Children against parents? The politics of intergenerational recalibration in Southern Europe

Traditionally, Southern European countries displayed remarkably elderly biased social policy arrangements. This article introduces the notion of intergenerational recalibration to capture reforms aimed at rebalancing the generational profile of Southern European welfare states via the expansion of family policy and social assistance schemes—both monetary benefits and care services—and retrenchment in the field of pensions. Then, it elaborates theoretically on the political dimension of this policy strategy, focusing on the implications of the peculiar combination of expansionary and retrenchment reforms, to advance the hypotheses that domestic politics would prevent the realization of such an agenda, whereas the latter would be favored by a major role of supranational actors, especially the European Union. To test these hypotheses, we systematically analyze policy trajectories in the field of pensions and social assistance in Italy and Spain between the mid‐1990s and 2016. This allows, first, to argue that investment in “pro‐children” measures has not adequately balanced the reduction of pro‐parents expenditure and, second, to question the idea that domestic political incentives to expand “pro‐children” policies are necessarily too weak as well as the “enabling” role of external pressures in pursuing intergenerational recalibration.     

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.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Migrant Care Work Going Dutch? The Emergence of a Live‐in Migrant Care Market and the Restructuring of the Dutch Long‐term Care System

In recent years, a live‐in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long‐term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live‐in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash‐for‐care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. Our findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change.     

Comparing Formal Unemployment Compensation Systems in 15 OECD Countries

This study contributes to the welfare regime literature by analyzing unemployment compensation programmes – unemployment insurance (UI)/assistance (UA) programmes and redundancy pay schemes – of welfare state/occupational welfare regimes. It covers 15 countries of the Organisation for Economic Co‐operation and Development (OECD) selected from Southern European, Liberal, Continental‐corporatist and Social Democratic country clusters. In contrast to the common argument that Southern European countries have underdeveloped formal unemployment compensation systems, this study argues that they (especially in Spain, Portugal, and to some extent Italy) are comparable in strength to those in Continental‐corporatist countries if occupational welfare programmes – notably redundancy pay – are considered alongside welfare state programmes for unemployment protection. The study also outlines the characteristics of redundancy pay schemes in the four country clusters and shows how different redundancy pay schemes are linked to UI/UA schemes in these clusters.     

Older People's Family Contacts and Long-term Care Expenditure in OECD Countries: A Comparative Approach Using Qualitative Comparative Analysis

In recent decades there has been a suggestion that public and private long-term care (LTC) expenditure might be replacing traditional family care for older people. The decline of family contact is known to be more advanced in some OECD countries than others, with southern Europe identified as where family contact is still strong. This article explores at a country level whether there is an association between levels of expenditure on long-term care and the availability of family contacts. Qualitative Comparative Analysis is used as a comparative method, so as to use national quantitative indicators with a small sample of countries. An association between higher levels of family contact and lower levels of expenditure on LTC is suggested, but it is weakened by a number of untypical cases. Countries that defy this relationship have government care policies that seek to promote informal social care through the family contact that continues to be available. Austria, Canada, Great Britain and Japan are discussed in this context.     

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.     

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?     

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.     

Principles and practice of social security payments for care

This article examines the dimensions which determine whether national social security systems make payments towards the costs of long-term care needs and whether they do so where these needs are met within the family; what kinds of payments are made and to whom; and what levels these payments are set at. The article is based on empirical material from five European Union countries (the United Kingdom, Ireland, France, Italy and Germany). We argue that differences between countries along three dimensions account for most of the diversity between national systems in this field. These dimensions are the allocation of responsibilities and powers to local versus central levels of government; assumptions of to whom long-term care represents a "risk"; national principles of subsidiarity and the relationship between the family and the State. This is, however, a field undergoing change (albeit mostly incrementalist and ad hoc) in the face of the demands placed on social welfare systems by growing levels of disability (related to the growth of elderly populations) and demands from women's movements and disability movements for recognition of their needs within social welfare systems.     

Paths towards Family‐friendly Working Time Arrangements: Comparing Workplaces in Different Countries and Industries

Although studies have examined the distribution and conditions of employer‐provided work–family arrangements, we still lack a systematic investigation of how these vary for different countries and industries. Based on the European Working Conditions Survey 2010, this study examines the conditions under which firms provide family‐friendly working time arrangements and what the differences are across four countries (Austria, Denmark, Italy and the UK) and four industries. The impact of employee representatives, employee involvement, manager support and female managers varies across countries and industries because of the institutional environment (prevailing family model, industrial relations) and workforce composition (gender). The impact of employee representatives depends on their co‐determination rights, and the direction of their effect on the prevailing family model (e.g. negative in conservative countries such as Austria) and the gender composition of the workforce (negative in male‐dominated production, but positive in services). Employee involvement in the work organization is significantly positive in Austria and Denmark (both with co‐operative industrial relations), while manager support has the strongest effect in the UK (liberal regime). At the industry level, female supervisors are positively associated with family‐friendly working time arrangements only in the male‐dominated production industry. These findings suggest that the effects of agency variables and their direction vary depending on the institutional context.     

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.     

Straddling Two Continents: Social Policy and Welfare Politics in Turkey

There has been an increasing academic interest in understanding the dynamics of social policy in the Middle East and developing a conceptual ‘model’ to account for the particular characteristics of welfare arrangements in the countries of the region. While part of this framework, Turkey represents an exceptional case due to the Europeanization processes the country is undergoing in various policy areas, including social policy. The influence of the European Union on the shape of Turkish social policy, as illustrated by the government's recent reforms in the labour market and social security domains, is hereby used to outline the position of Turkey vis‐à‐vis both the Southern European welfare regime and the Middle Eastern pattern. This article seeks to assess the dynamics of Turkish social policy in light of the country's political, and socio‐economic dynamics, as well as the external influence exerted by the EU and international financial institutions. The aim is to examine Turkish welfare arrangements in a comparative manner and consider its suitability with reference to either of the two models. Looking at major trends in social security and the labour market, the article argues for a Turkish ‘hybrid’ model embodying the characteristics of both. Subject to EU explicit pressures for reform absent elsewhere in the Middle East, the data nevertheless show that Turkey has yet to make the qualitative leap forward that could place it firmly within the Southern European welfare group.     

Means Testing and the Heterogeneity of Housing Assets: Funding Long-Term Care in Spain

The access to publicly funded long‐term care (LTC) in Spain has been traditionally rationed through the use of means tests based on individuals’ current income and needs. However, individuals’ wealth, primarily housing assets, is progressively taken into account. Parallel to this feature, the responsibilities for the organization of LTC services have been devolved to region‐states – autonomous communities (ACs), giving rise to some regional heterogeneity, though limited evidence has been reported on the underlying determinants. This paper examines the current role of housing assets in determining public and private funding for long‐term care in Spain. Secondly, we present a qualitative and quantitative examination of the regional heterogeneity in the provision and public funding criteria determining eligibility for public support for LTC. Finally, we report survey evidence on the individual's willingness to sell (WTS) their housing assets in order to either totally or partially finance the access to LTC. Our findings suggest that housing assets are the main source of wealth accumulation at old age. Yet there is significant regional heterogeneity in the access to LTC resulting from regional differences in the means testing criteria. Progressively, all ACs are considering housing assets in their means testing criteria. Interestingly, individuals’ willingness to sell their housing assets declines with age and is more common among less skilled and widowed individuals.     

Alike but not alike: Welfare state and unemployment policies in Southern Europe. Italy and Portugal compared

Although Italy and Portugal are considered to be part of the same welfare state family – the Southern European one – analysis of a key component of the welfare state, namely, unemployment policies and regulations, reveals a different evaluation. A comparative analysis of a series of specific indicators of Italian and Portuguese unemployment regimes shows that they represent two different models. Portugal appears to be a more inclusive system, closer to continental or Northern European countries than it is to Italy, or at least representing a hybrid system that combines characteristics of continental European welfare states with characteristics that are more typical of Southern European welfare states. Italy, on the contrary, is much more clearly a Southern European welfare state.     

Long-term Care Policies in Italy, Austria and France: Variations in Cash-for-Care Schemes

Cash benefit provisions have been at the core of many recent reforms in the long-term care sector in Europe. The respective schemes, however, vary widely in terms of the definition of entitlements, the level of benefits, and the ways in which benefits can be used by recipients. This article investigates cash-for-care schemes in three European social insurance countries. It asks whether the diversity of these schemes indicates different paths or just differences in the pace with which the respective policies address the risk of dependency. A characterization of the three schemes and a discussion of the implications for care work arrangements lead to the conclusion that the context and timing of long-term care reform processes are in fact quite variegated. All three countries have histories of cash schemes and of applying the cash approach to support – and to some extent relieve – traditionally strong family obligations. Differences predominate in terms of linking cash to employment, although some convergence is apparent in the effects on qualifications, working conditions and wages in care work.     

From walls to homes: Child care reform and deinstitutionalisation in Ghana

In 2006, the Ghanaian government, in partnership with the United Nations Children's Fund (UNICEF), began to reform the child welfare system. The main aim of this reform was to provide a sustainable and culturally appropriate system of care for children without parental care by shifting from an institutional‐based model to a family and community‐based one. Drawing on existing peer‐reviewed and grey literature, this article provides an overview of the major components of the reform, including reintegration with the extended family, foster care and adoption. In addition, the article discusses the prospects and challenges involved in achieving the reform's intended component. Key Practitioner Message: ● Use community development techniques to raise the resources needed to provide family support services for vulnerable families; ● Social work practitioners partner with non‐governmental organisations to train community members as para‐social workers; ● Social workers, especially in developing countries, understand the challenges they face when embarking on deinstitutionalisation.     

The Political Construction of Elder Care Markets: Comparing Denmark,Finland and Italy

In Europe over the last two decades, marketization has become an important policy option in elder care. Comparative studies predominantly adopt an institutional perspective and analyze the politics and policies of marketization. This analysis takes a step back and examines the fundamental ideas underpinning the policies of marketization, using the ‘What's the problem?’ approach by Carol Bacchi. The central question is how the market was discursively framed as the solution to the perceived problems of three different systems of elder care, and how such processes are similar or different across the three countries. The analysis includes two extreme types of elder care systems, the Nordic public systems in Denmark and Finland, and the Southern European family‐based model in Italy. Empirically, the analysis offers interesting insights into processes of constructing and legitimating markets at the level of discourse; this occurs by defining specific problem representations, underlying assumptions and silences. In all three countries, marketization is presented as a solution which builds on rather than challenges dominant ideas of care. Conceptually, in addition to its institutions, it is crucial to understand the ideas behind the marketization of elder care. Ideas emerge as a key leverage for making policies and practices of marketization acceptable and which decision makers and other influential political/societal actors use in policy and public debates. The importance of ideas is further underlined by the fact that they do not necessarily relate to the institutions of elder care systems in a linear way.     

Long-term Care in China: Issues and Prospects

One of the major socioeconomic challenges China faces is the rapid aging of its population. China is now an aging society, even though it is still regarded as a middle-income economy. Coupled with the market-driven reform of social services and rapid erosion of family support, the provision of affordable and accessible social care services to older people has already become an urgent issue for the government to address. Looking into the future, the formulation of a sustainable position on long-term care (LTC) will increasingly become the major focus of social policy. This article sets out the background to the demographic shifts resulting in the emerging need for LTC in China. It analyzes the issues facing LTC services and reviews their prospects, including the structure, operation, financing, and interfacing of residential and community-based home care services.     

Work and Care Strategies of European Families: Similarities or National Differences?

This paper examines the work and care strategies chosen by full‐time working families with children in Finland, Italy, Portugal and the UK. It asks whether European families in different countries, facing the same problems of balancing employment and childcare responsibilities, respond to their situations in similar ways. An increase in dual‐earner families where both parents work full‐time represents a general employment trend in today's Europe. Also, within families with children, such employment patterns are now more common than they were previously. National differences may therefore not any longer be as marked as often indicated by country‐based surveys. The qualitative data from the SOCCARE Project offer a way to examine this issue. The focal point of the paper is to make a comparative analysis of couples in similar work and care situations. Using their working hours as the common denominator, this paper analyses their daily childcare arrangements and how these are impacted by gender roles, working schedules, flexibility of workplace, income levels, parents’ educational background and availability of care facilities. The paper concludes that European families’ work and care strategies have many similarities whereby national differences may not be as marked as often indicated by contemporary research.