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.     

Children's journeys through organizations: how inspectors evaluate coordination of care

Inspectorates have been criticized for assessing compliance with the rules rather than outcomes for children. In the Netherlands, inspectorates have developed a ‘journey tool’ to reconstruct children's travels through all the organizations providing care. Using document analysis and semi‐structured interviews, we evaluated how inspectors use this tool in practice. We applied an ontological theoretical framework to the coordination of care to analyse 24 journeys through care organizations, including a selection of six journeys in further detail. Our analysis shows that up until now, inspectors used only one form of coordination, the creation of a hierarchy, resulting in one problem definition. However, in complex care practices, children have multiple and often incompatible problems so that one coherent problem definition cannot be made. We show that ‘patchwork’, a form of coordination that allows discrepancies enables inspectors to reflect on complex care practices and evaluate options to improve outcomes for children.     

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.     

Health informatics for older people: a review of ICT facilitated integrated care for older people

Growing demands on welfare services, arising from expanding populations of older people in many countries, has led policy makers to consider the use of information and communications technologies (ICTs) as a means to transform the cost-effective delivery of health and social care. The evidence for these claims is examined by reporting the main findings of a review of worldwide published literature documenting the adoption of health informatics applications to improve health and social care for older people. It focuses around two dimensions of the UK government's programme for 'modernising' public services, which emphasise the use of ICTs to facilitate the sharing of health and social services information and its potential to foster person-centred approaches to independent living. Findings suggest that there is little evidence that these dimensions have been realised in practice and the perceived incompatibility between them is more likely to produce expensive and ineffective health informatics outcomes.     

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.     

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.     

Improving primary level home and community care services for older people: The case of Hong Kong

The aims of this study were to assess the impairment levels of users and waitlisted applicants for Hong Kong's Integrated Home Care Services (Ordinary Cases) (IHCS [OC]), reveal their possible hidden needs and potential demand for higher level services, assess their unmet needs for IHCS (OC) and explore whether not using IHCS (OC) was associated with any deterioration in impairment. In all, 567 respondents were clinically assessed twice, over a 6‐month interval, by the Minimal Data Set Home Care questionnaire. The results showed that some moderately or severely impaired respondents had only limited access to higher level services. Some respondents with either no impairment or only low‐level impairment had applied for higher level services. Most waitlisted applicants had not received any IHCS (OC), even after 6 months of waiting. Using IHCS (OC) or not had no significant impact on the deterioration in impairment. Several ways of improving home and community care services are discussed.     

Unheard voices,unmapped terrain: Care work in long‐term residential care for older people in Canada and Sweden

Daly T, Szebehely M. Unheard voices, unmapped terrain: care work in long‐term residential care for older people in Canada and Sweden This article aims to contribute to comparative welfare state research by analysing the everyday work life of long‐term care facility workers in Canada and Sweden. The study's empirical base was a survey of fixed and open‐ended questions. The article presents results from a subset of respondents (care aides and assistant nurses) working in facilities in three Canadian provinces (n= 557) and across Sweden (n= 292). The workers' experiences were linked to the broader economic and organisational contexts of residential care in the two jurisdictions. We found a high degree of country‐specific differentiation of work organisation: Canada follows a model of highly differentiated task‐oriented work, whereas Sweden represents an integrated relational care work model. Reflecting differences in the vertical division of labour, the Canadian care aides had more demanding working conditions than their Swedish colleagues. The consequences of these models for care workers, for older people and for their families are discussed.     

The school experience of children in residential care: A multiple case study

Children in residential care are the out‐of‐home population group with the lowest rate of access to postsecondary education. Research aimed at understanding their situation within the school context suggests that besides learning progress and outcomes, subjective experiences should be taken into account. Qualitative research based on a multiple‐case study was designed and carried out in Spain with the aim of deepening the understanding of the individual school experiences of three children in residential care. Each case was analysed from the perspective of the child, the educators and the teachers. Semistructured, one‐to‐one interviews were carried out, and children's files were consulted. The results pointed to emotional distress and accumulated educational delay as common traits of the three children in the study. In shaping each particular school experience, the key themes identified included (1) individual characteristics, (2) the children's academic aspirations and strategies, (3) relationships with peers and teachers, (4) response experienced in school, (5) the complex structure of the residential centre, (6) the sense of belonging to the residential centre, (7) team work and (8) political action and investment in inclusive education.     

Getting behind the closed door of care leavers: understanding the role of emotional support for young people leaving care

There have been significant changes in the legislative frameworks and guidance that surround social work practice with young people leaving the care system over the recent years. However, care leavers continue to face a range of challenges, achieve poor outcomes and research has consistently highlighted the insufficient attention paid to sources of emotional support. This paper provides empirical data from a small number of care leavers reflecting on their experiences of transitioning to independence. The findings provide further evidence of the lack of attention paid to emotional support by professionals and highlight the impact that this had on the young people's experiences. The young people identify their changing perceptions and needs as their experiences post‐care change, the complex reasons for why they may have rejected offers of support and make key recommendations for practice. This paper provides valuable insight into the process of leaving the care system from the perspective of care leavers themselves and raises key questions that challenge the structure of the current support systems, the nature of the professional relationship with young people in care and the priorities of current policy initiatives.     

The social networks of young people in Ireland with experience of long‐term foster care: some lessons for policy and practice

This paper presents findings from the first study of the social networks of a group of young people in Ireland who have experienced long‐term foster care. The study group was composed of two groups of young people, a group who were currently in care and a group who had left the care system. The central focus was to examine the impact of foster care on the social network experience of the young people. Findings indicated that foster care impacts on the young people's social network experience in the following ways: losing contact with extended family; a greater challenge in making and sustaining friendships; an impact on education; and an inability to maintain contact with groups and activities that are of significance. This paper also presents recommendations in relation to policy and practice, including the raising of awareness of the importance of a social network approach in working with young people with care experience.     

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.     

Living Close to a Person With Cancer: A Review of the International Literature and Implications for Social Work Practice

To help family caregivers (FCs), social workers need to understand the complexity of FC’s experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC’s own health risk, caregiver burden, and experiences over time can enhance a social worker’s awareness of an FC’s challenging situation and the potential impact this has on the FC’s ability to provide care to the patient.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

Securing permanence for children in care: A cross-country analysis of citizen's view on adoption versus foster care

If children in child protection cannot be cared for by their natural parents, should they be adopted or live in foster home? Results from a study of representative samples of populations (n = 12 330), in eight European countries—Austria, England, Estonia, Finland, Germany, Ireland, Norway and Spain—and California, USA, reveal that people would recommend adoption over foster care, if a child in public care cannot grow up with their natural parent(s). There are cross-country differences between populations, and examining if institutional context such as type of child protection system explains differences, we find that child maltreatment-oriented systems are more supportive of adoption than other types of systems. Citizens having little confidence in the child protection system were only weakly correlated with preference for adoption. In conclusion, people prefer adoption as placement options for children in care are more than foster homes, and possible this finding reflects a sort of refamalialization of children into the private sphere.