Financial hardship assistance behind the scenes: Insights from financial counsellors

Financial hardship, in a credit society such as Australia, can affect almost anyone. To protect consumers from the negative impacts of financial hardship—which can include the stresses of enforcement action and disconnection from essential services—legal protections have been incorporated into the regulatory frameworks for the consumer credit, energy, water and telecommunications sectors. In this article, we outline the findings of our study, which used a survey of financial counsellors around Australia and focus group interviews with Victorian financial counsellors to examine how these legal protections are being implemented by service providers in these four sectors. Our findings highlight a tendency on the part of service providers to take a generic, one‐size‐fits‐all approach to compliance with these legal protections that prevents them from effectively assisting consumers struggling with debt. We discuss the particular shortcomings of this approach in the context of consumers living on low incomes—especially Centrelink incomes—and outline the policy implications of our findings for assisting these vulnerable groups.     

Consumer‐directed care for older Australians: Are resources identified on the Web adequate to support decisions about home‐based care packages?

Consumer‐directed care (CDC) was introduced as part of aged care policy reforms in Australia in 2012. CDC aims to promote choice and control for people with complex needs who need home care and supports. While more choices may bring benefits, information and resources are needed by people to navigate new and complex care‐related decisions. In 2017, we identified the resources available to support consumers of the new CDC Home Care Packages (HCP) program via an Internet search. Forty‐six resources were analysed to assess the adequacy of information to inform care choices. General information was most frequently found, but information to guide specific choices, such as choosing or changing service providers, was limited. Accessibility of information was limited for non‐English speakers and for people with low literacy or reduced capacity for decision making. No training opportunities were identified, and only one non‐partisan organisation offered support for decision making. Overall, the information and supports analysed were not adequate to assist older people to make choices to ensure consumer direction of care. There is an urgent need to improve the quality and accessibility of information and provide training and support for choice, particularly for those with limited decision‐making capacity, such as those living with dementia.     

The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations

Winterton R, Warburton J, Oppenheimer M. The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations The global phenomenon of population ageing is impacting on how community care is delivered, and a key component of health and social care services for the frail elderly is Meals on Wheels (MOW), a service that has traditionally encompassed delivering meals to older people in their homes. However, aspects of this conceptualisation of MOW are being redefined in order to address challenges posed by tightening global financial contexts, a reliance on volunteers and increasing social isolation among ageing populations. Through a review of the literature and websites from selected countries (UK, USA, Canada, Australia), this article explores and critically evaluates models of MOW delivery addressing these challenges. Findings suggest that MOW services are utilising a marketised approach, moving outside of the home and incorporating diverse volunteer roles. These findings demonstrate how services such as MOW can develop sustainable approaches to service delivery in a contemporary context. Key Practitioner Message: ?A review of innovative MOW highlights service models of broader applicability;?Varied delivery models and more diverse volunteer roles appeal to new sources of volunteers;?Research into the development of sustainable models with positive client social outcomes is now required.     

Social Inequality under a New Social Contract: Long-term Care in Japan

The 1990s saw the beginning of new developments in the social policy agenda of Japan. A combination of further cuts in social expenditure and increases in financial resources through various means has become inevitable in response to the increasing cost burden of an ageing society, the prolonged recession and changes in the Japanese family. In this context, “kaigo hoken” (long‐term care insurance) was introduced in 2000 to increase revenue and fill the gap vacated by the family. The scheme introduced a different concept to the public: that long‐term care was no longer “expected’’ from the family or “allocated” by the state, but has become part of a “social contract” based upon a system of mandatory contributions, uniform entitlements and consumer choice. This paper first explores the role of the new scheme in creating social inequalities among individuals (and families). A panel survey is used to highlight different patterns of care provision and the varying degree of financial pressure among different income groups. Second, based on qualitative research, the paper examines how the new scheme has transformed the relationship between older people and their families who have played a central role in this arena. The scheme has consequently divided “traditional” families and their liberal counterparts, as a result of care work being “commodified”. It is apparent that this scheme has not only responded to fill the existing care gap but may also help accelerate the changes that have been taking place for the last two decades.     

Coexisting principles and logics of elder care: Help to self‐help and consumer‐oriented service?

Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self‐help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer‐oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people? Using neo‐institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self‐help is the dominant principle, that it is deeply entrenched in the identity of the professional care worker and that it coexists with consumer‐oriented service and without major tensions in the logics identified in their practices.     

Integrating Health and Social Care at the Micro Level: Health Care Professionals as Care Managers for Older People

A common problem in the provision of coordinated long‐term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user‐centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.     

Perceptions of Difference Between Aging and Disability Service Systems Consumers: Implications for Policy Initiatives to Rebalance Long-Term Care

This study explores service professionals' perceptions of how and why older adults and younger persons with disabilities are different consumers and clients within the long-term care service sector. Data are from 2004, early in the history of federal long-term care rebalancing initiatives, reflecting perceptions at that time. Findings suggest professionals working within aging, developmental disability, and physical disability service networks believe significant distinctions exist related to age of clients and nature of service required and how it is delivered. Overall need for greater professional and organizational capacity to support provision of service to both aging and disability populations is reported.     

Contextualising the ‘Crisis in Aged Care’ in Australia : A Demographic Perspective

Australia's ‘old‐old’ population is growing even faster than the total aged population and despite improved incomes, living conditions, health risk behaviours and health care this will result in a concomitant increase in the numbers of older people with disabilities. This paper examines ABS 2003 survey data on the incidence of disability among older Australians and their need for, and utilisation of, formal and informal care. It uses this as a basis for projecting the incidence of disability among older Australians and the need for informal and formal care up to 2031. These indicate there is a major challenge since the aged care workforce has grown only slowly in Australia and is concentrated in the older working ages presaging a loss of workers through retirement. There needs to be a significant effort put into attracting workers to both the skilled and unskilled parts of the aged care industry.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

Absent Role of the State: Analysis of Social Support to Older People with Disabilities in Rural China

China is experiencing rapid population ageing and already has 44 million older people with disabilities aged over 59 years. Yet social support of these older people with disabilities is undeveloped and not well researched. This article contributes by using a disability rights framework (right to life and protection, economic security and social support) to analyze local cases in rural China. It finds that, although the family is still the main provider of economic and care support to rural older people with disabilities, the absence of a state role in welfare provision has negative impacts on the well‐being of older and younger generations in rural families.     

Strengthening kinship families: scoping the provision of respite care in Australia

Kinship care is the fastest growing form of out‐of‐home care in Australia, as it is in many other countries. The Victorian Government's response has been to establish 18 programmes across the state to provide support to kinship families. The scoping project described here, based on interviews with key programme staff, explores the experiences of the new programmes in providing support, specifically respite care, to kinship families. It has produced a picture, based on qualitative and quantitative data, of how respite care is understood, the perceived respite needs of kinship families, how services are organized and provided, identified barriers to families accessing support, the effect of respite provision and what constitutes optimal practice. The findings establish a basis for a best practice model of service provision for this increasingly significant family type.     

A Comparison of the Lifetime Economic Prospects of Women Informal Carers and Non‐carers,Australia, 2007

Informal care provided at home to family members with a disability is a major part of the disability and aged care system in Australia. Using data from the 2007 Household Income and Labour Dynamics in Australia survey, this study provides an updated comparison of the financial wellbeing, or lack thereof, over the working life of women primary carers and non‐carers. This study focuses on selected groups of primary carers and non‐carers disaggregated by partnership status, level of education and self‐assessed health status. While women primary carers tend to be more financially disadvantaged than non‐carers, having a post‐school education and being in good health contribute positively to bridge the gaps.     

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.     

Receipt of Formal and Informal Help with Specific Care Tasks among Older People Living in their Own Home. National Trends over Two Decades

Sweden is seen as a typical example of a social democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care‐receipt in older people (77+) living in their own home and with a perceived need for help with two specific tasks: house cleaning and/or food shopping. Trends in care‐receipt were examined in relation to gender, living alone, having children and socio‐economic position. Data from the 1992, 2002 and 2011 data collection waves of the national study, Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), were used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care‐receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care‐receipt, associated with a greater likelihood of formal care‐receipt and a lower likelihood of informal care‐receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.     

Hybridization in China's elder care service provision

Although the party‐state has embarked on a mission to increase elder care services, evaluating this development according to different sectors demonstrates certain challenges. Official statistics do not include sector‐specific information, and while provider websites suggest that elder care services are largely in public hands, Chinese experts argue that they are mostly “civilian‐run.” How can we explain these discrepancies in data on Chinese elder care? Drawing on the concept of hybridization and triangulating quantitative and qualitative data, I argue that the party‐state's efforts to “socialize” elder care provision has resulted in hybridization within the industry which blurs the line between care providers and obfuscates the stark role of the state in elder care service provision. During the implementation of state‐initiated hybridization, providers misclassify their ownership type to benefit from financial incentives or circumvent political control, resulting in even greater hybridization and fragmentation on the ground.     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

An Analysis of Selected Pension and Health Care Initiatives for Informal Sector Workers in India

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.     

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.     

Financial Literacy and Superannuation Awareness of Indigenous Australians: Pilot Study Results

Financial literacy in the general Australian population and how to improve it is now firmly on the national agenda, partly as a result of compulsory superannuation. This paper reports the results of a pilot study which explored the financial literacy levels and superannuation knowledge of Indigenous Australians living in an urban environment. Previous studies have indicated that social disadvantage has a strong correlation with poor financial literacy but previous surveys of financial literacy in Australia have not reported specifically on the Indigenous population. Findings suggest that in some areas financial literacy is significantly weaker than that in the general population. Several of the areas of comparative weakness relate to an over belief in the role of government and the extent to which financial matters are regulated. There is also a high level of desire for financial education and information but a lower level of usage of potential sources of financial information. The findings suggest that a closing of the financial literacy gap is required.     

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.