Supplemental home care and topping‐up: A shift from service universalism towards a new and privatised public service model?

How does a public service model based on service universalism react to the introduction of market principles of topping up? In a recent so‐called Free Municipality Scheme (an experimental scheme that allowed for greater operational autonomy locally in an effort to reduce state bureaucracy), a number of Danish municipalities were for the first time ever allowed to compete with for‐profit providers of home care in selling supplemental home care services paid entirely by the user. The take‐home message from this experience is that the introduction of supplemental home care entails challenges and eventually wider implications for the public service model, on an economic, organisational and cultural level. Supplemental services represent a new and potentially powerful combination of market and state logics that eventually redirects away from the universalist welfare state and towards a new and increasingly privatised public service model – a model where the service level is determined by the user's capacity to purchase and pay for services. The introduction of such services therefore implies a change of the potential of the Nordic welfare state to ensure equal access regardless of class and income.     

‘Actually There is a Brain in There’: Uncovering Complexity in Pathways Through Education for Young Adults Who Have Been in Care

Internationally, research has highlighted disruption to the educational trajectories of young people in care, documenting concern about upheaval and poor educational outcomes. We present findings from English data arising from qualitative longitudinal research with care experienced people (16–32 years) who were also in education, employment or training. The analysis extends understanding of the experiences of those who achieve educational ‘success’, including those who followed non‐linear trajectories. The need for a flexible education system, and leaving care entitlements, which take into account the disruption experienced by young people in care and the consequent possibility of delayed educational pathways, is discussed.     

Reconciling care and justice in contesting social harm through performance and arts practice with looked after children and care leavers

The proportion of young people taken into the care of the state has increased recently and there is evidence that this social group suffer negative long‐term outcomes that might be conceptualised by the emergent criminological category of ‘social harm’. Debates in social work around an ethics of care and justice offer different ways of thinking about responding to social harm. This paper reports findings from an innovative arts‐based intervention with Looked After Children and young people and concludes that holding these competing value sets in creative tension is central to the success of the programme in helping young people to cope with and contest social harm.     

Social investment effects of public education,health care,and welfare service expenditures on economic growth

The purpose of this study is to theoretically and empirically examine whether public spending in education, health care, and welfare service operates as a fruitful investment in welfare states, which has been implied in the literature of social investment arguments. Based on comprehensive review of existing literature, this study suggested a tripartite mechanism of social investment effect of such spending, that is “enhancement of human capital,” “support for labor force participation,” and “job creation.” To find the empirical evidence, a pooled time‐series cross‐section analysis was conducted with the data of 15 advanced welfare states from 1980 to 2015 using estimation technique of fixed‐effect model. The results confirmed that public spending in education, health care, and welfare service had a positive medium‐term as well as long‐term effect on economic performance, while cash‐type welfare spending had an obscure or no visible effect on economy. Government consumption that is a proxy and control variable of size of the welfare state showed a positive effect on real GDP in the medium term but a negative effect in the long run. In conclusion, this study suggests that reinforcing social services should be recognized and dealt with as essence of social investment strategy.     

Driven by Inequalities: Exploring the Resurgence of Domestic Work in U.S. Cities

Domestic work, once the most common occupation for women around the globe, was thought to be well on its way to extinction at the end of the twentieth century. However, in the 1980s and 1990s, evidence began to appear that domestic work was in many places again becoming a growth occupation. My goal in this article is to examine the factors related to the recent expansion of domestic work in countries in the Global North, using the United States as a case study. I draw on U.S. Census data to document the resurgence of domestic work both nationally and in many large cities across the country, and then use multivariate analysis to compare rates of domestic work across these cities. The results indicate that rates of domestic work are highly related to variables measuring structural inequalities (racialization of the labor force, immigration, and economic polarization), while showing little relationship with variables measuring unmet care needs (care dependency ratios, female/maternal labor force participation, and availability of institutional care options). These findings underline the urgency of providing protections to domestic workers and point to the need for scholarship that better theorizes the relationships among unpaid care and different forms of paid care.     

Who cares? A lack of self‐care for women in the non‐profit/non‐governmental sector

In this article I examine the lack of self‐care regimes for women working in the non‐profit/non‐governmental sector. While I draw on ethnographic research conducted in the Malaysian context of women's organizations, the issue of self‐care for activists and feminist activists is a global one that crosses borders and boundaries. I explore the gendered nature of care and care professions to demonstrate how women are predominantly affected in these working environments. To date, there has been little scholarship on self‐care and care in non‐profit/non‐governmental working environments. Using interviews with women working in the sector, I argue that women's emotional, mental and physical health comes at a cost in these hectic workplaces. This article contributes to the literature on gender, work and care in women's organizations by taking seriously women's concerns working in these spaces, where they experience self‐neglect and institutional barriers in care regimes.     

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

BackgroundThe number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.ObjectiveTo examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.MethodsA cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1−2 midwives), medium-sized (3−4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15–75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p < .001) and large-sized practices (score 57.9) (p < .001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p < .001), showing a medium effect (d .69).ConclusionThere is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by women receiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman-centred care practice from ‘good’ to ‘excellent’ practice.     

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study

BackgroundHaving a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women.MethodsThis cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance.ResultsFollowing hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private).ConclusionsA higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.     

福利多元主义视角下城市“老漂族”精神赡养问题研究——以广州市三个典型社区为例

本研究聚焦渐趋普遍的“老漂族”群体异地养老现象,关注其精神健康。以福利多元和精神赡养理论为分析框架,对广州市三个老年流动人口较集中地区的“老漂族”进行问卷调查及访谈,通过多元线性回归分析政府、家庭、社区、市场等主体的服务供给对“老漂族”异地养老精神需求产生的影响,剖析“老漂族”异地精神赡养的需求和供给现状。本文的主要结论是,目前的养老福利托底政策和市场补充供给的不足给“老漂族”带来异地养老尤其是精神赡养上一定的困难,建议更多地发挥家庭、社区和社会组织的作用,提倡养老资源供给模式应将物质服务和精神扶助结合起来,实现养老渠道多样化、社会福利供给主体多元化,形成多元供给主体之间的协调与互补,共同支撑起能够惠及“老漂族”异地精神赡养的养老服务体系。