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.     

Helpful citizens and caring families: Patterns of informal help and caregiving in Sweden in a 17‐year perspective

Jegermalm M, Grassman EJ. Helpful citizens and caring families: patterns of informal help and caregiving in Sweden in a 17‐year perspective This article reports on an analysis of informal help and caregiving in Sweden with, for the first time, a focus on patterns of change over 17 years regarding scope, type of caregivers and the recipients of help. The discussion is based on results from a national survey repeated four times between 1992 and 2009. In the 1990s, the figures were stable, but from the late 1990s to 2009, there seems to have been a dramatic increase in the extent of informal help giving. Concerning types of helpers, the patterns implied involvement not only from family members, but also from other types of helpers. Two interpretative perspectives were used in the analysis: the first from recent welfare state changes and the substitution argument; the second from the present debate on civil society and its possible and changing role. These perspectives represent two partly complementary approaches to the understanding of the dynamics of informal involvement in contemporary Swedish society.     

Interaction between Voluntary and Statutory Social Service Provision in Sweden: A Matter of Welfare Pluralism,Substitution or Complementarity?

Many welfare states have met with criticism and it has been argued that they are in crisis. Simultaneously, there has been a greater openness to voluntary work as an alternative to statutory services, for example in Sweden. Sometimes the activities of voluntary organizations have been seen as complementary to those of local authorities; at other times this issue has been addressed in terms of welfare pluralism. However, countries with strong welfare states have often been assumed to have insignificant voluntary work—as claimed in substitution theory. The purpose of this article is to examine variation in welfare service provision in the light of welfare pluralism, substitution theory and complementarity theory. The study was carried out in the area of support for relatives of older people in Sweden. It was conducted by means of national questionnaire surveys of voluntary organizations and local authorities in 1999 and 2002. In this period, there was an increase in statutory service provision and more voluntary organizations were involved in service provision. However, it is yet too early to describe this in terms of welfare pluralism. Neither was any evidence found for substitution theory. Furthermore, overlaps in service provision from voluntary organizations and local authorities question complementarity theory, which assumes that different actors specialize in different tasks. Nevertheless, the actors tended to be complementary at a local level. It is suggested that this complementarity might be explained by ideological support for a norm of complementarity.     

Class, Attitudes and the Welfare State: Sweden in Comparative Perspective

One of the most important arenas for contemporary class politics is the welfare state. In this article, attitudes towards welfare policies among different classes in Sweden are compared with other Western countries and over time. In the first part of the article, attitudes towards state intervention among different classes are compared across four Western countries: Sweden, Germany, Britain and the USA. The data come from the 1996 survey on “The Role of Government” conducted within the International Social Survey Programme. In the second part of the article, more detailed national data sets are used in order to track developments within Sweden from the early 1980s until 2002. Attitudes towards welfare spending, financing of welfare policies and service delivery are used to track developments of class differences in attitudes over time. It is concluded (a) that class differences are particularly large in Sweden, and (b) that changes over time indicate stability in overall class differences, combined with changes in attitudes among non‐manual employees. The implications of the results for recent arguments about the restructuring of class relations and the impact of welfare policies on stratification are discussed.     

The Informal Economy: A Case Study in Unrestrained Competition

The New Labour government in Britain is the first post-deregulation regime in Europe and the first to attempt to re-regulate the labour market. In particular, its welfare-to-work programme and New Deal for Lone Parents are aimed at shifting activities from the informal to the formal economy, and at enlarging labour market participation. Its commitment to social justice and inclusion is closely linked to increased employment opportunities and a responsibility for contributing to national prosperity. The new programmes must also reconcile these aims with the retention of the flexibility that it sees as giving Britain a competitive edge over other European economies. In order to combine efficiency and equity, increased participation must not involve excessive transaction and enforcement costs. The problem is that those at present engaged in the informal economy (and especially in undeclared cash work while claiming) do not have strong incentives to cooperate with the new schemes. This paper uses the example of the informal relations of taxi-driving in a small town to illustrate the paradoxes of this situation. It is a case study in the rational strategies of individual actors, which collectively frustrate each other; and in the difficulties of starting collective action for mutual restraint of competition. The New Labour government must solve many such problems if its policies are to succeed.     

Dementia Caregiving Outcomes: The Impact of Caregiving Onset,Cognitive Impairment and Behavioral Problems

With a projected increase in the prevalence of Alzheimer’s disease (AD) and related dementias, family caregiving is steadily increasing. Caring for an individual with AD is characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Research reveals a number of negative emotional health outcomes for AD caregivers, including depression and role overload, but less research has examined the influence of key transitions on the emotional adaptation of caregivers. The purpose of this study is to examine how different patterns of caregiving onset (gradual and abrupt) impact emotional health outcomes for AD caregivers. This study also explores how care-recipient cognitive impairment and behavioral problems moderate these relationships. Cross-sectional, quantitative data from 100 caregivers completing self-administered surveys were used. A series of one-way ANOVAs and multiple regression analyses were conducted to address study aims. Results indicate that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and emotional health outcomes for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering different onset transitions and moderating factors within the caregiving career to target clinical interventions. Implications for social work practice are discussed.     

Unmet Home Care Service Needs of Rural Older Adults With Alzheimer's Disease: A Perspective of Informal Caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

Welfare State Changes and Outcomes – The Cases of Portugal and Denmark from a Comparative Perspective

It is well known that welfare states ensure a certain level of social protection affecting levels of well‐being and the extent of inequalities in society. Changes within crucial domains of social policy, such as education, health, or social protection, have, therefore, a major effect upon individuals' opportunities. In this article I compare the effects of these changes in two countries from the mid‐1980s to the financial crisis of 2008. Portugal that was a latecomer in welfare state development and Denmark was at the forefront of de‐commodification and universalization of social rights. The conclusion of this article is that income inequality has been steadily increasing in Danish society; while in Portugal, despite improvements in many social domains (healthcare, poverty alleviation, unemployment protection), problems of inequality remain deeply embedded in the country's social and institutional structures.     

A Bedrock of Support? Trends in Welfare State Attitudes in Sweden, 1981–2010

This article reports findings about Swedes' attitudes towards the welfare state from 1981 to 2010, building on data from the Swedish Welfare State Surveys. Attitudes towards social spending, willingness to pay taxes, attitudes towards collective financing and public organization, suspicion about welfare abuse, and trust in the task performance of the welfare state are tracked. Overall, there is a large degree of stability in attitudes, and where change is registered, it tends to go in the direction of increasing support. More people state their willingness to pay higher taxes for welfare policy purposes; more people want collective financing of welfare policies; and fewer people perceive extensive welfare abuse in 2010 than was the case in previous surveys. Class patterns change so that the salaried and the self‐employed become more similar to workers in their attitudes. Hence, the unprecedented election loss of the Swedish Social Democrats in 2010, and the rise of the Moderates (conservatives) as the dominant party cannot be explained by changing attitudes towards the welfare state. Nor can any corrosive effects from increased marketization of the Swedish welfare state on public support for welfare policies be detected.     

Caregiving Load and Respite Service Use: A Comparison between Older Caregivers and Younger Caregivers

Study aims were to explore differences in predictors of respite care use between older (aged 65+) and younger caregivers (aged 18–64 years), and associations between caregiving load and respite care use using multivariate logistic regression analysis and unpaid caregiver (n= 10,500) data from the 2009 California Health Interview Survey. Caregiving load comprised number of care recipients, weekly hours in caregiving, and caregiving duration. Variables with a significant association with respite care for older caregivers were female gender, income, and health insurance. For younger caregivers, respite care use associations were with ethnicity, caregiving relationship, education, and availability of substitute help.     

Floods in Mumbai A Case Study of the Psychological Impact and Volunteers' Help

This article is a case study of help provided by volunteers of a non-governmental organization, Bharatiya Stree Shakti (BSS), to people affected by floods in Santacruz, Mumbai, India. It demonstrates that post-disaster work needs to go beyond meeting basic needs (shelter, food, sanitation, and immunization) and address the psychosocial impact of the disaster on people.     

Combining Work and Family in Two Welfare State Contexts: A Discourse Analytical Perspective

This paper describes and compares the way in which British and Finnish mothers of dual‐career families construct discourses on the work and family interplay. Through this comparison, the paper also considers the presence or visibility of larger welfare state frameworks at the level of the discourse of mothers. The paper argues that, despite the many structural and ideological differences between the British and the Finnish welfare states, mothers living in them often construct their daily lives by using similar discursive frameworks. These discourses are, however, contextualized and interpreted differently. This level of contextualization and interpretation of the discourses is argued to be the stage where the structures and gender constructs of welfare states step in.     

Patterns and meaning of unemployment

This article introduces the special issue. Unemployment in Argentina, the Netherlands, Poland and Spain is placed in the context of global economics. The end of full employment in Sweden was part of an international deinstitutionalization that connected employment closely to economic growth. The immediate causes of the economic decline and mass unemployment in Sweden were a financial crash and neoliberal government policies. The ambiguity of unemployment in the criteria for evaluating the performance of policy-makers and three different cultures among unemployed people are outlined. An overview of what is known about the consequences of unemployment in terms of excess illness and mortality is given.     

Labour Market Policy in the United States, Canada and Sweden: Addressing the Issue of Convergence

'Convergence theorists' suggest that domestic and/or global challenges and pressures are rendering welfare states broadly similar across national boundaries. 'Resilience theorists', in contrast, argue that a range of socio-political factors have allowed states to respond differentially to these pressures and maintain their distinct national social policy approaches. However, both research streams have addressed the 'welfare state' writ large in a multitude of nations and typically relied upon narrow, quantitative budgetary indicators. This study examines qualitative changes to key income security and social service programmes in one central social policy domain – labour market policy – in three nations, the United States, Canada and Sweden. It suggests that there is evidence of some degree of 'convergence' in the broadest sense of the term across these three nations. However, while both the USA and Canada have readily embraced genuinely neo-liberal restructuring, and become increasingly similar over the past two decades in this policy area, Sweden has managed to retain its distinctive social policy approach so far, despite notable changes, developments and trends. It also suggests that the character and direction of change may vary across and within policy domains in a single nation. The conclusion provides a discussion of universality, equality and solidarity, concepts that are commonly employed in accounts of welfare state change.     

Informal social networks in Korea: Covering the cost of major life events

This article investigates an informal voluntary social arrangement for financial assistance with discrete major life events known in Korea as Sang-Ho-Bu-Jo. This informal voluntary arrangement is neither public nor private, but is based on social networks that produce a unique form of civic society. Sang-Ho-Bu-Jo covers people's transitional one-time needs. This study explores the practice of Sang-Ho-Bu-Jo and its origins and provides the first systematic empirical study of this social phenomenon. Three large databases are used to analyze the scope and level of participation, as well as what variables correlate with such involvement. The study finds a high rate of participation, over 80% of households, and an average investment of 2–4% of household expenditure. Sang-Ho-Bu-Jo can help scholars and policy makers worldwide in understanding the role of socialization, social networks, and social capital in explaining innovative informal methods of social care.     

Slippery Concepts, Shifting Context: (National) States and Welfare in the Veit-Wilson/Atherton Debate

The debate between Veit‐Wilson and Atherton raises key conceptual questions for the analysis of welfare states. Veit‐Wilson, in particular, focuses on the important, but strangely neglected question of when and why a state qualifies as a welfare state. Atherton usefully draws attention to historical debates about the legitimate purposes of state welfare policies and worthy recipients of state benefits, particularly in the Anglo‐Saxon countries. His contribution may draw our attention to the shifting meaning of concepts (such as poverty) over time. In this contribution I seek to broaden the debate. First, without underestimating the importance of such criteria, rather than presenting one single (normatively based) “discriminating criterion” defining welfare statehood, I argue that other conceptions of “the welfare state” may be useful as well—so long as analysts are clear and explicit about how they are using the phrase. Second, in the current conjuncture of the perceived “transformation” perhaps even “destruction” of the welfare state, historical and comparative research grounded on clear and explicit concepts is crucial.     

Lone Parents and Informal Childcare: A Tax Credit Childcare Subsidy?

The Labour government aims to increase the lone parent employment rate to 70 per cent by 2010. To achieve this aim, it has introduced a state subsidy for childcare in the form of the childcare element of the Working Tax Credit. So far this has been limited to formal childcare despite evidence that lone parents are more likely to use informal childcare. This article investigates the potential of a state subsidy to be extended to support informal childcare. Utilizing evidence from a study of 78 qualitative in‐depth interviews with lone parents, it explores preferences for informal care and the way that informal care is negotiated. On the one hand, we found that some lone parents held deeply embedded preferences for informal childcare based on trust, commitment, shared understandings and children's happiness. Thus it can be concluded that it is important for the government to support informal as well as formal care. On the other, we found that the way lone parents actually negotiated informal childcare involved complex notions of obligation, duty and reciprocity, suggesting that a subsidy could potentially intrude upon complex private family relationships. However, the evidence suggests that care was negotiated differently depending on whether it was provided by a grandparent or other family and friends, with lone parents tending to favour paying for childcare provided by other family and friends than grandparents. This has implications for a state subsidy, which needs further investigation.     

城市社区居民的非正式支持网络:现状与前瞻

非正式支持以其人性化、人本化的理念和人与人之间守望相助的价值观,成为城市社区居民可信任的支持来源。当前城市社区居民的非正式支持网络呈现出以亲属支持为主、朋友和邻里支持为辅的格局,也面临着人力、能力和财力等方面的困境。完善城市社区居民的社会支持网络,关键在于实现正式支持与非正式支持的整合。     

The Impact of Caring on Informal Carers' Employment,Income and Earnings: a Longitudinal Approach

In Australia the policy balance has shifted away from institutional forms of health and aged care towards supporting people in their own homes. This change presupposes a significant and growing supply of informal caring labour. A large proportion of informal carers (40–60 per cent) currently combine paid employment with their caring responsibilities. Using the longitudinal Household, Income and Labour Dynamics in Australia Survey, the paper examines the effect of caring on employment, hours worked and earnings. The analysis shows that working age carers experience disadvantage. Carers are more likely than non‐carers to reduce their hours of work or exit from the labour force, and earn lower levels of income. In planning for an ageing population, policies will need to address these negative effects and privatised costs of caring if the supply of informal care is to be sustained in the future.     

The Politics of Welfare State Retrenchment: A Literature Review

Welfare state retrenchment is widely seen as a highly unpopular endeavour and, therefore, as politically difficult to pursue. This assumption has underpinned most of the political science research on this issue, notably Paul Pierson's seminal contributions about the ‘new politics of the welfare state’. Yet, the question remains why and under what circumstances cutbacks take place in highly developed welfare states despite these formidable political obstacles. This article reviews the literature on the politics of retrenchment, namely on the impact of socio‐economic problem pressure, political parties, political institutions, welfare state structures and ideas. Most authors agree that socio‐economic problems – particularly domestic problems – contribute to an atmosphere of ‘permanent austerity’ which inspires cutbacks. Moreover, according to most scholars, the extent of retrenchment possible depends on the specific institutional configuration of a political system and the path dependence of existing welfare state structures. The debate on the relevance of political parties and ideas, by contrast, is still far from settled. Further unresolved issues include the nature of the dependent variable in retrenchment studies. Also, the exact motives for cutbacks are theoretically still little understood, as are the political mechanisms through which they are realized. I argue that, because of the nature of these persisting issues, the pluralistic dialogue between different methods and approaches – as well as their combination – remains the most promising way forward in the study of welfare state politics.