities as part of the social services. It is inclusive by nature, as there are no separate kindergartens with only special needs children. Such children are mostly in ordinary groups; only 1% are in special groups. Children with socio-emotional difficulties have been a challenge for the Finnish day-care and comprehensive school system for decades. In both educational systems such children are experienced as problems. This article deals with the discourse of day-care personnel about these children and examines the meanings behind this language.     

The state and future of social service enterprises—a Finnish case

There has been a rapid increase in private social services in Finland, where the tradition of social care services has placed the main emphasis on public services. The aim of this article is to compare the situation of Finnish social service enterprises in 2001 and 2005/2006, in the light of two national surveys, in order to increase knowledge about the state and the future of such enterprises as providers of social care. Particular attention is paid to the profiles of men and women as entrepreneurs, as these differed somewhat. The composition of private care enterprises and their management remained fairly similar between 2001 and 2005/2006. Most of the enterprises were owned by middle-aged women with an extensive experience of social and health care. The owners of the older enterprises were more pessimistic about the future than the owners of the more recently-established firms. Social workers have not been active in setting up firms, but the public–private processes should be steered and evaluated from the social work perspective, too, because they are actors who have a relevant part to play in the long-term co-operation and development work of public and private social services.     

Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing

As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg–Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N?=?126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including “equal access to services,” “enhancing economic stability,” “providing safe and affordable housing with trauma-informed services,” and “training service social workers to deliver well-informed linkages and services” are discussed.     

Changes in the health status of newly housed chronically homeless: the Alaska Housing First program evaluation

The Housing First (HF) model is an evidence-based supportive housing initiative that provides permanent housing for the homeless without preconditions such as sobriety or treatment compliance. This three-year longitudinal study investigated the effects of Alaska's inaugural Housing First projects in Anchorage and Fairbanks on local service usage, costs and tenant quality of life (QoL). A total of 94 tenants participated at baseline in the QoL study and 68 continued to follow-up. Cost data was collected from local municipalities, Alaska Department of Corrections, and local hospitals, health care clinics, behavioral health providers, and detox facilities. Emergency services use by tenants decreased from the year before moving into Housing First to the year after. Changes in health care costs were more variable depending on site and type of service.     

Self-reinforcing spatial clusters of migration and socio-economic conditions in Finland in 1998–2006

All the time the long economic growth period of 1992–2008 prevailed in Finland, the economic landscape was changing constantly and markedly. We analyse in this article how net migration plagued certain less competitive, mainly rural push-lose municipalities, and boosted in-migration to the pull-win municipalities in metropolitan environments during the very affluent period of 1998–2006. A persistent spatial match of net migration with pull and push conditions is evident in the socio-economically polarized extremes of the Finnish municipalities, indicating the existence of self-reinforcing processes which generate spatial clusters or in more theoretical terms, spatial formations. During the period of economic growth a spatial cumulative causation emerged to bring about a metropolitan type of regional development with only a few metropolitan areas, geographically wide and relatively stable intermediate areas and semi-peripheral, highly rural clusters of pronounced decline. Negative spatial cumulative causation brought about by the impacts of the shrinking primary and service sectors emerged in sparsely populated semi-peripheral municipalities, enforcing the regional polarization in demographic characteristics between growth centres and the poorest municipalities. The observed spatial clusters emerge as classes of their own in the Finnish typology of municipalities, exposing the areas of strongest flux. Our results indicate that various regional policy measures contributed to generating the success of economic evolution within fairly narrow, limited geographical areas.     

Normality or care – an inventory of Swedish municipalities’ responses to unstable accommodation for vulnerable groups

This article presents an inventory of policies and housing support interventions to the homeless and those at risk of becoming homeless in a representative sample of Swedish municipalities. Two types of intervention are included: various types of accommodation for those who are already homeless and daily life support for those at risk, either provided or financed by the social services in the municipality. Data were collected in 2004–2005 through a questionnaire e-mailed to local authority officials, in a stratified sample of about half of the Swedish municipalities (n=147). The results show that two types of housing intervention dominate the field: daily life support and sublet contracts, both of which have a relatively high normality factor, with a setting in normal housing. Daily life support includes care and is usually implemented before the tenant is evicted. The level of care related to various interventions fluctuates more between the municipalities than normality does. The more densely populated municipalities were more engaged in developing housing policies and administrative bodies to handle these. However, the implementation of housing policies does not seem related to improvements in the qualities of the interventions. On the contrary, the local authorities that have housing policies and administrative tools adapted to these policies provided a lower degree of both normality and care in the interventions. The results suggest that aspects of normality and care in the same type of housing interventions vary depending on the type of municipality, while the existence of policies has no influence on care and a negative effect on the degree of normality provided through the interventions.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

Advancing Program Theory for Licensed Assisted Living Services in Independent Housing

Assisted living programs (ALPs) embed licensed assisted living services within independent housing. To advance nascent research on this type of housing plus services, this study aimed to develop empirically grounded program theory on the processes through which ALPs benefit residents within independent housing. Eighteen in-depth interviews were conducted with current and prospective consumers of an ALP in northern New Jersey, including residents and family caregivers. The setting for the ALP was a federally subsidized independent housing building, which had introduced the ALP approximately 1 year prior to the study. Themes emerging from an iterative coding process indicated the most valued aspects of the ALP’s service delivery, including the comprehensiveness of the service options, the flexible timing for their delivery, and the relational aspects of care. Participants further described the ways in which the structure of the ALP facilitated prevention, such as preventing the occurrence and escalation of adverse health events. The study concludes by presenting a program model that integrates these findings, which suggests that ALPs deliver care in ways that make long-term services and supports more accommodating and acceptable to consumers. This, in turn, can enhance their preventive value to facilitate aging in place among independent housing residents in clinical need of such supports.     

精神残疾群体的社会保障需求与供给:现状、问题与发展建议

精神残疾人多生活困难,构成社会最为弱势的群体。本文采用实地研究与文献研究的方法,对精神残疾人的社会保障需求与供给进行专门考察。研究发现,精神残疾群体的主要需求包括治疗、基本生活支持、康复、长期照护与监管以及社会参与。对此,我国政府已通过多项社会保障制度安排予以回应,基本满足了精神残疾人的基本生活与治疗需求,但还存在社区康复服务匮乏、替代性照护服务供给不足、就学、就业难等问题。基于以上发现,本文认为精神残疾人的基本生存权虽得到较好保障,但是对其发展权和参与权依然关注不足。原因在于当前精神残疾人社会保障存在三个不平衡:经济保障与服务保障发展的不平衡,医疗服务与社会服务发展的不平衡,以及卫健、民政、残联不同部门能力与投入的不平衡。针对这些问题,笔者对未来政策的完善提出了参考建议。     

Household Income,Women's Earnings,and Spending on Household Services, 1980–2010

The authors investigated changes in household outsourcing, the practice of spending on services that replace household labor, from 1980 to 2010. During this time, women's labor force participation, increased and economic, household bargaining, and time availability theories predict increased spending during this period. To test these predictions, the authors used data on spending on housekeeping, day care, babysitting and nannies, gardening and lawn services, eating out and pre‐prepared foods from the 1980–2010 Consumer Expenditure Surveys using 327,903 household‐quarters from the interview survey and 86,877 household‐weeks from the diary survey. The results indicate that changes in income predicted increases in housekeeping, child care, and gardening services. Changes in household characteristics predicted little change in food outsourcing, although food outsourcing did increase. Changes in women's earnings predicted little change in most outsourcing. The authors conclude the article with a discussion of the changing context for outsourcing.     

Reimagining Nursing Homes: The Art of the Possible

Long-term care (LTC) needs to be reconceptualized. The current efforts to reinvent the nursing home perpetuate a flawed model of care. The heritage of the nursing home as the dominant model for LTC needs to be reexamined. The basic LTC building blocks—housing, services, and medical care—can be combined in various ways to meet consumers' needs and preferences. We need innovative solutions that can offer reasonable service while recognizing the value of acceptable risk taking. Modest personal care should not come at the price of surrendering one's autonomy.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

Lesbians Leaping Out of the Intergenerational Contract:

Changing demographics and economic models in modern industrial countries have led to changes in the nature of the intergenerational contract, repositioning of the family as the site for care, and increasing privatization of welfare, housing and health services for the aged. These shifts have important implications for access to services for lesbians and gays as they age and enter their third age, often in the absence of traditional family support. The needs and desires of some older lesbians in Australia in relation to housing and health care were explored via focus group interviews. The results are discussed in relation to the intergenerational contract, policy shifts and the social organization of aged care in Australia.     

Australia's leading social work authors: the devil in the detail

Abstract

Many care leavers with disabilities face difficulties as they transition from out-of-home care (OoHC), and suffer multiple, ongoing forms of disadvantage after they leave care. This paper is drawn from a study comprising six focus groups, involving 21 participants employed in disability and OoHC services in Victoria, Australia. The findings suggest that care leavers with disabilities do not receive the transitional and postcare support and housing they need. Many are transitioned into housing options that are unsuitable for their needs, or unsafe. The argument of this paper is that care leavers with disabilities may benefit from adult guardianship legislation. When appropriate an application for a guardianship order should be made prior to the young person exiting care, to enable a smooth transition between the child and adult systems. Adult protection services with an advocacy function should be given the opportunity to advocate for care leavers with disabilities.     

Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.