Feeling motivated yet? Long‐term unemployed people's perspectives on the implementation of workfare in Australia

A key thrust of labour market policy in Australia and many other western countries is that long‐term unemployed people lack the personal motivation to engage proactively and successfully in the search for paid employment. In this paper we argue that the implementation of what are experienced as paternal workfare programs are counter‐productive to achieving the official policy goal of improving self‐efficacy and gaining paid employment. The empirical discussion presented in the paper is based on a semi‐longitudinal study that tracked 75 long‐term unemployed people in three different labour markets in Australia between 2005–2007. The study was funded by the Australian Research Council and Jobs Australia.     

You matter to me: important relationships and self‐esteem of adolescents in foster care

This study examined the extent to which relationships with biological mothers, foster parents and peers influenced the self‐esteem of adolescents in foster care. A subsample from the National Survey of Child and Adolescent Well‐Being of adolescents in long‐term foster care was used for this study (n = 188). The findings indicated that when considering relationships with biological mothers, foster parents and peers and controlling for demographic characteristics in one regression model, relationships with peers had the greatest impact on self‐esteem of adolescents. Implications for child welfare and clinical work are discussed.     

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.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

Design limitations of long-term care insurance schemes: A comparative study of the situation in Spain

Social and demographic changes are gradually transforming the way Western societies cope with old‐age dependency, in particular the provision of long‐term care (LTC). In response to the need for formal care services and financing instruments, this study examines a range of both private and public insurance tools. As a general rule, LTC insurance is markedly underdeveloped. Furthermore, in southern European countries, the role of the public sector in LTC is unclear compared with its role in other, related welfare areas such as healthcare. The study examines the financing alternatives for LTC insurance, taking as its benchmark the Spanish LTC financing reform. It briefly examines some existing, publicly funded LTC financing tools and explores the potential role of private LTC insurance, arguing that it has an active part to play alongside compulsory mainstream insurance schemes and self‐insurance alternatives. As in other European countries, Spanish social attitudes show a preference for some kind of general entitlement to publicly funded schemes, although this preference is subject to significant regional heterogeneity.     

“A game of two halves?” Understanding the process and outcomes of English care home closures: Qualitative and quantitative perspectives

With care services increasingly delivered via a market there is always a risk that care homes could fail financially or struggle in terms of quality, ultimately having to close. When this happens, the received wisdom is that subsequent relocation can be detrimental to the health and well‐being of older residents (possibly even culminating in increased mortality). However, there is very little formal evidence in the United Kingdom (UK) or beyond to guide policymakers and local leaders when undertaking such sensitive work. Against this background, this article reports findings from an independent evaluation of what is believed to be the largest care home closure program in the UK (and possibly beyond). This consisted of qualitative interviews with older people, families, care staff, and social work assessors during the closure process in one case study care home and one linked day center, as well as self‐reported health and quality of life data for older people from 13 homes/linked day centers at initial assessment, 28 days after moving and at 12‐month follow up. The study is significant in presenting public data about such a contested topic from such a large‐scale closure process, in its focus on both process and outcomes, in its mixed‐methods approach, and in its engagement with older people, families, and care staff alongside the use of more formal outcome measures. Despite significant distress part‐way through the process, the article suggests that outcomes either stayed the same or improved for most of our sample up to a year after moving to new services. Care homes closures may thus be a “tale of two halves”, with inevitable distress during the closure but, if done well, with scope for improved outcomes for some people in the longer term. These findings are crucial for current policy and practice given that the risk of major closures seems to be growing and given that there is virtually no prior research on which to base local or national closure processes. While some of this research is specific to England, the underlying issue of care home closures and lessons learned around good practice will also apply to other countries.     

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.     

From Street‐level Bureaucrats to Street‐level Policy Entrepreneurs? Central Policy and Local Action in Lottery‐funded Community Cancer Care

Recent contributions to the policy implementation literature have applied Kingdon's model of ‘policy windows’ to the implementation of policy on health inequalities in the UK, and have identified the key role played by ‘policy entrepreneurs’ at local as well as national level. Despite this, the picture that emerges is of frustration of central policy intentions at the local level, alongside frustration of local aspirations by the centre. This article explores the relationship between central policy and local implementation in the context of a Lottery‐funded initiative to develop community cancer care in the UK. We examine the relationships: between the BIG Lottery Fund and central government; between BIG and the cancer care projects it funded; and between the projects and their local economy of cancer care. We found evidence of success both in vertical cascading of policy and in local policy innovation; 83 per cent of projects succeeded in obtaining continuation funding at the end of their Lottery funding. We suggest that this was due, in part, to two features of Lottery funding and accountability that combined to differentiate it from the other policy initiatives studied. They meant that projects were ‘buffered’ not just from national policy churn, but also from competing local priorities. In the ‘protected space’ that was thus formed, ‘street‐level policy entrepreneurs’ played a key role in developing cancer care innovations for adoption by mainstream funding agencies.     

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.     

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?     

Will Direct Payments Make Adult Residential Care more Personalized? Views and Experiences of Social Care Staff in the Direct Payments in Residential Care Trailblazers

Direct payments, i.e. cash payments made directly to the individual in lieu of social care services, have become an established option in council‐funded domiciliary care as a means to better personalize care and support. As part of its agenda to modernize social care, the Government tested their use in long‐term residential care in 18 trailblazing councils in England. This article presents findings from the independent evaluation of this initiative, using interviews with project leads seconded to the programme in all participating councils, and with council and care home staff involved in implementing direct payments in residential care in five sites. Interviews were conducted between September 2014 and November 2015. They explored professionals' views and experiences of personalization in residential care and their thoughts on the potential contribution of direct payments to promoting personalization. Whilst there was agreement that good care takes personal preferences into account and that many care homes could provide a more personalized service, doubts were voiced about whether direct payments were an appropriate mechanism to achieve this aim. This was seen as particularly pertinent in relation to residents with very high care needs and limited capacity to exercise choice and control. Interviewees also identified a number of risks and challenges to implementation, including financial risks to care homes. The findings from these interviews suggest that the contribution of direct payments to personalizing residential care may be more modest than expected.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Renewing the Social Vision of Care

Care is a fundamental condition of human existence, an inherently social activity. Yet surprisingly, care has only recently begun to receive serious attention from social researchers and the public. Despite the fact that care has become a public issue over the past twenty‐five years or so, current thinking in policy and advocacy for carers has developed an overtly narrow and self‐limiting focus with a strong emphasis on the plight of primary or sole carers, with care being seen predominantly as a burden. From looking at Australian policy on carers, it may be concluded that care is essentially understood as a private, individual concern, a one‐way activity in which the active agent, the carer, does something to the other, passive, recipient. The challenge posed in this paper is to move beyond this approach to that of a more social conception of care. Following a review of the uses of the terms ‘care’ and ‘carers’ in the current Australian policy context, a discussion of the meaning of the term ‘care’ is presented and an alternative understanding of the term, with the potential of recognising and promoting care as a complex, social outcome is advanced.     

Does Size Matter? Comparing Medium‐Term Cost‐Effectiveness of Group Homes with Institutional Care in South Korea

Using unique 5‐year longitudinal data on Korean children in group homes and those under institutional care, this paper compared the medium‐term cost‐effectiveness of group homes and that of institutional care facilities in terms of developmental outcomes. Results from propensity score matching estimation show that children in group homes tend to have more desirable positive outcomes and fewer behavioral problems in the medium term to a statistically significant margin. The cost‐effectiveness ratio of being placed in a group home is consistently higher than placement in an institutional care facility. That is, for one dollar spent on an out‐of‐home care service, we anticipate the children in group homes have more desirable outcomes in the medium term than their counterparts in institutional care facilities.     

Private Children's Homes

Summary The paper provides survey and intensive research material onthe private children's homes sector. It is shown that this sectoris currently in decline. Private homes are found to be shelteringchildren with long and complex care histories and to adopt adistinctive residential style. Although private homes providevaluable long term continuity, they are less likely to offerthe same range of community services as do residential settingsmanaged by the local authority and voluntary child care agencies.     

Towards Understanding Variations in Social Care for Older People in England

Indicators of the public provision of old age social care are routinely recorded in England and have been used for diverse purposes including performance monitoring. Despite long‐term policy guidance promoting more homogeneous service provision, large variations can still be observed between local authorities (the providers of state‐funded social care). Our aim is to better understand such variations in a small selection of key aggregate indicators. Drawing on multiple data sources and pursuing a two‐step strategy, we first assess the explanatory power of a set of structural predictors and then add to the models a set of specific care management ‘process’ predictors. We find that structural factors beyond the control of local authorities explain a considerable share of the observable variation. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when aggregate indicators of service provision are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. Past attempts to influence the aggregate pattern of service provision – apparently seeking greater ‘territorial justice’– are likely to have had adverse implications for service users and the uniformity of service delivery across England. Questions are raised about the adequate role of central government in a policy environment characterized by longstanding local government responsibility.     

Does Parental Participation in Schools Empower or Strain Civil Society? The Case of Community‐managed Schools in Central America

Among the various educational models in Latin America that seek to increase parental participation in schooling, perhaps the most far‐reaching is the experiment with self‐managed schools. These are publicly funded schools administered by parents. Broad public powers, such as the capacity to decide the budget and make staffing decisions, are given to parents, many of whom have had very limited prior administrative experience. How does this policy innovation impact on civil society? Does parental participation in school administration empower participating citizens or strain civil society? There are various ways of answering these questions. This article looks at some possible ways to conceptualize and assess the relationship between parental participation in self‐managed schools and civil society. The article draws from the experience of El Salvador, Guatemala, Honduras and Nicaragua, where these reforms have advanced significantly since the 1990s.     

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.