Slicing Up the Pie: Allocation of Central Government Funding of Care of Older People

The allocation of central government funds is a critical element in the equitable provision of local authority‐commissioned and ‐provided services. A variety of approaches to allocating funding for social services for older people have been used over the years, most recently founded on ‘needs‐based’ formulae. In 2004, the Department of Health for England commissioned research to help inform the improvement and updating of the formula. The results of individual‐level analyses were compared with the results obtained from analyses of small area (ward‐level) data on service users. Both analyses were affected by problems of data availability, particularly the individual‐level analysis, and the Department of Health and the (then) Office of the Deputy Prime Minister decided that the formula calculations should be based on the results of the small area analysis. However, despite the differences in approach, both methods produced very similar results. The correlation between the predicted relative needs weights for local authorities from the two models was 0.982. The article discusses the strengths and weaknesses of each approach and developments that could allow a normative approach that would incorporate future policy objectives into formulae that, to date, have inevitably been based on historical data and service patterns.     

Facing Up to Underfunding: Equity and Retrenchment in Community Care

Local social services departments in the UK are expected to distribute their cash-limited budgets for community care in ways that achieve an equitable allocation of resources in situations where, with present levels of funding, they cannot meet all the needs with which they are presented. This paper discusses a case study of the introduction of a "needs-based" formula to allocate a local authority's budget for home care services and a follow-up survey to investigate whether services reached the people intended to benefit. The article argues that the "gatekeeping" role of community care assessments is important to safeguard equity without the inflexibility of highly standardized tests of eligibility. However, with the new Labour government seeking to reduce dependency on public expenditure, and a growing lobby for national standards of social care, it will be increasingly important that local authorities justifiy their different practices with evidence about how they relate to local needs.     

Inequality in the welfare state? Local variation in care of the elderly – the case of Sweden

This article uses Sweden as an example to describe and analyse municipal variation in services and care for elderly people. Responsibility for these services lies with the municipalities. National statistical data on municipalities are analysed to map out the variations in old-age care; to study compensating factors in the care system; and to explore the connection with municipal structural and political conditions. The overall finding of the bivariate analyses was that most relations with structure and policy were weak or non-existent. The final multivariate model explained only 15% of the variance. The large differences between municipalities makes it more appropriate to talk about a multitude of 'welfare municipalities' rather than one single welfare state. The article concludes that this municipal disparity constitutes a greater threat to the principle of equality in care of the elderly than gender and socio-economic differences.     

Do cutbacks pay off? Perceived changes in the standard of municipal services and attitudes towards services among citizens and municipal decision makers in Finland

One common aim in the Nordic countries during the last decade has been to lessen state control over municipal affairs and to increase the local community's influence over the development of (welfare) services. These reforms happened to coincide with the economic depression of the 1990s, which especially hit Finland and Sweden, and enforced extensive cutbacks that negatively influenced the standard of services in a number of ways. However, according to some indicators the cutbacks also made public services more efficient. This article – utilizing Finnish data from 1995 – focuses on a comparison between how the general public on the one hand and leading municipal politicians and administrators on the other hand perceived the development of services and, further, whether these perceptions influence the groups' attitudes towards future changes in the system. Results show that decision makers, in contrast to a significant proportion of citizens, have a quite positive view on the development of services as well as on the continuation of cutbacks and a reduction of the municipalities' responsibilities for service provision. The study also indicates that citizens' views on the decline of various services are related to negative attitudes towards further decrease or changes in the municipalities' responsibilities. Among the decision makers, those politicians who think that (particularly efficiency aspects of) services have developed favourably also exhibit the weakest support for the prevailing system. The results raise questions concerning the role of citizens' attitudes in the development of services in the municipalities.     

Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town

The article reports on an exploratory study that examined access to alcohol and other drug treatment for historically disadvantaged communities in the Cape Town metropole. In-depth interviews were conducted with 20 key informants from various sectors of the alcohol and drug treatment system, including treatment service providers, members of local drug action committees and social workers from district social service offices. Findings highlighted three structural barriers to service delivery: (i) difficulties in developing and implementing a strategic plan relating to alcohol and drug problems due to poor capacity and other infrastructural issues, such as a lack of information, poor intersectoral collaboration and limited consultation with service providers; (ii) limited allocation of resources to alcohol and drug treatment which has restricted the availability of affordable services as well as the capacity of established services to meet increased demand for services in this area; and (iii) fragmented service delivery. The study highlighted the need for further transformation of the South African social welfare system responsible for alcohol and drug treatment service delivery through public–private partnership development and the introduction of a management information system.     

Social Welfare: Availability and Delivery of Services and Benefits for Children

It is contended that social welfare legislation is principally concerned with the allocation of resources of income, wealth, position and power. Australian legislation providing welfare services and benefits for children is assessed from this perspective. It is argued that the present legislation providing income support payments for young people accords excessive weight to the promotion of economic interests of the community such as the work ethic and fails to address the social and human needs of that population. It is also contended that the structure of the child welfare services legislation is overly concerned to cater to conservative forces in society who favour social control measures designed to protect their values and interests and who resist efforts to provide a network of non-coercive preventive services. Both areas of the law are criticized on the basis that they place excessive reliance on the notion that the family unit is capable of carrying the major responsibility for income support and service provision.     

Client-oriented Quality Assessment within Municipal Social Services

The hypothesis of this article is that quality assessment, despite the fact that it has now become a part of social services, has largely occurred without taking clients into consideration. There are supposed to be at least three possible explanations for this: organizational structures and professionalism, the difficulty in defining client needs, and the opinion that a client is not an equal companion in social service organizations. The research method entailed a questionnaire which was sent to 60 managers working within municipal social administration during the periods of construction (1950–1965), supplementation (1966–1983) and reform and redistribution (1984 onwards) of the Finnish welfare state and a questionnaire for 146 public social welfare organizations in Finland. Fewer than 30% of the social managers of the construction (1950–1965) and supplementation (1966–1983) periods and fewer than 50% of the managers of the last period (1984 onwards) said that clients really had assessed quality. The needs of clients and client feedback were said to be important during all three periods but the managers did not include them in the most important tasks. The managers of the period of supplementation did this the least. The managers from the period of reform and redistribution (1984 onwards) were more likely to trust the ability of clients to assess quality of social services and they also gave more opportunities to do so. The most important reasons for neglecting client needs and feedback in quality assessment were organizational structures and difficulties in defining client needs. There also seem to have been some methodological difficulties in assessing social services. Statistics are still largely in use and concrete criteria related to quality are missing. More specific questionnaires, cross-experimental designs and interviews, more possibilities for clients to describe needs in their own words, and the specification of general concepts in more concrete terms of quality are needed in order to avoid abstract and general assessments.     

Is Sweden Being Torn Apart? Privatization and Old and New Patterns of Welfare State Support

This article examines the potential impact of institutional change on popular welfare support. The encompassing welfare state of Sweden provides an interesting case where the privatization of social service delivery has been widespread over the last decades. We use survey data from five rounds of the Swedish Welfare State Survey (1992, 1997, 2002, 2006 and 2010) in order to study how public preferences for the financing and organization of welfare services have changed over time. Based on a theory describing an ideal‐typical pattern of public support for an encompassing welfare model, we derive three types of public preferences: support for a pure state model, a pure market model and a mixed model (welfare services are funded by taxes but provided by private firms). We begin by tracking the development of these ideal‐typical attitude patterns between 1992 and 2010. We then investigate how preference patterns vary across municipalities displaying different degrees of privatization of social service delivery. Our results show that welfare support among Swedes over the last decades is better characterized as dynamic rather than stable. Swedes seem to take an overall more ideologically based position on the role of the welfare state over time. The share of respondents expressing such ideologically based preferences has increased from 54 per cent in 1992 to 78 per cent in 2010. This change is principally manifested in increased support for the state and mixed models. This trend seems to be parallel to the increasing share of private welfare service providers over the last decade. We also find a link between the municipal degree of privatization and support for our three ideal‐typical welfare models. Public support for a mixed welfare model and, to some extent, a market model, is comparatively stronger in municipalities where welfare services to a large extent are carried out by private actors. Conversely, data shows that public support for the traditional Swedish state model is more widespread in municipalities having a low degree of welfare services privatization. Lastly, we discuss some theoretical implications of our findings.     

Formal Social Participation and Utilization of Community-based Services among Urban Elderly Chinese Living Alone in Shanghai,China

This research examined formal social participation among elderly Chinese adults living alone and the association between utilization of community-based services and formal social participation, which refers to participation in employment, volunteer jobs, and social groups. Using a secondary analysis on a survey data from a simple random sample of 228 adults aged 60 and older living alone in a Shanghai neighborhood, it was found that only small percentage of older adults living alone were involved in formal social participation. Hierarchical multiple regression analysis showed that use of community-based services is significantly associated with formal social participation among elderly Chinese living alone. Thus, future policies and programs should focus on strengthening community-based services for elderly Chinese, to more effectively promote and facilitate their social participation.     

The Utilization of Social Services by the Mexican-American Elderly

One of the knowledge gaps in empirical research on utilization of service is that little attention has been given to testing causal models of use among the various ethnic elderly groups. The purpose of this study is to analyze the pattern of determinants of social service use among the Mexican-American elderly. A causal model of social service use was tested using a subsample of data obtained from a national needs assessment interview of 1,805 randomly selected noninstitutionalized elderly Hispanics. The findings, indicate that knowledge of social services, need for social services, perceived health status and income have direct effects on the use of social services. The major findings are discussed in relationship to past empirical research.     

Coordinating community organizations in urban China

Since its introduction in the 1980s, China's housing privatization reform has gradually transformed urban residents into private homeowners, and reinforced disparities in housing allocation and living conditions. Various studies have analyzed the mobilization of private homeowners in newly built, upscale apartment complexes. Using data from field observations and in-depth interviews conducted in five low-income, urban neighborhoods in Beijing in 1999–2000, this article investigates the shifts in the organizational and power structure in older, working-class communities. The article describes the changing status of traditional and newly developed organizations and agencies within these neighborhoods, and analyzes the underlying reasons for the displacements and conflicts they experienced. Drawing on the author's subsequent fieldwork with community organizations in the USA in 2001–2002, the article suggests means of coordinating community organizations in low-income, urban neighborhoods in China, and discusses the opportunities and challenges for the social work profession in its attempts to deliver social services and advocate social justice.     

Coordinating community organizations in urban China

Since its introduction in the 1980s, China's housing privatization reform has gradually transformed urban residents into private homeowners, and reinforced disparities in housing allocation and living conditions. Various studies have analyzed the mobilization of private homeowners in newly built, upscale apartment complexes. Using data from field observations and in-depth interviews conducted in five low-income, urban neighborhoods in Beijing in 1999–2000, this article investigates the shifts in the organizational and power structure in older, working-class communities. The article describes the changing status of traditional and newly developed organizations and agencies within these neighborhoods, and analyzes the underlying reasons for the displacements and conflicts they experienced. Drawing on the author's subsequent fieldwork with community organizations in the USA in 2001–2002, the article suggests means of coordinating community organizations in low-income, urban neighborhoods in China, and discusses the opportunities and challenges for the social work profession in its attempts to deliver social services and advocate social justice.     

Local authority family centre intervention: a statistical exploration of services as family support or family control

This paper sets out findings from a statistical exploration into services arising from child protection referrals which became open cases allocated to local authority child care social workers employed by a large local authority social services department in South Wales. The workers operate from six local authority family centres located in areas of high social need. They offer a range of family support services as well as carrying out child protection investigations and related activities. In analysing the data a probability ratio was created to identify which offered services were more likely to be taken up. An activity index for services offered and taken up was then constructed followed by an attempt to delineate families' likely orientation to a family support or 'protection and control' mode of intervention. This is achieved by creating a simple range of lower and upper bounds of perception by imputing service orientation from the position of three 'representative individuals': a 'very suspicious client', a 'neutral third party', and a 'very optimistic social worker'. These three positions allow manipulation of the questionnaire data to estimate the probable interpretation of services from provider and recipient standpoints. From these sources parameter estimates to explore key variables associated with worker views about the sufficiency of their service in relation to family support and/or more controlling forms of intervention are deployed. The study suggests that child protection cases receive a family centre service strongly orientated to support rather than a narrow policing activity. However, there remain some notable differences of perception between worker and 'representative individuals' that imply potential difficulties over the role of local authority family centres.     

Decentralization of decision making: the case of payment policies for children's daycare

To bring about equality, the Nordic welfare states have provided a broad range of services with as homogenous eligibility criteria as possible. This homogeneity of social benefits has been obtained by centralized decision making and a high degree of statutory regulation. Recent trends in all welfare states veer towards greater local independence and decentralization. This article examines how the decentralization of decision making in Finland has affected the realization of basic welfare state principles. The specific aspect from which the topic is examined are user fee policies for children's daycare. The analysis gives a rather inconsistent picture of possible explanations for the differences between daycare payment policies. Municipal decision making is influenced by economic rather than political or structural factors. However, logical economic explanations are found only in large municipalities. This study highlights that decentralization of decision making has put families in very different economic positions in different municipalities - municipal traps are emerging. The relationship between welfare services and income redistribution has become ever more complicated as decision-making powers have been localized. A family may, for example, be paying the highest daycare fees but at the same time be entitled to social assistance.     

Allocating Homes for People with Intellectual Disability: Needs,Mix and Choice

Allocation of housing and support services for people with intellectual disability is based on three major sets of criteria: an assessment of the applicants' needs; considerations of social mix; and the applicants' own choices. This article examines the philosophical and institutional rationales underlying each of these notions and the tensions arising when seeking to achieve a balance between them. The first section of the article is based on a review of related studies in the UK, the USA and Australia, mainly on allocation policies in mainstream social housing. The second section presents original empirical work carried out in the state of Victoria, Australia, in 2007–08, illustrating some of the implications of a new balance that was created between needs, mix and choice in allocation of housing and support for people with intellectual disability. The article argues that the concepts of needs, mix and choice should be redefined in a way which reflects the interdependencies between them. Further, the article calls for more extensive mutual learning between studies of mainstream social housing and housing for people with intellectual disability.     

Utilization of Community-Based Social and Health Services Among Foreign Born Hispanic American Elderly

ABSTRACT

This study examined factors associated with the utilization of community-based social and health services among foreign born elderly Hispanic Americans. The data came from a nationwide probability sample of Hispanic Americans age 65 and older including 296 Mexico-born Mexican Americans, 571 Cuba-born Cuban Americans, and 247 respondents from other Hispanic countries. Being a Cuba-born Cuban American, living alone, having poorer self-rated health and living below poverty level were positively related with the utilization of community-based social services. Cuban Americans with more limitations in activities of daily living (ADL) used more community-based health services. Among Mexico-born Mexican Americans, those who lived alone used more social as well as health services while those who were married used more social services. Those with greater limitations in ADL used more health services. Among other foreign born Hispanic Americans, going to church, living alone and living below poverty status, were positively correlated with the utilization of social services. Respondents with better English language ability were less likely to use community based health services. Elderly men and people who rated their health as poorer or had more ADL limitations were more likely to use these services. Implications of these findings for health and social services are discussed.     

Nursing Home Social Services Directors Who Report Thriving at Work

Nationally representative data from a sample (n?=?928) of full-time nursing home social services directors were used to investigate whether knowing characteristics of the social environment at work can help to explain which directors report job thriving. Two-thirds of directors reported they were thriving in their jobs. Multiple regression results show that thriving is increased by job autonomy, being treated like an important part of the team, having enough time to identify and meet resident psychosocial needs, not having to do things that others could do, and being clear what the social services role is. Findings suggest that addressing these aspects of the social environment and social services role will likely contribute to increasing a sense of thriving at work among social services staff members.     

Exploring the 'Need' for Family Centres: The Perceptions of Social Workers and Their Importance for Planning

Correspondence to Ms J. R. Fells, Wooster Arms, The Walk, Islip, Oxon OX5 2SD. Summary This article follows Gilbert Smith in questioning the usefulnessof some traditional ways of regarding need, which rely mainlyon surveying potential client populations in order to decidewhat provision a social services department ought to make. Itdescribes a small study which examined in detail what socialworkers meant when they said that certain families ‘needed’a Family Centre, and which also looked at the subsequent historyof the department's contact with those families in the absenceof such a resource. It is, therefore, based on looking at whathappened to families when the Centre was not provided, and onanalysing social workers' perceptions of the need they encountered. It is argued that, despite its limitations, such an approachcan give useful indications, not only of what services shouldbe provided but as to the specific way they should be offered.In view of the role played by social workers in assessment for,and allocation of, services, it is suggested that a clearerunderstanding of their perceptions is essential to achieve effectiveservice utilization.