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

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

Economic Determinants of Voting in an Era of Union Decline*

Objective. The objective of this article is to test competing hypotheses regarding union vote effects by economic sector. Overlooked in existing research on political participation and the labor movement is de‐unionization's sectoral dimension: declining union rolls is a private‐sector phenomenon. The sectoral dimension of union decline carries important political consequences if the influence of unions on voter turnout varies by sector. Method. Using Current Population Survey (CPS) November Voting and Registration Supplements for all national elections between 1984 and 2006, I estimate union vote effects for public‐ and private‐sector employees. Results. The results of the analyses reveal that while union members continue to vote at higher rates than otherwise similar nonmembers, the union effect is nearly three times as large for private‐sector members: private‐sector unionists have a predicted probability of voting 6.7 points higher than nonmembers, while public‐sector members have a predicted probability of voting only 2.4 points higher than nonmembers. Conclusions. Given the small fraction of private‐sector workers now in labor unions, recent fluctuations in the unionization rate have little aggregate affect on turnout. Given that private‐sector union members tend to be less educated and earn less than their public‐sector counterparts, the near disappearance of private‐sector unions from the economic landscape removes an important institutional buffer against political inequality in the United States.     

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.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

Poverty affects access to regular source of primary care among the general population in Hong Kong

A territory‐wide two‐stage stratified random sample of 2,282 community‐dwelling Hong Kong adults were surveyed between 2014 and 2015 to investigate the association between poverty and regular source of primary care utilization. Poverty was operationalized by income‐poverty and deprivation. About 94% of our sample reported having regular source of primary care (Western and/or Chinese medical practitioner) and about 69% among them were in private sector. Multivariable logistic regression showed that people who were income‐poor and deprived were less likely to have regular source of primary care (income‐poor: OR = 0.523, p = .027; deprived: OR = 0.488, p = .007) and visit private primary care doctors (income‐poor: OR = 0.445, deprived: OR = 0.222, both p < .0001). Those who had chronic diseases were more likely to have regular source of primary care (multimorbid: OR = 10.709, p < .0001), but less likely to access care in the private sector (one chronic disease: OR = 0.690, p = .019; multimorbid: OR = 0.374, p < .0001) than those without. Further, being older and less skilled were significantly associated with less likelihood of visiting a private doctor. Path analysis showed that the number of chronic diseases had significant indirect effect on having regular source of primary care with being income‐poor and deprived as the mediators (β = ?.0183, p = .0016). Therefore, despite a public health‐care system that aims to deny no one from adequate health care for lack of means, regular source of primary care in Hong Kong is found to be pro‐rich. Future policies should tackle the problem of health‐care inequalities to meet the needs of the underprivileged.     

Overcoming barriers to effective practice in child care

This paper describes the work of three Action Learning Sets – two groups of child care social workers and one group of health visitors. Given the substantial investment in child care research and its dissemination, we wanted to examine barriers to effective practice from the vantage point of workers themselves. Our core question was: ‘What can we do about the things that get in the way of effective practice?’ The method, based on that of ‘co‐operative inquiry’, sought to engage front‐line practitioners as active collaborators in the research. While several of the barriers can be seen as part of the common predictable experience of professionals working in large public sector organizations, a key message is the importance of re‐invigorating models of supervision that can sustain high quality practice. What emerges is a contemporary picture of the pressures on child care workers and of the struggles to make sense of professional roles in different organizational landscapes. We are committed to evidence‐based practice, practice that is derived from the best knowledge available. We would simultaneously stress the importance of ‘holding environments’ to promote effective learning. Our experience suggests that Action Learning offers a constructive method for encouraging such environments and facilitating better practice.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.     

Mergers and Acquisitions in the Private Sector: What Are the Lessons for Health and Social Services?

In seeking a more seamless provision of health and social care, the government is promoting the merger of the functions of primary and community health services and social services. In the private sector, mergers have been commonplace. The primary aim of this paper is to identify the key concepts and explanatory frameworks in the literature on mergers and acquisitions in the private sector that are relevant to the development of new organizational structures in health and social care. The evidence suggests that it is difficult to merge two organizations successfully. Reasons for this are explored and the implications for health and social care mergers drawn out.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

Motivation and mission in the public sector: evidence from the World Values Survey

It is well-recognised that workers may have intrinsic—as well as extrinsic—motivations. Previous studies have identified that public sector workers typically have a higher level of intrinsic motivation, compared to workers in the private sector. This paper compares (measures of) intrinsic motivation among 30,000+ workers in the two sectors across 51 countries using data from the World Values Survey. We find that public sector workers exhibit higher intrinsic motivation in many countries, but that this is not a universal relationship. One possibility is that public sector mission may influence whether or not motivated workers choose to work in the sector. In support of this, we show that the level of (public) corruption—which plausibly affects mission—can explain some of the variation across countries in the proportion of motivated workers in the sector.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Comparing the Pension Promises of 30 OECD Countries

This paper takes a microeconomic approach to compare prospective pension benefits in the 30 OECD countries. It shows entitlements gross and net of taxes and social security contributions for male and female single workers based on 2002 pension rules and parameters. The models cover all public and private mandatory sources of retirement income for full‐career private‐sector workers across a broad earnings range. The paper shows that average earners in OECD countries can expect a post‐tax pension of about 70 per cent of their earnings after tax. The average minimum retirement benefit is just under 29 per cent of national average earnings.     

Good Jobs,Bad Jobs?: Understanding The Quality of Aged Care Jobs,and Why It Matters

Much research on paid care work focuses on this work as care. An equally important issue is its characteristic as paid work. This paper focuses on the characteristics of jobs in Australian aged care facilities, using data from a comprehensive 2003 national survey of direct care workers in Australian aged care facilities. It shows that, on a range of characteristics including pay, aged care jobs compare quite well with other jobs held by Australians who have similar characteristics to aged care workers. Aged care jobs are certainly not unequivocally ‘bad’ jobs. Yet turnover rates amongst these workers are quite high. The paper shows that workers' expectations about remaining in the aged care sector depend largely on their experience of work, particularly their job satisfaction. Job satisfaction, in turn, is affected most by their experience of the work of caring. As in most workplaces, the ability to use their skills without hindrance is important. But care work offers distinctive rewards not captured by notions of professional identity and commitment. The paper concludes by suggesting that a focus on these distinctive rewards will be important in fully understanding paid care work as paid work.     

Extending pension and savings scheme coverage to the informal sector: Kenya's Mbao Pension Plan

The Mbao Pension Plan is a voluntary individual account savings plan to which all workers in Kenya may contribute without regard to income or age. It is designed to provide a programme that is suitable for the unique nature of the informal sector and to encourage a savings culture for those workers. The key innovation is that low‐income workers can easily make small contributions at relatively low cost, considering the small contributions and small account balances. Participants can conveniently make contributions anytime and anywhere using their cell phones. This savings innovation is made possible by technological innovations that have reduced the costs of cell phones and airtime, and by the entrepreneurial innovation of mobile money. The plan is provided through private‐sector businesses.     

Rolling Back the African State: Implications for Social Development in Ghana

The New Policy Agenda of the Reagan and Thatcher years has profoundly influenced aid flows from the industrialized countries of North America and Western Europe to the developing nations of sub‐Saharan Africa. The application of neo‐liberal principles to the disbursement of multilateral and bilateral aid for social development has resulted in the diversion of donor funding away from the public sector towards non‐governmental organizations. The consequences of relegating the role of the public sector in social development is explored through qualitative research conducted in Ghana with state‐employed community development workers. The study exposes how severe financial constraint within the state sector distorts the targeting of beneficiaries and social development activity. This differs from findings revealed by interviews with social development workers employed by international non‐governmental organizations. These indicate that such agencies are able to sustain effectively resourced fieldworkers who are in a position to form positive working relationships with beneficiaries. The circumstances of the Department of Community Development and its relationships with non‐governmental agencies in Ghana are used to explore the effects on state‐building of the New Policy Agenda in the sub‐Saharan region.     

应对地震灾害的社会工作的方法与开发——借鉴阪神淡路大地震、中越大地震、东日本大地震的经验教训

日本3.11大地震后,各种专业组织、社会福利组织致力于灾后重建的社会工作,有力佐证了日本护理保险制度中的护理管理在震灾救援中的巨大威力。针对震灾的社会工作,需要注重以个人援助为主的护理管理,与以地域社会为主的网络相结合。在灾害社会工作的发展方向上,需要社会工作把医疗和团队结合起来,通过加深相互之间的配合,建立在灾害医疗援助小组(DMAT)或日本医师会灾害医疗团队(JMAT)进行治疗后开展生活援助的机制。在社会工作中导入与灾害医疗援助小组同样的体系,平时就要培养好应对震灾的社会工作者。注重培养社会工作者应用现存的社会资源的能力,以及动员、调动灾区以外地区的社会资源的能力。重建受灾者的社区,非常有必要保持并进一步强化以往的居民间的关系。需要建立区域综合援助中心,配有保健师、社会福利士(社会工作者)、主任护理经理。以区域综合援助中心为主来开展灾区和灾区以外地区的社会工作者互相合作的"区域综合照顾"。在生活圈里重建各种组织机构的网络,社会工作者在各自的生活圈内,以地区的需求为基础,制定解决这些需求的计划,动员灾区居民参加,力求实现正式和非正式组织、机构的组织化,并在各种组织、机构的合作下进行实施推广,为社区复苏提供援助,促进地域社会中的各种组织的网络建设,从而形成地区的组织化。     

Adverse Selection,Bequests, Crowding Out,and Private Demand for Insurance: Evidence from the Long-term Care Insurance Market

Adverse selection, moral hazard, and crowding out by public insurance have all been proposed as theoretical reasons for why the market for private long-term care insurance has been slow to evolve in the U.S. Using national samples of the elderly and near elderly, this study investigates which is most important. The data contain direct measures of risk aversion, expectations of future nursing home use and living to old age, and the bequest motive. For both groups, we find evidence of adverse selection, and, for the elderly, crowding out of private long-term care insurance by Medicaid. However, we do not find that demand for such insurance is motivated either by bequest or exchange motives.     

Social Workers who Move into Private Practice: The Impact of the Socio-economic Context

Summary This paper is based on a doctoral research project, conductedin New Zealand between 1993 and 1999, that considered factorsin the movement of social workers into private practice (vanHeugten, 1999). The study employed a qualitative methodologyin which 33 private practitioners were interviewed using semi-structuredquestionnaires. All respondents had at least a first professionalqualification in social work. The research grew from a realizationthat there had been an upsurge in private practice since themid-1980s, during a time of increasingly right wing governmentpolicies, and free market philosophies. These policies and philosophiesled to a radical restructuring of government and not-for-profitorganizations that employed social workers. Some workers respondedto the changes by seeking alternatives to organizational employment.Concurrently opportunities for private practice were createdby the availability of third party payments for counsellingof survivors of sexual abuse and parties to marital disputes.A similar pattern of confluence of expanding social work privatepractice and free market ideology has been noted in countriessuch as Great Britain and Australia. The implications of thismovement into private practice are considered in relation toprofessional social work associations.     

Marketisation policies in different contexts: Consequences for home‐care workers in Germany,Japan and Sweden

Market‐oriented restructurings of long‐term care policies contribute significantly to the aggravation of care workers’ situations. This article focuses on the effects of broader long‐term care policy developments on market‐oriented reforms. Germany, Japan and Sweden are three countries that have introduced market‐oriented reforms into home‐based care provision embedded in distinct long‐term care policy developments. Conceptually, this article draws on comparative research on care to define the institutional dimensions of long‐term care policies. Empirically, the research is based on policy analyses, as well as on national statistics and a comparative research project on home‐care workers in the aforementioned countries. The findings reveal the mediating impact of the extension and decline of long‐term public care support and the corresponding development of the care infrastructure on both the restructuring of care work and the assessments of the care workers themselves.