Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

The ABC of Child Care Politics

The care and education of children below school age is an area of intense public debate and the subject of considerable policy innovation in Western democracies. Child care raises complex philosophical and policy issues ranging from broad questions about the relative responsibilities of state, market and family to technical aspects of policy design such as the interaction of child care subsidies with income support, family payments and taxation. Across the developed world, countries are finding new ways to address the growing need for child care, with market‐based solutions looming large in several countries. This paper analyses Commonwealth policy towards long day care in Australia since the early 1990s. It explores the shift towards market‐based, for‐profit care for children below school age, especially the growth of publicly listed child care corporations. In allowing a single corporation to assume a dominant position in the provision of long day care, Australia has embarked on a vast experiment in the care of children, unparalleled in other countries.     

Child Support: The Limits of Social Policy Based on Assumptions of Knavery Extending the Pillars of Social Policy Financing to Aged Care

Julian Le Grand has argued that a key component of welfare reform involves changes in the assumptions about human behaviour which are embedded in social policies. Policy assumptions have been transformed from espousing a belief that social service providers act as well-intentioned knights and recipients as passive pawns, to a stance in which all participants are regarded as self-seeking knaves. These ideas are particularly pertinent to policy developments concerning financial obligations for children, and this paper examines these issues in relation to child support policy in New Zealand. It highlights the evident and inevitable failure of this policy to meet its primary stated aim of revenue generation. In New Zealand this failure is compounded by the creation of parallel systems for dealing with children and families, one for financial obligations and the other for care and development, which are founded on diametrically opposed assumptions about human behaviour and capabilities. This confusion is symptomatic of a wider failure in government policy towards families in New Zealand.     

The Consequences of Implementing a Child Care Voucher Scheme: Evidence from Australia,the Netherlands and the USA

In the Netherlands, the USA and Australia, public funding has promoted parental choice by introducing a voucher scheme for child care, where parents are free to choose the provider. The policy experiments and the outcomes in these three countries provide useful information about the consequences of introducing a voucher scheme in the child care market. We show the voucher system can be effective in increasing demand, but there can be uneven supply responses. The structure of the voucher income scheme and quality controls affect the nature of the supply response. We argue that voucher schemes must take into account the complex nature of the child care market and the substitutability among free public care, private market care and unpaid household care. To secure quality and access, government also must play a coordinating role that vouchers alone cannot supply.     

Cash versus Child Care Services in Finland

In 1985 the Finnish Parliament passed a law which stipulated that all children under age three were to be guaranteed a day care place as from the beginning of the 1990s. The law was made possible by a political compromise in which the agrarian Centre Party won the backing it needed to push through a system of state subsidies for the home care of children. As an alternative to a day care place, parents were now given the option of taking a child home care allowance and using that allowance either for purposes of looking after their child themselves or for paying for a private place. Measured in terms of the number of users, the child home care allowance was a hugely successful innovation. Most parents of small children have used the allowance for at least some period of time. This was due above all to the size of the allowance compared with other social benefits. However, following cutbacks in allowance expenditure of more than 20 per cent from 1995, the use of home care allowances declined at almost the same rate as the allowances were reduced. This brought significant short-term savings to the Government and to local authorities, but in the longer term other costs have been rising. There has even been a sharp, unexpected decline in the birth rate. The case of Finland goes to show that, even in a country where wage-earning motherhood has become firmly established, income transfers through family policy can have a very significant influence on the numbers opting temporarily for homemaking.     

Children's Living Conditions in Sweden. Social Patterns and Trends in Parental Accessibility, Child Care and Economic Resources

In this study, using data from the Swedish level of living surveys in 1981 and 1991 of more than 3,500 children, social patterns and trends in children's living conditions are analysed. The conditions focused on are linked to parental employment, namely, parental accessibility, use of child care and economic resources. The primary statistical method used is logistic regression analysis. The results show differences in children's access to mothers and fathers as parental access is restricted by various aspects of employment. There were also differences in childrenrsquo;s resources by social class and family structure. Of further importance was the combination of these, especially in the way that social class was more decisive for the children of single parents.     

英国医疗卫生体系问题与医疗卫生政策改革研究

健康是人们福利的重要组成部分,因此医疗卫生政策和体系是社会政策的重要领域。该项研究从贫穷、低收入和健康之间的关联中评估人们对医疗保健的需要;指出英国存在全科医生、医院医生及公共卫生医生是医疗卫生服务提供的主体;英国在医疗卫生政策改革方面的内容包括:(1)对英国全民医疗体系(NHS)多渠道的财政支持,(2)提高服务质量的机构管理改革,(3)实施提高服务质量的安全、有效、病人中心、及时、效率、和平的原则;英国存在的强大政治集团及其利益影响着改革;政府需要在减少医疗服务中不平等和提供及时有效的服务方面努力。     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Labour Markets,Care Regimes and Foreign Care Worker Policies in East Asia

This article analyzes the politics of foreign care worker policies in Japan, Korea and Taiwan. In the face of socio‐demographic challenges, these countries have responded differently to the increasing demand for hiring foreign care workers, creating distinct policies with respect to the origins of the foreign care workforce, the size of the foreign care workforce in the labour market, and job specifications. In this article, I argue that the interaction of female employment patterns, the public provision (or lack) of social care, and labour market policies in the care service sector determines the diverging political pathways of foreign care worker policies in these three countries over the past two decades.     

Learning from Japanese Experience in Aged Care Policy

Like Singapore, Japan is projected to age rapidly. Japan is the first country in the world where more than 20% of the total population is over 65. Even as Japan adapts from western Europe and America where population ageing is more advanced up till now, it has been pioneering its own aged care policy, given the differences in sociocultural and political contexts. Of particular interest is its introduction of long-term care insurance and its effectiveness in meeting the needs of the long-term care of the aged and their family caregivers. In this article I seek to compare and contrast Singapore and Japan in terms of their demographic changes leading to rapid ageing, and their respective policy and program responses to a rapidly ageing population, drawing lessons from the Japanese experience.     

Balancing Long-term Care in Japan

This article discusses Japan's long-term care (LTC) from the perspective of balancing the provision and financing of care. Specifically, this article provides an overview of the long-term care insurance (LTCI) system in Japan and analyzes the current state of Japan's LTC with current statistical data as to whether the supply meets the demand for care by frail elders and their families.     

To Coordinate Information in Practice: Dilemmas and Strategies in Care Management for Citizens with Dementia

ABSTRACT

This qualitative study, based on 19 interviews with care managers, explores the experiences of care-managers involved in assessing the need for social services for people with dementia. The study shows that social workers, as care managers, face several dilemmas in their practice concerning people with dementia, in relation to the exchange of information and in regards to conflicting interests between different actors involved in the assessment of the need for support for people with dementia. Strategies used to handle problematic situations that arise in their work are using other sources for information (e.g., relatives and actors from other professions), persuading, and pursuing creative forms of consent. However, the study shows that dilemmas and strategies used generate other, prominently moral, dilemmas for care managers in their practice, which relate to participation and self-determination by the person with dementia. The study shed light on the problematic situation for care managers in their work to coordinate information and further the new “realities“ that they encounter as well as on how to handle these new situations. This study suggests possible ways to improve the everyday work of care managers, as well as how policies concerning social work and people with dementia can be improved.     

Economic Policy and Social Policy: Policy-linkages in an Era of Globalisation

This article argues that changes in the role of the state in economic affairs will affect the process of social policy. Growing economic integration caused by globalisation now places a greater constraint upon the discretion of the nation state, bringing about a transformation into a more competitive state. States are increasingly having to compete against each other in order to promote competitiveness and attract foreign direct investment (FDI) from international capital markets. This competition influences in turn the social policy formation requiring the redesigning of social policy. Thus, welfare states may need to reform their social policy towards a "business-friendly social policy". The analysis of social policy inputs and outputs presented here suggests that there are common trends in most welfare states towards: a market-conforming policy on business taxation, a reduction of the share of employer's contributions in social protection revenues, more limited income security programmes, an increased allocation of resources for active labour market programmes and less state intervention in the labour market. All these reforming trends in social policy can be understood as a response of welfare states to the evolving needs of business caused by structural change, notably globalisation.     

Extending the Pillars of Social Policy Financing to Aged Care

Against the background of a recent resounding rejection of substantial increases in user contributions for funding long-term residential care in Australia, and especially of measures that could require realization of housing assets, this paper examines the scope for extending to long-term care the "pillars" approach to financing of retirement incomes and health care. The two latter areas are funded through pillars of general revenue, private insurance, social insurance by way of compulsory levies, and direct user contributions, whereas long-term care is financed only by a large pillar of general revenue and a smaller pillar of user contributions which are themselves drawn largely from transfer payments. Examination of the various pillars in each area suggests that there is limited scope for extending private insurance and user contributions in long-term care, but that there are several social policy grounds for incorporating a social insurance pillar. However, while discussion of social insurance options is growing in several quarters, the current political climate offers little prospect for the adoption of such a scheme.     

Child Poverty and Ecological Contexts of Deprivation and Well‐being: A Critical Review of Budgeting and Social Policy in India

In the context of global developments in the measurement of child poverty, this article critiques the limited success of the Indian government to develop a comprehensive social policy approach to address multi‐faceted deprivation suffered by Indian children. Since independence in 1947, Indian governments have focused on childhood deprivation through various programmes to improve food security, education and health. However, these programmes have functioned in siloes without any linkages to each other, along with poor budgetary commitment which has resulted in sub‐optimal policy outcomes. Based on the theoretical approaches of Amartya Sen's capability approach and Townsend's consensual approach to poverty measurement, this article highlights the intrinsic importance of child well‐being to society. To achieve its objectives, the article is organized into four main parts. First, the article provides an overview of Indian children's deprivation and poverty, and the policy approach. Second, it provides conceptual advancements globally on the measurement of child poverty and deprivation. Third, it highlights the importance of utilizing these indicators to measure child poverty in the Indian context. Fourth, it concludes with a critical analysis of children's budgets and social policy in India to highlight that the Indian government's approach towards child well‐being is not only conceptually flawed, but that its commitment is extremely poor.     

Child Care Caregiver Sensitivity and Attachment

Changes in child care caregivers' sensitivity and in children's attachment security were examined in three studies. Study one involved 55 children enrolled in community based child care. There was no intervention in these sites. Caregiver responsive involvement and children's attachment security did not change over time or when children changed caregivers. Study two involved 71 toddler age children enrolled in family child care homes. The caregivers of these children were enrolled in a family child care training project. Six months after the training security scores increased and caregivers of children who became secure or remained secure were more sensitive following training. Study three involved 36 children enrolled in center-based child care. Children were observed before and after selective staff replacement and in-service training to increase caregiver sensitivity. Six months following intervention security scores increased and caregivers of children who became secure or remained secure were more sensitive following training.     

Meeting the Needs of Male Caregivers by Increasing Access to Accountable Care Organizations

As the population of male caregivers continues to grow over time, they have become more visible to the service system. However, as the vast majority of supports serve female caregivers, it is important to bring men “inside” of the service system. Following a review of the male caregiver experience, this commentary discusses how Accountable Care Organizations (ACOs), a provision of the Patient Protection and Affordable Care Act of 2010, is one way that men can be brought into and access the service system. Although male caregivers are the focus of this paper, the recommendations suggested are useful for professionals working with all caregivers regardless of gender. Discussion includes a rationale as to why ACOs are a unique service that are currently being developed that provides a window of opportunity for health professionals to meet caregiver needs in new ways. This would include the evaluation of and addressing male caregiver psychosocial and support needs at the time of addressing care receivers’ medical needs.     

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

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

Perspectives of South African caregivers in receipt of Child Support Grants: Implications for family strengthening interventions

Cash transfers have delivered measurable benefits for poor and vulnerable children in low‐ and middle‐income countries. However, on its own, a cash transfer is insufficient to promote holistic child well‐being. In the quest for appropriate complementary family support services, known as ‘cash plus’ programing, this qualitative study sought to explore the perspectives of a group of South African caregivers, all of whom were in receipt of a Child Support Grant (CSG), in relation to their own caregiving and family functioning. Critical areas of support to families were identified to further scale up the already positive impacts of the CSG, such as mental health services, social supports for caregivers, decreasing levels of poverty and growing caregiving knowledge and skills. Key conclusions are that improving the quality and integration of public services and developing culturally appropriate and evidence‐based family strengthening programmes are critical to complement and boost the positive impacts of the CSG.