Trends in long‐term sickness absence in Sweden 1992–2008: the role of economic conditions,legislation, demography,work environment and alcohol consumption

Lidwall U, Marklund S. Trends in long‐term sickness absence in Sweden 1992–2008: the role of economic conditions, legislation, demography, work environment and alcohol consumption Int J Soc Welfare 2011: 20: 167©179 © 2010 The Author(s), International Journal of Social Welfare © 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. In Sweden, absence from work because of illness or injury has fluctuated considerably over time. This study aimed to identify potentially important factors behind variations in long‐term sickness absence. Aggregated data were used to assess factors correlated with the number of ongoing cases of sickness absence lasting more than 59 days. Trends were analysed using statistics from national social insurance records, labour force surveys and other official statistics. Although specific changes in the degree of generosity in the sickness insurance scheme were important in some cases, the results showed no consistent associations for the study period 1992–2008. Men were generally more sensitive to macroeconomic factors than women. Furthermore, compared with earlier findings, workforce composition had less impact on variations in long‐term sickness absence. Notably, public health indicators such as alcohol sales and working conditions were clearly related to long‐term sick leave during the period under investigation.     

Sick but at work: Graded sick leave in a comparative perspective

Measures to activate sick‐listed workers and to combine work with sickness benefits are a growing but little‐studied policy field. This article investigates graded sick leave benefits in Sweden, Finland and Germany. The analysis reveals some commonalities between countries, as well as substantial differences in terms of institutional background, benefit design and governance. The schemes range from models in which grading has become an integral component of the regular sickness certification process, to models in which the graded‐work option is targeted at a much smaller category of workers and has a stronger therapeutic character. The variation in design and governance of the models is reflected in large differences in terms of their diffusion. All schemes face a common set of obstacles and challenges. They relate in particular to the distribution of stakeholders' roles and responsibilities, the involvement of employers and the assessment of residual work ability.     

Unemployment and economic security for young adults in Finland,Norway and Sweden: From unemployment protection to poverty relief

In this study, we investigated if there has been a displacement in the type and coverage of welfare services available for young unemployed adults in Finland, Norway and Sweden over the last two decades. This question is important because a number of studies have argued that the generous unemployment benefits and extensive labour market intervention found in the Nordic welfare states shield young people from the most severe consequences of economic inactivity. In this article, we instead show that during this period, less generous means‐tested unemployment and social assistance benefits have become the most important form of income protection for young people. In evidence, earnings‐related unemployment benefits now cover only 10 per cent of unemployed Swedes and Finns and 45 per cent of unemployed Norwegians aged 24 years or younger. This development marks a significant change in our understanding of unemployment protection for young people in Nordic countries.     

Fear of the Brown Envelope: Exploring Welfare Reform with Long‐Term Sickness Benefits Recipients

This article presents qualitative data taken from in‐depth interviews with 25 long‐term sickness benefits recipients in the north east of England, UK. A key theme emerging from the research is the importance of listening to the narratives of long‐term sick and disabled benefits recipients, particularly in relation to the formation of policy responses and in terms of practice. The findings also illustrate how stigma associated with claiming benefits can deter people from accessing the support they need, leading to under‐claiming and the risk of amplified financial strain and hardship. Further, the importance of evidence that emerges from research which focuses upon the lived experiences of sickness benefits recipients to provide evidence in the framing of disability and welfare policy is crucial. Lastly, the article discusses how the narratives presented have implications for social policy and practice, alongside the potential implications for sick and disabled people themselves.     

Micro‐level dynamics of social assistance receipt: Evidence from four European countries

This study investigated the monthly dynamics of social assistance benefit receipt – in particular the incidence of long‐term benefit receipt – in four European countries: Luxembourg, The Netherlands, Norway and Sweden. The analysis is based on four separate administrative panel data sets, each covering the 96‐month period from January 2001 to December 2008. Benefit dynamics were found to vary considerably across countries. In the two Nordic countries, long‐term benefit receipt was found to be a rare exception. Most recipients, however, had multiple spells and the majority of benefit leavers returned to benefits within a few months of leaving. In Luxembourg and The Netherlands, long‐term benefit receipt was frequent, but benefit leavers were much less likely to return to benefit receipt after exit. The total duration of benefit receipt per individual across spells was two to three times as high in The Netherlands and Luxembourg as in Norway and Sweden.     

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.     

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.     

Working time: implications for sickness absence and the work–family balance

Olsen KM, Dahl S‐Å. Working time: implications for sickness absence and the work–family balance
Int J Soc Welfare 2010: 19: 45–53 © 2008 The Author(s), Journal compilation © 2008 Blackwell Publishing Ltd and the International Journal of Social Welfare. The article analyses the impact of working time on two outcomes: sickness absence and the work–family balance. Working time is distinguished along two dimensions: irregular versus regular working hours and control versus no control over working time. There are three main findings. First, working irregular working hours with no control over time increased sickness absence, for men. Second, irregular hours, particularly with no flexibility, caused distress to the work–family balance, for both women and men. Third, flexibility in the work schedule when working regular hours had no effect on sickness absence nor on the work–family balance. This last finding may be explained by the institutional setting: employees in Norway already have substantial flexibility in, for instance, access to leave of absence. The findings suggest that increasing flexibility may benefit employees who work irregular hours.     

Effects of individualised follow‐up on activation programme participants' self‐sufficiency: A cluster‐randomised study

Recent developments within activation policies emphasise tailor‐made and individualised services; however, little is known of what the effects of these initiatives are. The aim of this study was, therefore, to analyse, in a cluster‐randomised design, the long‐term effects of an individualised follow‐up model on welfare recipients' self‐sufficiency. The follow‐up model systematises the work done by social workers within the Qualification Programme, which is a welfare‐to‐work programme in Norway. In the study, 18 labour and welfare offices were randomised to experimental and control groups. The data consist of baseline questionnaires for Qualification Programme participants (n = 617) and follow‐ups based on administrative data at 12, 24 and 30 months after baseline. The results show significant effects of individualised follow‐up on self‐sufficiency at the 30‐month follow‐up and strong positive trends at the 18‐ and 24‐month follow‐ups. Thus, comprehensive and individualised follow‐up of participants within activation programmes seems to generate positive long‐term effects on self‐sufficiency.     

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.     

Long‐term foster care or adoption? The evidence examined

Based on an examination of the research literature, this paper contrasts six variables connected with the outcome of adoption and long‐term fostering. It provides some answers to the question often being asked by policy makers and family placement workers, as well as judges, about the relative merits and limitations of these two forms of substitute parenting for children who cannot return to live with their birth families. Because of the type of child currently adopted or fostered, breakdown rates by themselves are increasingly an unreliable outcome measure. The main defining difference found between these two forms of substitute parenting appears to be the higher levels of emotional security, sense of belonging and general well‐being expressed by those growing up as adopted compared with those fostered long term. However, for reasons outlined in the paper, long‐term fostering still has a definite place for a range of children who require long‐term plans.     

Income Security During Sickness Absence. What Do British Middle‐classes Do?

Income maintenance during sickness absence is an under‐researched field within social policy analysis, and yet it is conducive to exploring the interplay between statutory, corporate and private forms of income protection. Drawing on original qualitative interview data, the article shows that British middle‐class couples largely ignore or dismiss public provision, which is due to a relatively low level of sickness benefits, but also based on misconceptions about social rights and the role of employers as mandatory (and voluntary) sick pay providers. Despite a considerable degree of mistrust, mortgage‐related private sickness insurance mattered to some extent, although this does not necessarily reflect policyholders’ strategic choices vis à vis current household needs for income security. Other potential sources of income replacement, such as savings, are relied on much less. In general, the analysis shows a heavy middle‐class reliance on, and strong confidence in, employer‐based sickness pay. This finding may be contrasted with questions about the sustainability of voluntary corporate provision, as well as its capacity to provide income security for the workforce as a whole.     

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.     

Applying the ICF‐CY to identify children's everyday life situations: A step towards participation‐focused code sets

Adolfsson M. Applying the ICF‐CY to identify children's everyday life situations: a step towards participation‐focused code sets With the long‐term goal to create an interdisciplinary screening tool with code sets focusing on children's participation in everyday life situations (ELS), the purpose of the present study was to identify ELS for children 0–17 years. The views of professionals and parents in Sweden, South Africa and the USA were integrated based on ICF‐CY ¹ 1 The WHO International Classification of Functioning, Disability and Health, version for Children and Youth.
linkages. The chapters Self‐care and Major life areas seemed most obvious to include in ELS. At the 2nd ICF‐CY level, 11 categories emerged as ELS, with Hygiene and Recreation as the most obvious. Two sets of ELS were identified for infants/preschoolers and school‐aged children/adolescents. Professionals and parents agreed on ELS for the older age group. Findings suggest that ELS differ in context specificity depending on maturity and growing autonomy. The study has implications for the future screening tool that is intended to support children with disabilities in describing what matters most to them in intervention planning. Key Practitioner Message: ?Children and parents need opportunities to express their opinions during intervention processes, but a structured family–professional collaboration model is lacking; ?Using ICF‐CY‐based models, including holistic views of participation in everyday life situations, increases professionals' focus on family perspectives; ?Models to connect interventions to participation in everyday life situations enhance children's motivation and support interdisciplinary assessment.     

Short-term and long-term effects of an outpatient rehabilitation program for patients with musculoskeletal disorders

The objective of the study was to investigate whether intensified rehabilitation efforts in primary health care may produce any short-term or long-term reduction of sick leave. The resources at the health care center were fortified with a coordinator from the local insurance office and a specialist group from the hospital. In one primary health care district, a prospective study was performed among 100 patients with a musculoskeletal disorder, having caused at least 21 consecutive days of full-time sick leave (patients). Serving as a control group were individually matched patients from any other health care center in the surrounding municipality of Kristianstad (controls). The number of sick leave days was assessed during year one (short-term) and year three (long-term) after rehabilitation was initiated. The median number of days with sickness benefits for men in the short-term was lower for patients than for controls (34.5 vs 48.5). No difference was found among women. No differences were found in the long-term between patients and controls, either for men or women. We conclude that rehabilitation in primary health care was made more efficient through collaboration with the local insurance office and the specialists, but the effects were not maintained after the collaboration ended.     

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.     

Change and Resilience in Welfare State Policy. The Politics of Sickness Insurance in Norway and Sweden

This article compares the processes of reforming sickness insurance in Norway and Sweden. Despite the many similarities between the Norwegian and Swedish welfare states, they have taken different paths when it comes to reforming their sickness insurance systems. In the period between 1990 and 2010 Sweden changed its wage replacement levels and levels of employer financing several times, while in Norway they remain basically unchanged since 1978, notwithstanding many reform initiatives by political authorities. Why have the two cases evolved so differently? We address this question by using Peter Starke's review of the retrenchment literature which outlines four major strands of theorizing the politics of welfare reform: neo‐functionalism, conflict theories, institutionalist theories and discourse theory. Rather than treating these as providing competing explanations, the article suggests that elements from all perspectives bring insights to the case. The need for policy reform must always be communicated in a way that can be understood and approved in order to materialize as actual policy change. But discursive change and apparently seductive frames will not always be enough. This comparative analysis illustrates that the chance of success for new frames or discourses depends on the institutional, political and functional context into which they are inserted. Similar attempts at framing the need for reform and cutbacks have had different effects in the two countries depending on the character of the counter forces and extant frames reformers are up against. On the other hand, over time discourses and frames also shape institutions and political relations.     

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?     

Attachment‐facilitating interactions in non‐kin foster families

This study aims to analyse the interaction between children in foster care and their main caregivers during a microcoded co‐construction task, focusing on the verbal and non‐verbal behaviours that the adults use to promote a secure attachment in the child. It also examines how children and caregivers' socio‐demographic variables relate to the interaction. The sample is made up of 28 Spanish children between 4 and 9 years old in long‐term non‐kin foster care and their foster families. The building task was administered to 28 dyads, composed of the child and the main caregiver in each family. Our results showed that the caregivers' use of attachment‐facilitating behaviours was frequent during the interaction. Moreover, children tended to display a positive attitude when adults used these attachment‐facilitating behaviours. We also found some differences in the interaction according to the caregivers and children's age, the child's gender and the caregivers' satisfaction with the child's development. These results offer us a better understanding of the functioning of the adult–child relationships in foster families, which helps us make more efficient interventions to improve the caregivers' sensitivity towards the children's needs and difficulties.     

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.