The gap in social care provision for older people in China

Because of its unprecedented sociodemographic changes, particularly rapid population aging, China faces huge challenges in social care. Using data from the 2012 Chinese Longitudinal Healthy Longevity Survey (n = 9,765), this article examines the need for social care, as well as the major sources of provision. The findings indicate that the majority of older people face some restriction in their daily living activities. From their perspective, however, the most urgent social protection services are related to health care and legal aid rather than services supporting daily living. Although Chinese Government policy since the 1990s has been a strategy of social welfare socialization, the role of government, both as provider and funder, is limited and focuses only on the most deprived and on urban areas. The result is a massive “care gap” between the need for social care and its supply. The primary responsibility for care provision is borne by the family. The direction of social policy in the future should focus on shared care between the family and the state, giving priority to expanding the coverage of social care services, especially in rural areas.     

Defining responsibility for care: approaches to the care of older people in six European countries

This article examines the social care of older people in six contrasting European countries. Family, institutional and community care are compared, focusing on vulnerability, empowerment and the gatekeeping of resources. The article considers the position of older people in each care system by presenting individual case studies. The six countries include the family-oriented systems of Ireland, Italy and Greece, and the individual-oriented systems of Denmark, Norway and England. To improve the care of older people in any of these welfare cultures, resources need to be developed that work with existing sources of care but extend the rights of older people, at least to assessment and an equitable matching of needs to the care services available. Overall, the different levels of provision of organised social care services are a major aspect of inequality within and between the countries. Whilst there is little prospect for any major policy transfer across national boundaries, there is potential for selective cross-national learning with regard to particular service developments.     

Choice and control in social care: Experiences of older self-funders in England

This paper considers the experiences of older self-funders in England in the context of policies promoting choice and control. Self-funders are people who are not state-funded; they pay for social care from their own resources. Choice and control have been operationalized through personal budgets, based on the assumption that managing resources enhances ability to access appropriate care and support. This paper uses data from 40 qualitative interviews with self-funders and their relatives, and 19 with professionals. It explores the impact of the financial and social capital that self-funders are assumed to have and asks how older self-funders experience choice and control. The study found that older self-funders drew on personal experiences, family, and friends for information; were reluctant to spend their wealth on care due to competing priorities; and felt they had more control over the timing of decisions than people who were state-funded. Personal wealth appears to be perceived differently to funds “gifted” to people through cash for care schemes.     

The welfare state, the individual and the need for care: older people's views

The aim of this qualitative study was to study how older people experience aging and reflect on their need for care in the Swedish welfare context. Sixteen people were interviewed, aged between 77 and 92 years. Staying healthy and independent in their everyday lives were prized values for the informants. Some brushed aside thoughts of being in need of home help services in the future and others had a more reflecting attitude. The informants did not want to burden either society or their children. Through mass media and the experiences of their neighbours, they had gained a negative impression of eldercare. They were uncertain if there would be any helping hand of good quality in the future. On the other hand, informants who already had home help thought that it was helping them to maintain independence in everyday life and they were also satisfied with the help they received.     

Governing the coordination of care for older people: Comparing care agreements in Denmark and Norway

Increasing specialisation and demands to decrease the length of hospital stays have important consequences for the integration of specialised health and local care services. Based on case studies of care agreements in Denmark and Norway, this article compares subnational governance strategies for coordinating care services for older people discharged from hospitals. The question is how, and to what degree, national government regulations have an impact on local service coordination strategies. The analysis reveals that the numerous subnational procedures for coordination are somewhat more itemised in Denmark, and that regional variation in care agreements is greater in Norway. The identified differences can partly be accounted for by national differences in regulation, which is tighter in Denmark than in Norway. The study suggests that despite decentralisation of responsibility, subnational procedures to facilitate coordination are heavily influenced by national government policy.     

Welfare policies for older people in transition? Emerging trends and comparative perspectives

The article examines how the three Scandinavian countries are responding to the seemingly growing gap between demands and resources. Various strategies and approaches are identified and evaluated, and their relevance and potential are discussed in a comparative context across time and between countries. What about the recent changes in the Scandinavian welfare policies on aging? Do they merely represent minor adaptations in order to protect and sustain “the Scandinavian model”, or are they early signs of major changes in progress?     

Policy and practices relating to the active engagement of older people in the community: a comparison of Sweden and Australia

This article compares policy and practices for engaging older people in community life in Sweden and Australia. Barriers and support for active engagement through paid work, social activism, volunteering and aged services are compared. Both countries face issues of ageing populations, services for rural areas and people with small needs. Issues for Sweden were the absence of age discrimination legislation, availability of funds and lack of recognition of the growing levels of volunteering. Issues for Australia concerned the new managerialist approach to services, with associated complexities of access and limited social activism.     

A comparison of state support for young people leaving care in Norway and Sweden: Differences within comparable welfare systems

The aim of this article is to account for and discuss support to young care leavers within the comparable welfare regimes of Norway and Sweden and to explore key differences between these 2 countries. This model implies that children and young people are included and entitled to support through being family members, not as independent actors in their own right. This makes young care leaver's transition from care to adulthood problematic—as they often do not have access to family support, they may be positioned in a vacuum where they are clients neither entitled to support from the child welfare system nor supported by their families of origin. In Norway, legislators and policymakers have agreed that care leavers need particular attention and targeted support, whereas in Sweden, there has been no such agreement. However, the Norwegian system of giving leaving care services is not strong enough to provide transition support to all care leavers, even if the legislation gives stronger protection than in Sweden. The article discusses the need for targeted measures of support for a successful care‐leaving process.     

Breaking the mould: new trajectories in the domiciliary care of older people in Ireland

This article reviews the development of domiciliary care services for older people in Ireland over the last decade. It reveals three central developments, namely (i) the first steps, in the Irish context, towards a quasi-market; (ii) the introduction of cash-for-care and the subsequent notable segmentation of care tasks among three provider groups; and (iii) a rapidly increasing reliance on for-profit private home care providers. The authors conclude that while the Irish social care regime is still anchored in important ways in the primacy of informal (family) care and the subsidiarity principle, it has broken path-dependency by evolving towards an increasingly complex mix of public, not-for-profit and for-profit provision and financing. The most policy-relevant aspect of this new constellation is the lack of a regulatory framework that would enable the State to monitor the multiple and diverse providers with the view to ensuring the quality of home care services.     

Migration, ageing and mental health: an ethnographic study on perceptions of life satisfaction, anxiety and depression in older Somali men in east London

This ethnographic study was carried out in the aftermath of an epidemiological investigation, the first of its kind, on the health and social status of Somalis aged 60 years and over living in Tower Hamlets, east London. The main aims of the study are to explore views on mental health and well-being and identify sources of stress and support so as to gain greater understanding of background factors of life satisfaction and depression in 'first-generation' older Somali migrants in Tower Hamlets (males). Face-to-face interviews were conducted among 28 males in Somali with the help of a bilingual interpreter from the same age, sex and cultural background of participants. Several factors were perceived to decrease life satisfaction and increase vulnerability to depression in male Somalis, in particular low family support in the face of increasing physical disability, loneliness, inadequate access to community services and inability to return home. Social isolation, low level of control over one's life, helplessness and social degradation – ageism, perceived racial/religious discrimination and, to a lesser extent, racial harassment – were common themes identified in people who said to be depressed. Family support was the main buffer against depression; other coping resources were represented by religious practices and reliance on Somali peers. Avoidance coping seemed to encompass denial of depression in participants who had low mood. The study revealed multiple reasons for ill-being, in particular in people who had high expectations about medical and social care. Low levels of distress were found in Somalis who felt supported by their families. There is a need for social workers and other health professionals to advance discussions of mental-health issues in the community and for service providers to promote greater access to culturally relevant medical and social services for Somali elders in Tower Hamlets and strengthen their informal support networks.     

Person‐centredness in the community care of older people: A literature‐based concept synthesis

‘Person‐centredness’ is a ubiquitous term, employed in modern care services to signify policies and practices that attend to the uniqueness of each individual user. Despite being highly regarded in older adult community care services, there is much ambiguity over its precise meaning. Existing reviews of person‐centredness and its attributes have tended to focus on the medico‐nursing literature, neglecting other interpretations, such as those relevant to community social care. A new literature‐based concept synthesis reported here identified 12 common attributes within the broad themes of ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’. The review also contrasts how these attributes are applied across different interpretations of person‐centredness. The article argues that not all attributes necessarily pull in the same direction, and that older adults may require them to be delivered in different ways than they are to younger people. Thus, a ‘one‐size‐fits‐all’ approach should be discouraged in community care. Key Practitioner Message: ? ‘Person‐centredness’ is open to multiple interpretations, causing difficulties for services trying to gauge performance and quality; ? Three themes are central to person‐centred services: ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’; ? A ‘one‐size‐fits‐all’ approach to applying person‐centredness is to be discouraged.     

Older people within transnational families: the social policy implications

Given that more people 'permanently' migrate today than in the past, migration has taken on a heightened profile internationally. Such mobility raises fundamental social policy questions of entitlement and (re)negotiation of caregiving obligations and arrangements. Social policy has traditionally approached problems and developed responses within the confines of the nation-state and faces difficulties in recognising and addressing issues arising from mobility. Migration contributes to family being 'stretched' beyond national boundaries to become dispersed, global or transnational families. This article focuses attention on one dimension of transnational living – older people as members of transnational families. The combination of increasing population mobility and the elongation of new post-retirement life-stages is resulting in a set of pressing social policy issues. It explores immigration, pension eligibility and portability, and social services and caregiving issues. To illustrate these issues the article draws on New Zealand's diverse transnational family forms and experience.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People

Risk management systems and structures are developing rapidlywithin UK health and personal social services. However, therisk management strategies of organizations need to take intoaccount the conceptual frameworks used by professionals. Thisgrounded theory study used data from nineteen focus groups andnine semi-structured interviews (ninety-nine staff in total)to explore perspectives on risk and decision-making regardingthe long-term care of older people. Focus group participantsand interviewees comprised social workers, care managers, consultantgeriatricians, general medical practitioners, community nurses,occupational therapists, home care managers and hospital dischargesupport staff. Social work and health care professionals conceptualizedrisk and its management according to six paradigms that appearedto be in a state of reciprocal tension: (i) Identifying andMeeting Needs; (ii) Minimizing Situational Hazards; (iii) Protectingthis Individual and Others; (iv) Balancing Benefits and Harms;(v) Accounting for Resources and Priorities; and (vi) Warinessof Lurking Conflicts. The effective translation into practiceof risk management strategies needs to address the complex andoften contradictory issues facing health and social servicesprofessionals.     

Substitution in statutory and voluntary support for relatives of older people

This study investigates the relationship between statutory and voluntary activity in the field of support to family carers of older people in Sweden. The relationship is considered in regard to substitution theory. A survey was conducted comprising 80 local authorities and 358 voluntary organisations. All the local authorities and about a third of the voluntary organisations arranged support activities. The number of activities varied substantially across the municipalities. However, correlation analysis found no significant relationship between local authority and voluntary activity, even though both sometimes arranged the same kinds of activities. In other words, this study finds no support for substitution theory. On the contrary, it shows that a higher level of voluntary activity is found in municipalities where the local authority cooperates with or supports voluntary organisations.     

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.     

Financing health services for pensioners in Argentina: a salutary tale

The article examines the problems facing a programme to finance health care for pensioners in Argentina, known as PAMI. The programme is accumulating large deficits and many of its services are of doubtful quality. PAMI's problems and its resistance to reforms are put in the wider context of Argentina's liberalised health-care system, neo-liberal adjustment and flawed governance. The Argentine experience has relevance for other developing countries with weak state regulatory capacity, and points to the dangers of delegating health financing of older people to the private sector.     

From bureaucracy to technocracy in a social welfare agency: a cautionary tale

Electronic information systems (IS) have been implemented quite extensively in social welfare agencies the North America, Europe and Australasia and the problems that have arisen have been well documented by researchers. In the Asia Pacific region, IS are less common in social welfare agencies, though many agencies are increasingly expected to implement one. This paper reports on an ethnographic study of an agency in Australia during the initial phases of developing and designing an IS and provides timely insights which may assist in avoiding the costly mistakes and unintended consequences that have arisen elsewhere.     

United We Stand? Partnership Working in Health and Social Care and the Role of Social Work in Services for Older People

The concepts of ‘partnership’ and ‘collaboration’have become amongst the most critical themes of ‘new’Labour’s social policy, particularly in respect of thedelivery of health and social care. Although the terms are rarelyprecisely defined and hence have become problematic to analyse,in most understandings successful partnerships rely upon goodsystems of inter-professional collaboration. Through revisitingthe extensive literature on the sociology of the professions,and the nature of inter-professional working, this paper willargue that effective collaborative working within health andsocial care is hard to achieve, particularly in the light ofthe vast differences in power and culture between various occupationalgroupings, and the inherently competitive nature of professionsjostling for territory in the same areas of activity. It suggeststhat these issues cannot be resolved unless they are properlyunderstood; a rhetorical appeal to the unmitigated benefitsof ‘partnership’ alone will not produce more effectivejoint working. In addition, it notes that an appropriate rolefor social work in the context of partnership working has yetto be defined and proposes specific tasks and values that distinguishthe social worker from other related professionals.