Cash‐for‐care payments in Europe: Changes in resource allocation

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind?     

Regulating the delivery of cash‐for‐care payments across Europe

The article aims to understand how governments across Europe have modified the regulation of the delivery of cash‐for‐care schemes (CfCs) to dependent older people since the beginning of the century. In our terminology, the regulation of the CfCs delivery defines the norms, rules, and practices that public actors adopt to manage how beneficiaries can use the benefits. To discuss the regulation of CfCs delivery, we employ an original framework that take three analytical dimensions into account: the degrees of freedom in benefits' utilization (“CfCs utilization” dimension), the provision of information/orientation/advices/counselling to older people and families (“professional support” dimension), and the relationship between the delivery of CfCs and the delivery of the other publicly funded long‐term care inputs (“care system” dimension). The analysis adopts a comparative perspective, looking at six countries—Italy, Austria, the Netherlands, France, Germany, and England. Among various findings, the main one consists in showing that there has been a shared and increased interest in consolidating the regulation of CfCs delivery. This trend has been mostly directed towards the new policy aim of strengthening the professional support, a goal underestimated in the past, when this dimension was not a major topic of both debate and practice concerning CfCs across Europe.     

The turn to optional familialism through the market: Long‐term care,cash‐for‐care,and caregiving policies in Europe

Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care.     

Cash‐for‐care policy in Sweden: An appraisal of its consequences on female employment

In 2008, Sweden introduced a cash‐for‐care benefit consisting of a flat‐rate sum paid by municipalities to parents whose children were between the ages of one and three and who did not use publicly subsidised childcare. The main object of the reform was to increase parents’ ‘freedom to choose’, but the policy was criticised because of its potentially negative effects on gender equality and mothers’ employment. This study focuses on the effects of cash‐for‐care on female employment in Sweden. The study shows that the adoption of this policy had negative effects on female employment, although primarily in rural areas. Cash‐for‐care was abolished in Sweden in 2016. To evaluate the effects that the policy had on female employment during the time it was in place is important as it indicates what may happen if the policy is introduced again.     

Child Well‐Being Scales (CWBS) in the assessment of families and children in home‐care intervention: an empirical study

This paper reports research carried out in Italy designed to investigate the usability of Child Well‐Being Scale (CWBS) for the outcome evaluation of home‐care interventions for vulnerable families and children in need. Using a pre‐ and post‐test design, the study traces the changes in 18 vulnerable families and 23 children in need included in a programme of home‐care intervention over a period of 11 months. All the families and children were assessed twice: at intake and at the end of the intervention (after 6 months). Furthermore, 10 families and 11 children had a longer intervention and were assessed three times. Moreover, two focus groups involving 13 home‐care workers and 11 face‐to‐face interviews were used to collect practitioners' points of views on CWBS. The results generally support the idea that families' and children's situation improved over time, as shown by an improvement in almost all of the considered dimensions after 6 months and after 11 months. Specifically, the families improved more on household adequacy in the long term while children on the child performance dimension improved in the short term. Practitioners reported that CWBS was an aid to multi‐professional decision‐making, as the systematic evaluation of the subscales was a practical base upon which to activate shared decision‐making during the casework.     

Foster care assessment: an exploratory study of the placement assessment process in Flanders and the Netherlands

Family foster care placement decision‐making has a weak scientific underpinning. The identification of clusters of foster children (groups of foster children with similar characteristics) can help improve decision quality. In this study, we investigated if foster children could indeed be clustered, which problems were identified at the time of placement and what might be the influence of placement history. Two clusters of foster children were found: (i) young children with coinciding parental child‐rearing incapacity and familial problems, and (ii) older children with child problems. At the time of placement, familial problems were more often identified in younger children with a placement history. These findings stress the importance of approaching foster care assessment as part of a dynamic decision‐making process. It is key to finding the most appropriate situation for the child. At the same time, it must be decided how the desired situation can be realized, wherein placement decisions are based on an appraisal of whether or not a foster placement is an appropriate solution. In conjunction with this, it needs to be decided how the parents can be supported towards reunification, or whether or not long‐term foster care is the best option for the child, and if so what conditions need to be met.     

Cash for long‐term care: Policy debates,visions, and designs on the move

Cash‐for‐care (CfC) schemes have introduced a key transformation in long‐term care policies across Europe since the 1990s. The article explores the extent to which CfC policies have changed over time and into which directions, the ways in which change (if any) has occurred and the forces underlying it. By combining the literature on institutional change with ideational approaches, the article focuses on policy theories and policy designs, on modes of change and factors pushing for change within the CfC policy, and in the long‐term care and neighbouring policy fields. In doing so, we aim to contribute to understanding institutional change and the transformation of an increasingly important sector of the welfare state.     

Cash for care and care employment: (Missing) debates and realities

The introduction of cash‐for‐care (CfC) schemes in different European countries over the last years has responded to a plurality of strategies aimed at attending the rising demand and increasing costs of the long‐term care needs of an ageing population. The specific system of care provision in each country shaped the response given to those challenges, as well as the room for manoeuvre for policymakers when trying to transform the domain of care into a sphere where markets may play a larger role, partly relieving families, and also the state, from these responsibilities. Policy debates and scholarly analyses largely overlooked the contribution of these schemes to the creation and shaping of employment. This article provides a comparative analysis of how CfC‐based policies entail—alongside the regulation of informal care—a(n implicit or explicit) connection with care employment and may contribute to structuring employment relations in this sector. It looks jointly at the specific features of CfC and at the institutional context—welfare regime—in which they are embedded in order to assess the extent to which these schemes contributed (generally unintendedly) to a transformation of the care employment size and features in seven European countries.     

Resisting your good intentions: substance‐misusing parents and early intervention to support and monitor children in need

Children from substance‐misusing families face elevated risks in growing up well and safe. Early intervention is an opportunity for local authorities to offer support and keep a watching brief on children's welfare. However, the basis upon which agencies voluntarily engage with families in advance of major problems becoming evident is far from straightforward. This qualitative pilot study in Scotland followed professional decision‐making over 6 months (n = 20 professionals) with a small number of families (n = 6) defined as in need of supportive intervention. This support was allied with an intention to monitor the family situation, which, in these data, appeared to affect the willingness of families to engage with services. As services sought to increase their voluntary oversight, sometimes by threatening escalating involvement, so families by various means appeared to resist it. Successful early intervention is reliant on voluntary family participation and thus requires close attention to means of positive and motivated parental engagement to disarm resistance.     

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

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

The restructuring of WA human services and its implications for the not‐for‐profit sector

Western Australia provides an interesting case study of the outsourcing of human services to the not‐for‐profit (NfP) sector. This article presents and discusses some of the key themes that emerged from a recently completed research project examining one large NfP in Western Australia. Key themes included the recruitment and retention of staff linked to pay and changing funding arrangements, and the sector becoming increasingly corporatised in outlook and goal orientaiton. Despite evidence that the shifting policy and funding environment within the NfP sector has had some negative consequences, the research findings highlight a degree of agency within which organisations can resist or counterbalance these changes. Efforts to avoid this trend, however, are reliant upon a number of factors; for example, a strong commitment to vision and mission supported by skilled leadership and adequate resourcing. Significantly, these factors are unlikely to be readily available, particularly for smaller NfPs. This discrepancy in organisational capacity is set to become more conspicuous with the potential introduction of ‘Big Society’ policies derived from the United Kingdom, and funding cuts proposed by the Coalition government.     

Employer‐sponsored programmes for the prevention and treatment of HIV/AIDS: Recent experience from sub‐Saharan Africa

This article examines a sample of employer programmes in sub‐Saharan Africa that supplement government efforts to prevent and treat human immunodeficiency virus (HIV). Some of these programmes provide workers with in‐house education, voluntary HIV testing and antiretroviral treatment. Others rely on new forms of employment‐based group health insurance that include an HIV treatment package. In addition, some enterprises use the workplace as a platform for launching efforts into neighbouring communities to reach spouses, children, sex workers, secondary school students and others. Early evidence suggests that employer programmes maintain the health of large fractions of workers living with HIV who are served by them. They further enable enterprises to avoid productivity losses and turnover costs associated with HIV. At the same time, they take pressure off government agencies that face demands for treatment far exceeding their capacity. The article identifies features of successful employer programmes including “elite appeal”, which mobilizes community leaders and role models to deconstruct stigma, change perceptions and call for behavioural change; and “collateral linkage”, which extends the reach of HIV workplace programmes by linking them to related community concerns: e.g. alcohol abuse, malaria and domestic violence. Looking forward, the potential for expanding employer programmes as well as the restrictions associated with the limited scale of formal‐sector employment within sub‐Saharan African economies is assessed. Actions by which governments, employer associations, trade unions and international organizations can encourage further development of such programmes and extend their reach are suggested.     

Navigations between regulations and gut instinct: the unveiling of collective memory in decision‐making processes where teenagers are placed in residential care

The decision to take a young person away from his or her family into out‐of‐home care and treatment is the most drastic intervention within the statutory powers bestowed upon social services. The results of reports on the quality of residential treatment reveal that state supervision has not proven to be a good substitute for parental care. In this paper we analyse the decision‐making process when young persons are placed in residential care. Focus groups and individual interviews with different stakeholders were conducted. The results show that the placements are a collective process involving negotiations between the different parties with a coordinating social worker in the middle, with the aim to bring something to build hope on in often desperate situations, regardless of the specific treatment method used. To inform the process, the social workers draw on a ‘collective memory’ shared among colleagues in the department. Important signs of quality of a residential unit were the relational and collaborative competence from the staff. The inclination to use soft, diffuse information in decision‐making shows a striking lack of evidence upon which social workers can build well‐informed and knowledge‐based decisions.     

Suicidal behaviour in transition‐aged youth with out‐of‐home care experience: Reviewing risk,assessment, and intervention

The rates of suicidal behaviours in youth with out‐of‐home care experience, particularly those who are on the verge of emancipation, appear to be alarmingly high. The purpose of the current study is to highlight the rates of suicidal ideation and behaviour in these youth, illuminating the empirical risk factors that may increase their vulnerability. We offer a review of screening measures and suicide interventions that may hold promise for administrators, practitioners, and researchers who wish to provide comprehensive assessment for transition‐aged youth with out‐of‐home care experiences and effectively treat those who may be at the highest risk.     

Placed and paid for: a national overview of the use of private and voluntary day care facilities for children in need

This paper examines day care provision for children in need, who are placed and paid for by local authorities in non local authority services. The England and Wales Children Act 1989 placed a new duty on local authorities to provide day care services for children who are defined as being 'in need', and the guidance accompanying the Act encourages the use of independent sector services for this purpose. This paper brings together the main findings from a survey of all English local authorities, an analysis of local authority documentation and secondary analysis of government statistics to provide a national overview of the use of sponsored day care places for children 'in need'. It concludes that the majority of English local authorities value the contribution of independent day care providers, but that there are potential problems with adopting a market approach to welfare services, such as low levels of training and support for such providers, and a shortage of suitable service provision in the areas where they are most needed. These require further consideration by policy makers and local authorities.     

Economic empowerment or cash‐dependency for orphans and vulnerable children in Kenya: Evidence from an alternative to cash‐only models

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional, and behavioral outcomes than non‐OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households, using cross‐sectional data from 1,060 OVC in a 3‐year Kenyan empowerment program that combined elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one‐third of the association was mediated by material inputs, indicating that a substantial portion may be explained by other unobserved program elements. Eighty‐five percent of increased rates of saving money in the past year were mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand how to improve household economic stability among OVC. Key Practitioner Message: ? Orphans and vulnerable children (OVC) are at risk of greater poverty, leading to multiple developmental and health challenges; ? Current policy in Kenya to offset costs of caring for OVC utilizes monthly cash transfers to households providing care for OVC; ? The present study found that increases in monthly income in an OVC multisectoral empowerment program were largely due to factors beyond the material inputs.     

Older Persons’ Views on Using Cash‐for‐Care Allowances at the Crossroads of Gender,Socio‐economic Status and Care Needs in Vienna

The article aims to contribute to understanding social inequalities resulting from familization (or de‐familization) tendencies among cash‐for‐care beneficiaries in a Conservative welfare state. It highlights justifications for choices in accessing and using care in a cash‐for‐care scheme from the perspective of care recipients aged 80 years and older in Vienna. Along key dimensions characterizing care recipients’ experiences, we identify four different user groups, which reflect recipients’ individual characteristics, particularly gender, socio‐economic status (SES), and care needs, and the respective care arrangement. The groups are dubbed: (1) the self‐confident; (2) the illiterate; (3) the dependent; and (4) the lonely. Narrative interviews with 15 frail older people were held in 2014 and analyzed using the framework analysis method. Results show that familiarity with support structures associates with higher SES, while those who depend on others for acquiring information or organizing care express ambivalence in choosing between formal and informal care. Engagement in deciding which care type to use is limited among people of lower SES or with complex care needs, but own experience as informal caregiver for a family member increases care recipients’ long‐term care (LTC) system literacy. Gender differences among care recipients were limited, yet middle‐class female recipients often expressed normative claims for family care from female relatives. We conclude that unconditional care allowance schemes may reinforce existing gender relations, particularly among informal caregivers, as well as underpin socio‐economic differences among LTC users in old‐age. Results also partly question the assumptions of choice and empowerment implicit in many cash‐for‐care schemes.     

Adult self-sufficiency and social adjustment in care leavers from children's homes: a long-term assessment

This paper presents a study carried out in Spain that followed up 260 young people, the majority of them adults, who had been in residential care for significant periods. The follow‐up takes place between 1 and 9 years after participants had left residential care, and assesses their level of social and work integration, as well as considering the incidence of problems related to marginalization and social exclusion. Furthermore, it analyses the reasons for the child being taken into care, the socio‐family context, length of stay, changes in placement and other features or incidents in relation to the residential care. The data show that close to 15% have serious problems (drug dependence, delinquency, etc.), 25% receive help from the social services and the rest manage independently to a greater or lesser extent. We discuss the significance of these data, especially the relationship between the final result and the initial and process variables.     

The role of informal caregivers in the well‐being of orphans in Botswana: a literature review

With the orphan population escalating, communities continue to rely on relatives to provide care to orphans. Therefore, there is a need to explore the role of caregivers with regard to the well‐being of orphans, the challenges they face, as well as how they could be empowered to be more responsive to children's needs. The paper acknowledges that informal caregivers play an important role in the lives of orphans. The paper also concedes that, in the process, caregivers are faced with challenges which make it difficult for them to fulfil their responsibilities and roles. As a result, they sometimes act as sources of stress to orphans, which eventually complicate the children's adjustment to the loss of their parents. Lastly, the paper paves the way to ensuring that challenges faced by informal caregivers are addressed in a manner that will make them more supportive to orphans.     

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.