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.     

Doing business or leading care work? Intersections of gender,ethnicity and profession in home care entrepreneurship in Sweden

This article critically explores assumptions underpinning Swedish elder care policies that the introduction of market practices in publicly funded eldercare services advances women's entrepreneurship. We argue that gendered privileges and disadvantages are being recreated on tax‐funded home care markets; furthermore, gendered inequalities intersect with ethnicity and profession in the management of small‐scale care companies' dealings with authorities governing home care services and standards for home care work. However, we find that the salience of categories depends on the context in which they emerge. While gender and profession are dominant in management, gender and ethnicity influence interactions with authorities. Only in standards for home care work do all categories simultaneously shape the business approaches of care entrepreneurs. Our analysis, based on data on size and growth of home care companies and interviews with small‐scale care entrepreneurs, suggests that regulations and practices privilege big companies and care entrepreneurs who echo the white, masculine gendering of entrepreneurship as ‘doing business' and disadvantage small‐scale entrepreneurs focusing on leading care work to produce quality care.     

Transnational migration and the commodification of eldercare in urban Ghana

ABSTRACT

Over the past 20 years, organizations to provide commercial nursing services, mainly to the sick and debilitated elderly, have sprung up in Accra, Ghana. This article assesses the degree to which transnational migration has generated social changes in ageing at the level of everyday practices. It argues that a range of social actors differently involved in transnational migration has created and sustained a market for home nursing agencies in Ghana through diverse processes involving the imagination of care work abroad, complex negotiations between the elderly at home and their anxious children abroad, increased financial resources among the middle class and the evaluations of western eldercare services by return and current migrants. These dynamics illustrate the complexity of the role of transnational migration in generating social change and highlight the significance of the needs of local families and the role of the imagination in shaping social remittances from abroad.     

Does job complexity mitigate the negative effect of emotion-rule dissonance on employee burnout?

In interactions with clients or patients, human service workers are at risk of experiencing discrepancies between felt and organizationally mandated emotions (i.e. emotion-rule dissonance). Given the documented detrimental effects of such discrepancies on employee strain, the present study investigated whether job complexity mitigates the relation between emotion-rule dissonance and employee burnout using data from a two-wave panel study of eldercare workers (N?=?583, 16-month time lag). Structural equation modelling revealed that emotion-rule dissonance at Time 1 preceded emotional exhaustion and depersonalization at Time 2. Beyond that, employees whose work offered job complexity were found to suffer less from emotional exhaustion and depersonalization when encountering discrepancies between felt and stipulated emotions compared to employees who conducted noncomplex work. Thus, designing complex tasks appears to be a crucial starting point for alleviating employee burnout in jobs that provoke emotion-rule dissonance.     

农村养老保障与计划生育工作拓展——安徽省的实证研究

本文通过分析安徽省计划生育工作和农村人口老龄化的现状 ,认为在现时和未来的计划生育工作中 ,应当解决好农村的养老保障问题 ;在适当的条件下 ,应将计划生育工作与建立健全农村的养老保障制度结合起来 ,更加有效地促进计划生育工作的开展。如何将二者结合起来 ,本文也提出了建设性的建议。同时 ,课题组认为 ,将计划生育工作与养老保障结合起来也能够为未来建立“大人口”的模式打下基础。     

Governance,Accountability, and Organizational Development: Eldercare Unit Managers’ and Local Politicians’ Experiences of and Responses to State Supervision of Swedish Eldercare

This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV’s narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.     

Social Policy and the Politics of Hispanic Aging

Abstract

This study examines the contributing factors to job satisfaction and commitment among lower-income, older (age 55 and over), part-time employees (N = 164). Job satisfaction index (JSI) scores were relatively high for all subjects and did not differ significantly for age, gender, or Senior Community Service Employment Program (SCSEP) status. While not particularly low, white employees were significantly less satisfied with their employment experiences than Hispanic or African American workers. The scarcity of fringe benefits was the least satisfying aspect of employment. Older Hispanics, whites, and men reported less interference between job, family, and home life than African Americans and women. Multiple regression analysis revealed that race/ethnicity, skill utilization opportunities, perceived views of elders held by younger workers and supervisors, availability of fringe benefits, and suitable work days explained the majority of variance in JSI scores. Opportunities to interact with others and stay active were more important than financial supplementation in these elders' assessment of the benefits of part-time employment. Findings provide further understanding of those elders likely to be placed successfully in part-time employment.     

The welfare state, the individual and the need for care: older people's views

The aim of this qualitative study was to study how older people experience aging and reflect on their need for care in the Swedish welfare context. Sixteen people were interviewed, aged between 77 and 92 years. Staying healthy and independent in their everyday lives were prized values for the informants. Some brushed aside thoughts of being in need of home help services in the future and others had a more reflecting attitude. The informants did not want to burden either society or their children. Through mass media and the experiences of their neighbours, they had gained a negative impression of eldercare. They were uncertain if there would be any helping hand of good quality in the future. On the other hand, informants who already had home help thought that it was helping them to maintain independence in everyday life and they were also satisfied with the help they received.     

Biała emigracja: variegated mobility of Polish care workers

ABSTRACT

This paper analyzes migration of Polish healthcare and eldercare workers since Poland's accession to the European Union. The research indicates that while many Polish doctors, nurses, and caregivers ‘left’ Poland, they did not necessarily ‘stay’ abroad. Contemporary Polish migration has become ‘liquid’ and has often taken on a form of ‘pendulum’ or ‘circular’ migration and, in some cases, transnational commuting, especially in the early years following Poland's accession to the EU. These patterns are particularly evident among healthcare and eldercare workers whose flexible working schedules or life stages allow for retaining employment positions and households in Poland while taking short-term or prolonged leave of absence to work abroad. The research also suggests that different migration patterns are related to the characteristics of the place of migrant origin and the geographic distance or proximity of the destination countries. Residents of border towns can easily commute to cities on the other side of the frontier, while those who want to work in geographically more distant countries and cities must, by necessity, consider longer-term or permanent arrangements. The analysis of the variegated mobility of elder care workers is situated in the context of policy discussions related to care drain and care supply as well as quality of migrant care.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.