The making of ‘the elderly’: Constructing the subject of care

The provision and arrangement of care for elderly people is one of the main challenges for the future of European welfare states. In both political and public discourses elderly people feature as the subjects who are associated with particular needs, wishes and desires and for whom care needs to be guaranteed and organised. Underlying the cultural construction of the care regime and culture is an ideal type model of the elderly person. This paper analyses the discursive construction of elderly people in the discourses on care in Austria. An understanding of how elderly people as subjects, their wishes and needs and their position within society are constructed enables us to analyse, question and challenge the current dominant care arrangements and its cultural embeddings. The paper demonstrates the processes of silencing, categorisation and passivation of elderly people and it is argued that the socio-discursive processes lead to a particular image of the elderly person which consequently serves as the basis on which the care regime is built.     

‘Our young people are worse’: family backgrounds,educational progression and placement options in public care systems

Introducing continental European approaches to UK child welfare practice raises a problem of comparison: to what extent are the problems and issues similar to or different from one country compared to another. Social pedagogues trained in continental Europe and working in English residential care services often encountered the phrase ‘our young people are worse’ from their English colleagues, with the implication that the social pedagogic approach was not suitable for the client group. This paper examines two propositions: (1) that in the context of introducing the continental European approach of social pedagogy into children's residential care services in England, young people are ‘different’ in England compared to other European countries and (2) that the placement options and practices for young people living away from their birth parents in continental European countries differ from those in England. Using data from a five nation study of young people from public care backgrounds, the paper argues that while family backgrounds are remarkably similar there are marked differences in the child welfare systems that might account for the perception that young people in care are ‘worse’ in England.     

Health care,social care or both? A qualitative explorative study of different focuses in long-term care of older people in France,Portugal and Sweden

Challenges with an ageing population are increasingly becoming a reality in the Western world. Since cognitive impairment increases with age, we can expect an increasing number of older people in need of care. The aim of this article is to describe, analyse and compare different focuses on care of older people with dementia, using examples from France, Portugal and Sweden. The questions are principally focused on the participants’ view about their tasks, the organisation of work, the professional role and cooperation with other professions. Everyday care was studied through observations and participant observations and the staff's opinion was explored by means of interviews. Twenty-two care settings for older people were included. The findings showed that France provided mainly ‘health care’, Sweden ‘social care’ and Portugal an integrated ‘health care and social care’. In a comparative perspective the Portuguese general care of older people, which focuses on integration of health care, social care and social work, also seems to provide care for older people suffering from dementia which best corresponds to the previously developed group living model.     

Good personal finances or a strong social capital—on different life conditions of importance for an active life when becoming alone in old age

Becoming alone in old age can be a decisive life event that brings major changes depending on various causes as health status, financial resources, family situation, and available welfare services. This article discusses the situation of older people in Sweden who have transitioned from a two-person to single-person household in recent years and what impact this might have on their everyday lives. Through in-depth interviews with 18 older people, age 67–90, their experiences about life conditions and opportunities were examined. Findings showed large differences between the men and women. They all tried to live as they always had done and they used the same personal life strategies that they always had. But the men could live as before on their own financial merits, while the women needed assistance from children, grandchildren and the welfare system. Transportation options were central and clearly related to both private economy and social services available. Shortcomings in the welfare state's way of caring for the elderly were clearly uncovered. The gap between social policy promises of opportunities for autonomy and independence to live an active life in old age and the everyday reality for older people still seems to be wide.     

The desire for control: Negotiating the arrangement of help for older people in Sweden

The interface between formal (public) and informal help for older people is unclear and subject to change in many welfare states. Our aim in this study was to contribute to increased understanding of the experiences of older people, their next of kin, and the care managers from the municipalities in the process of negotiating help in the everyday lives of older people who can no longer manage on their own. We took a qualitative approach, using qualitative interviews as the main data collection method. The results revealed that the different actors had contrary interests that made it difficult for all parties to be content with the outcome of the negotiations. The everyday lives of dependent older people and their next of kin are strongly affected by the conditions of formal eldercare.     

Mothering,equality and the individual: Feminist debates and welfare policies in the USA and Sweden

This paper addresses issues raised by ‘welfare reform’ in the USA by using the example of Sweden's women activists in constructing a ‘woman friendly’ welfare state. In the USA, feminist advocates see a tension between the argument that motherhood should be valued by the provision of care allowances, and the view that work should be reformed to meet the needs of parents. This reflects debates about gender difference/equality, the possibility of commonality, and the individual.

The Swedish ‘woman friendly’ welfare state was built on the recognition, through social policy, of the interrelationship among care, material resources, and public voice. The interrelationship was embodied in what I call the ‘social individual’, and articulated in public child care and other policies and collective services. The adequacy of those universal policies and services was frequently judged by the situation of lone mothers, who ceased being ‘deviant’, and often became a model for understanding the interrelationship. Cross-class solidarity among women was a prerequisite for, and was built on, the social individual. This solidarity is now threatened by neoliberal economic and social policies that fragment care, resources, and voice, and therefore the social individual.

It is possible to challenge the downsizing of welfare states by moving the terms of discussion away from the poor as deviant other, acknowledging that all women have much in common with the targets of current policy making. This involves the creation of concrete social policies that embody the relationship among care, resources, and voice, and recognize the inseparability of community, work and family.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

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.     

International migrations and care provisions for elderly people left behind. The cases of the Republic of Moldova and Romania

International migrations are posing numerous challenges to care systems in both sending and receiving countries. Based on a multi-method research conducted between 2011 and 2013, this article looks at how the care provisions for elderly people are rearranged in two Eastern European countries affected by the care drain phenomenon (the Republic of Moldova and Romania). The author charts and compares how transnational families, but also the other facets of the care diamond, such as the public sector, the market and the not-for-profit sector, provide care to elderly people left to cope at home alone because their close relatives have migrated. The main findings of the article are that transnational families are the principal welfare provider for elderly people left behind, while there is a serious delay in the adoption of specific policies for the elderly.     

Translating case management in a service for older people in Berlin

Case management is a coordinating process designed to align service provision more closely to the identified needs of people requiring assistance in the context of complex care systems. It is an approach that has crossed the borders of different national welfare systems where it has been adopted to address ostensibly similar problems. This empirically based but primarily methodological article draws on the author's doctoral research during which he spent an extended period in Berlin investigating a citywide case management service for older people in the context of German long-term care policy and legislation. It explores the extent to which a specific case study can illuminate how case management adapts in differing national welfare systems and highlights the particular methodological challenges of ‘translation’ and ‘equivalence’ in cross-national research. The article outlines how institutional context both shaped and constrained the Berlin case management service and highlights the necessity in cross-country research for a critical contextual examination of apparently similar features. This is particularly relevant where English words and expressions are directly absorbed into the local language, an important yet rarely addressed complicating factor.     

Presenting welfare reform: poverty porn,telling sad stories or achieving change?

Much is written about the suffering resulting from welfare reform and other cuts for disabled people and others on the receiving end. Usually this is seen as a ‘good thing’. But is it as simple as that? It may not be the same as so-called television poverty porn, but what is the point of constantly recycling welfare reform’s effects? Judging from last May’s general election, doing this does not seem to have had a significant effect on public politics/attitudes. So perhaps we need to look at it more carefully. When might discussion of welfare reform be helpful and when unhelpful? Is not the real task to develop alternatives, rather than hope as the Fabians did, that if we show how awful things are, ‘then something will have to be done’?     

The knowledge,skills and qualities needed for social work in a major paediatric teaching hospital

Abstract

The place of aged care in social work has long been ambiguous, if not marginal. Social work (as do other comparable professions) often displays a reluctance to place practice in this field within the core of the profession that embodies aspects of ageism in contemporary society. Working with older people is frequently characterised as ‘mundane’, ‘routine’ and even ‘not “real” social work’. This paper examines the practice implications of the current policy context. Forms of ‘indirect’ practice are identified as central to social work in aged care, and the implications of this for the standing of aged care social work in the wider profession are discussed. It is argued that ‘indirect’ practices are core to the development of the profession and so should be seen as ‘real’ social work. In conclusion, it is suggested that unless social work affirms practice with older people and their families we will fail to be congruent with our own values.     

Social Work Practice with Older Soviet Immigrants

ABSTRACT

With the recent sociopolitical changes in the Former Soviet Union, significant numbers of older Soviets have arrived in the U.S. with their families. Soviet immigrants who enter the U.S. are no longer automatically considered political refugees, which has limited their entitlement to services. Recent changes in public welfare and immigration policy place the responsibility for care of elderly members solely on the family. While caring for older adults is stressful for any family, new immigrants may be especially burdened since they have limited knowledge of services, few coping resources to provide adequate care, and little experience resolving cultural conflicts with their older parent. By using a practice model designed to evaluate late-life caregiving situations, two case scenarios are presented to examine practice and service delivery issues of older Soviet immigrants and their families.     

Understanding Professional Projects in Welfare Service Work: Revival of Old Professionalism?

The professional terms for occupations that provide welfare services are changing, and here the introduction of new public management in the Nordic countries since the 1990s is indicative of wider developments. The article explores professional projects in welfare service work from both conceptual and empirical perspectives. The aim is to produce a gender‐sensitive analysis of the professional projects at the lower levels of the occupational hierarchies in health care. The first part reviews the literature conceptualizing the societal and institutional embeddedness of professional projects. The institutional matrix of welfare states emerges as a key context in shaping the welfare service work performed by women‐dominated professional groups. The second part examines the case of Finland and suggests that recent reforms have created new inequalities in the system of professions, in which occupational groups in welfare service work are becoming marginalized. This signals a move away from ‘democratic professionalism’ towards a revival of ‘old professionalism’.     

Between Endless Needs and Limited Resources: The Gendered Construction of a Greedy Organization

One of the strategies of the modernization of public services is the decentralization of responsibilities and organizing work in autonomous co‐ operative teams with varied tasks. The empowerment of the public service workers in the front line is therefore a strategy in local government in Norway today. Under the assumption that women have ‘natural’ skills in caring, workers on the lowest levels are given responsibility for care and nursing. A study of the decentralization of public care for the elderly in their homes showed that being given interesting tasks and increased responsibility mobilized the efforts of the care workers. However, since the power of resources has been centralized, this has led to an intensification of work. In gendering the relevant discourses by explaining women's experiences of an over‐heavy workload as a result of their ‘mothering’ and their inability to set limits, women care workers were constructed by their managers as unprofessional and not to be taken seriously. This has made the public care organization a greedy organization for the women care workers.     

Over 1000 Aluminium Cans for Forty Dollars: The Provisioning Contributions of Older Children from the Perspectives of Welfare‐Reliant Lone Mothers

In this article, as a child and family mental health therapist, I connect the feminist concept of ‘provisioning’ and the experiences of ‘young carers’ to critically examine the family care contributions made by older children living in poverty. I present the findings of a qualitative study consisting of two focus groups in which ten (n = 10) welfare‐reliant lone mothers living in Toronto, Canada described the nature and significance of the contributions made by their older children (11–17 years old) to help their families ‘make ends meet’. Using grounded theory, two main categories emerged: (1) the nature of the provisioning by older children, and (2) the significance of the contributions. The implications of the findings suggest that mental health approaches with older children living in poverty inappropriately misrepresent and pathologise their emotional distress and family contributions.     

Care for place: The contributions older people make to their communities

Older people are often positioned as passive recipients of care and dependent on resources or as overly productive and active. In this paper, we seek a more nuanced, middle ground between such stereotypes, by exploring the question: what contributions do older people make to the places they live in? Drawing on qualitative research from Aotearoa New Zealand, involving focus groups and interviews, we examine the varied and active ways many older people are involved in and contribute to their neighbourhoods and communities, or what we term ‘care for place’. In particular, we identify the different forms of older people's care for place, including volunteering, activism, advocacy, and nurturing, and consider how these efforts positively impact on older people and the communities in which they live. Whilst we caution against assumptions that all older people should be productively involved, we argue that greater understanding of older people's care for place is central to challenging stereotypes of older people as either passive and dependent, or highly active.     

Financing Reform for Long-Term Care

The way the nation provides for the financing and delivery of long-term care is badly in need of reform. The principal options for change are private insurance, altering Medicaid, and 110 FROM NURSJNG HOMES TO HOME CARE public long-term care insurance. This article uses the Brookings-ICE Long-Term Care Financing Model to evaluate each of these options in terms of affordability, distribution of benefits, and ability to reduce catastrophic out-of-pocket costs. So long as private insurance is aimed at the elderly, its market penetration and ability to finance long-term care will remain scverely limited. Affordability is a major problem. Selling to younger persons could solve the affordability problem, but marketing is extremely difficult. Liberalizing Medicaid could help solve the problems of long-term care, but there is little public support for means-tested programs. Finally, universalistic public insurance programs do well in meeting the goals of longterm care reform, but all social insurance programs are expensive and seem politically infeasible in the current political environment. The way the nation provides for the financing and delivery of long-term care is badly in need of reform. No other part of the health care system generates as much passionate discontent as does long-term care. At the heart of the problem is the absence of any satisfactory way to help people anticipate and pay for long-term care. The disabled elderly find, often to their surprise, that the costs of nursing home and home care are not covered to any significant extent by Medicare or private insurance. Instead, they must rely on their own savings or, failing that, turn to welfare in the form of Medicaid. At a national average cost of $40,000 a year for nursing home care, long-term care is a leading cause of catastrophic out-of-pocket health care costs for the elderly. In addition, despite the strong preferences of the disabled for home and community-based services, current financing is highly skewed toward care in nursing homes. While the debate over long-term care reform has many facets, it is primarily an argument over the relative merits of private- versus publicsector approaches. Differences over how much emphasis to put on each sector partly depend on values that cannot be directly proved or disproved. Some believe that the primary responsibility for care of the elderly belongs with individuals and their families, and that government should act only as a payer of last resort for those unable to provide for themselves. The opposite view is that the government should take the lead in ensuring comprehensive care for all disabled older people, regardless of financial need, by providing comprehensive, compulsory social insurance. In this view, there is little or no role for the private sector. Between these polar positions, many combinations of public and private responsibility are possible.     

Staff responses to age‐related health changes in people with an intellectual disability in group homes

The purpose of this study was to explore how supervisors in group homes caring for people with intellectual disability responded to the development of age‐related health changes in their residents. Ten group home supervisors working in the disability sector were interviewed once. Data were analysed using Dimensional Analysis. The study identified several factors related to whether a resident could stay ‘at home’ or would need to be moved to residential aged care (nursing home) including: nature and extent of group home resources, group home staff comfort with residents’ health changes, staff skill at navigating the intersection between the disability and ageing sectors, and the supervisor’s philosophy of care. The ability of older people with an intellectual disability to ‘age in place’ is affected by staff knowledge about and comfort with age‐related illnesses, staff skills at navigating formal services, staffing flexibility, and the philosophy of group home supervisors. Despite the growing international concern for the rights of people with disability, particularly in relation to decision making, questions about the older person’s choice of residence and participation in decision making about what was best for them, were almost nonexistent. Rather, decisions were made based on what was considered to be in ‘the best interest’.