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.     

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash P, Shih Y.‐C. Introducing social insurance for long‐term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long‐term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform. Key Practitioner Message: ?Emphasizes the importance of policy learning from other environments; ?Highlights the need for a strong regulatory and provider infrastructure for delivering long‐term care services; ?Emphasizes the need for training, support, and appropriate regulation of the long‐term care workforce.     

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.     

Employers' attitudes towards long‐term unemployed people and the role of activation in Switzerland

Over the last few years, most OECD countries have extended their activation policy to new groups of non‐working people, including the long‐term unemployed (LTU). However, it is widely known that employers tend to regard LTU people as potentially problematic persons. This is likely to constitute a major obstacle for long‐term unemployed jobseekers. On the basis of a survey among employers in a Swiss canton (N = 722), this article aims to shed light on the perception employers have of the long‐term unemployed and whether this may matter for their recruitment practices. It also asks what, from the employer point of view, may facilitate access to employment for an LTU person. A key finding is that large companies have a worse image of the long‐term unemployed and are less likely to hire them. Furthermore, independent of company size, a test period or the recommendation of a trustworthy person is seen as the factors most likely to facilitate access to jobs for LTU people.     

Unemployment and conditional welfare: Exclusion and belonging in immigrant women's discourse on being long‐term dependent on social assistance

Long‐term unemployment with dependency on social assistance in Sweden has increased and is particularly high among foreign‐born persons. The present study explored immigrant recipients' experiences of being welfare reliant. Swedish‐Iraqi women's construction of exclusion and belonging in relation to policies and welfare regulations was scrutinised. The women referred to unemployment with frustration, expressing that it renders dependence on social welfare and enforces adherence to the stipulations of the social services. The individual's mobility and agency are restricted and concerted efforts to obtain employment are futile, which increase the sense of exclusion. However, the entitlement to social assistance also engenders feelings of belonging, of being connected to and cared for by the new country. More research is needed to examine the role that social assistance regulations play in forming feelings of belonging and exclusion. It appears essential that political initiatives be taken to reverse the trend of high unemployment among foreign‐born persons.     

The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities

The aims of this study were to examine South Korean social workers' understanding of a patient's right to end‐of‐life care decisions (EOLCD) in long‐term care facilities and to explore the effectiveness of their professional resources in their understanding of this issue. A survey was conducted of 297 social workers from multiple long‐term care facilities in South Korea using structured questionnaires and face‐to‐face interviews. A multiple regression model was used, controlling for gender and religion. The participants' professional resources were measured by years of work, license type, number of beds, knowledge of advanced directives, experience in the EOLCD process, and training. The results demonstrated that South Korean social workers' understanding of a patient's right to EOLCD was moderate (mean 3.46), and their general (β = 0.576, P < 0.001) and medical knowledge (β = 0.117, P < 0.001) of advance directives, experience in the EOLCD process (β = 0.222, P < 0.001), and training (β = 0.028, P < 0.001) positively and significantly increased their understanding of patient rights (R² = 0.449, P < 0.001). The findings suggested that the development of academically supported and legally enforced standards and regulations for an EOLCD practice manual for long‐term‐care social workers would be beneficial.     

Previous sickness presence among long‐term sick‐listed in Norway and Sweden: A retrospective study of prevalence and self‐reported reasons

The aim of the present study was to analyse previous sickness presence among long‐term sick‐listed individuals in Norway and Sweden and the reasons given for sickness presence. The study was based on survey data for 3,312 persons in Norway and Sweden who had been sick‐listed for at least 30 days. Two questions were used. One measured prevalence: During the last 12 months prior to your current sick leave, did you go to work even when feeling so ill that you should have taken sick leave? The second question concerned reasons for sickness presence. Large differences were found between Norway and Sweden in the prevalence of sickness presence. More long‐term sick‐listed Norwegians than Swedes reported sickness presence [adjusted odds ratio (OR) for Sweden 0.65 (0.53–0.80)]. The Swedes more often reported financial reasons for sickness presence [adjusted OR 2.77 (2.1 to ?3.54)], while the Norwegians more often gave positive reasons related to work. The national differences may be related to differences in sickness insurance strategies.     

Impression management in the market for residential care for children and youth in Sweden

In what has become quite a turbulent quasi‐market for residential care for children and youth, providers now compete for public contracts. To create visibility and attract customers, many providers use marketing activities to project the desired impression of themselves to maintain or strengthen their market position. In this article, we analyse how companies that provide residential care for children manage the impressions they project on their websites and in advertisements. The results reveal that residential care providers use a range of impression management strategies to enhance their organizational image and to respond to potentially damaging or threatening images. The information providers choose to disclose leaves customers—in this case, the social workers responsible for choosing and purchasing care on behalf of clients—with rather limited opportunities to evaluate the quality of care. This is a significant problem considering other, more reliable, sources of information are difficult to access.     

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.     

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.     

COVID‐19 and social work practice for older adults in China

After the spread of COVID‐19, the Chinese central government has issued a series of policies and regulations to guide the prevention and control of the epidemic in the elderly care industry. Social workers provided a series of services for older adults in nursing homes and in the community. All efforts made by government agencies and social workers have helped older adults go through the difficult time.     

Organization and Supply of Long‐term Care Services for the Elderly: A Bird's‐eye View of Old and New EU Member States

This article provides an overview of the organization of formal long‐term care (LTC) systems for the elderly in ten old and 11 new EU member states (MS). Generally, we find that the main responsibility for regulating LTC services is centralized in half of these countries, whereas in the remaining countries, this responsibility is typically shared between authorities at the central level and those at the regional or local levels in both institutional and home‐based care. Responsibilities for planning LTC capacities are jointly met by central and non‐central authorities in most countries. Access to publicly financed services is rarely means tested, and most countries have implemented legal entitlements conditional on needs. In virtually all countries, access to institutional care is subject to cost sharing, which also applies to home‐based care in most countries. The relative importance of institutional LTC relative to home‐based LTC services differs significantly across Europe. Although old MS appear to be experiencing some degree of convergence, institutional capacity levels still span a wide range. Considerable diversity may also be observed in the national public–private mix in the provision of LTC services. Lastly, free choice between public and private providers exists in the vast majority of these countries. This overview provides vital insights into the differences and similarities in the organization of LTC systems across Europe, especially between old and new MS, while also contributing valuable insight into previously neglected topics, thus broadening the knowledge base of international experience for mutual learning.     

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.     

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.     

Gender,emotions and fly‐in fly‐out work

This paper explores the emotional life of fly‐in fly‐out (FIFO) workers and their families, through an analysis of more than 500 postings made on an online chat forum for mining families. Building on literature on fly‐in fly‐out workers and understandings of emotions as socially constructed, analysis shows how posters to the forum, typically women whose male partners are FIFO workers, construct gendered emotional identities for their partners (sometimes referred to as ‘Mr Miner’), and for themselves, as ‘mining women’, ‘mining widows’ or the ‘mining missus’. Inherent in the creation of gendered emotional subject positions is the process of women undertaking emotion work on and behalf of themselves, their male partners and their children. The findings demonstrate the overarching normative dimensions of women's emotional self‐transformations in the service of their mining partners' careers and the attendant reproduction of everyday patriarchal relations in the private lives of mining families.     

Policy and practices relating to the active engagement of older people in the community: a comparison of Sweden and Australia

This article compares policy and practices for engaging older people in community life in Sweden and Australia. Barriers and support for active engagement through paid work, social activism, volunteering and aged services are compared. Both countries face issues of ageing populations, services for rural areas and people with small needs. Issues for Sweden were the absence of age discrimination legislation, availability of funds and lack of recognition of the growing levels of volunteering. Issues for Australia concerned the new managerialist approach to services, with associated complexities of access and limited social activism.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

China: Towards the introduction of dependency/long‐term care insurance

The Chinese social security system has been the subject of numerous publications, which have made policy developments more accessible to researchers and administrators from all countries. However, the steps introduced in response to growing demands for intervention by the authorities in favour of dependent persons have remained poorly documented in the international literature. The purpose of this article is to take stock of pilot experiments in this field since the beginning of the 13th Five‐Year Plan (2016–2020) with regard to their policy objective, operating mode and financing modalities.     

Contextualising institutional complementarity. How long‐term unemployment depends on employment protection legislation,active labour market policies and the economic climate

This study investigated if and how active labour market policies (ALMPs) and employment protection interact with each other in light of long‐term unemployment reduction. We argue that how well the interaction between both labour market institutions reduces long‐term unemployment depends on the level of economic growth. To improve analytical clarity, two types of ALMPs were differentiated, namely training and employment programmes. Using data on 20 European countries over 16 years, our results suggest that employment protection moderates the relationship between employment programmes and long‐term unemployment. The combination of high spending on employment programmes and less strict employment protection is associated with less long‐term unemployment. This moderation effect is stronger during an economic downturn. A moderation effect from employment protection on the relationship between training programmes and long‐term unemployment was not found, even when the economic climate was taken into account as a contextual factor.     

Need and support: determinants of intra‐familial financial transfers in Sweden

Lennartsson C. Need and support: determinants of intra‐familial financial transfers in Sweden Int J Soc Welfare 2011: 20: 66–74 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This study examined downward inter‐generational intra‐family financial transfers in Sweden made in the form of money transactions or gifts. The research questions focus on whether recipients of intra‐family financial transfers are children in ‘need’ of such support, and whether early family environment has any consequences for later financial transfers. Using data from a nationally representative survey, the results suggest that childhood disadvantages have long‐term consequences in connection with intra‐family financial transfers. Disadvantages and inequalities in childhood are likely to remain into adulthood, and children who experience adverse childhood conditions are less often recipients of later intra‐family financial support. Intra‐family transfers are also related to the ‘needs’ of the younger generation. Single parents and students from higher social class families are more often beneficiaries of financial support. In contrast, family support was no higher for unemployed children, for children lacking financial security in the form of a cash margin or for children reporting poor health.