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Peter Raeymaeckers, Bettina Leibetseder, Robert Fluder, Erika Gubrium and Danielle Dierckx
In this chapter we focus on social assistance services, such as housing, childcare, counselling and other types of benefits, that are provided to people receiving a guaranteed subsistence income from the state, defined here as social assistance beneficiaries. These services are delivered by social workers in public agencies, often collaborating with other public and non-profit service providers at the local level. We specifically address how these social assistance services have been affected by the so-called ‘activation turn’ in social assistance. We present evidence on the horizontal division of labour between local government actors and a variety of service organisations (public, non-profit and private) and how this division of labour is affected by activation policies in four European cities: Graz in Austria, Antwerp in Belgium, Berne in Switzerland and Oslo in Norway. At the end of the chapter we reflect on the consequences of the activation turn in terms of increasing pressure on local actors. We hypothesise that the latter are increasingly ‘creaming the crop’ by creating a selection mechanism that favours the ‘best’ clients, those who are able to make the transition towards the labour market, over the ‘worst’ clients, those who are not able to find a job.
Teppo Kröger and Angela Bagnato
Provisions and patterns of care for older people have recently undergone significant change all over Europe. This chapter maps the general directions of change in long-term care in different parts of Europe during the early twenty-first century, based on information reported in working papers produced by national teams in the course of the COST Action IS1102. The chapter covers 11 European countries, representing the Nordic countries (with Denmark, Finland, Iceland), Central/ Central-Eastern Europe (with the Czech Republic, Germany, Slovakia) and the Mediterranean region (Greece, Italy, Malta, Spain), plus the United Kingdom. Data-driven reading of the working papers helped identify five key dimensions of policy developments: (1) decentralized care–centralized care; (2) social care–health care; (3) outsourcing–in-house provision of care; (4) home-based care–institutional care; and (5) formal care–informal care. The chapter reports recent and ongoing change along each of these dimensions in different parts of Europe. It concludes that the main directions of change are: from the central state to the local level, from public provision to for-profit services, from institutional care to home care, and from formal care to informal family care. Altogether, these developments imply that governments in Europe seem in general to be trying to reduce their responsibilities for care of their older populations.
Blanca Deusdad, Sagit Lev, Charles Pace and Sue Vella
De-institutionalisation of care for older people in Mediterranean countries has not been sufficiently analysed, in terms of policy discourse and implementation. The aim of this chapter is to study and compare both aspects within a cluster of three different Mediterranean countries: Israel, Malta and Spain. Although these countries differ in their historical, geographic and demographic features, they share a number of features. The traditional provision of care by the family has decreased as women’s employment rates have risen and family sizes have shrunk. Despite attempts to counter this through various ‘ageing in place’ policies, in none of the three countries have such attempts managed to fully offset undue institutionalisation due to the lack of family or financial resources, let alone enable the return of older persons from institutions to the community. Despite differences, enough similarities exist to propose a Mediterranean variant of LTC for older persons. This is characterised by ongoing reliance on family care even in the face of rising female employment; by underdeveloped or under-resourced community services; and by growth in private care services including recourse to migrant care labour. These features have implications for older adults who lack family support or financial means, and for the sustainability of care policies in the face of rapid demographic ageing.
Blanca Deusdad, Jana Javornik, Rosa Mas Giralt and Raquel Marbán-Flores
This chapter explores changes in care policies and how these affect gendered opportunities in the wake of the 2008 financial crisis. It focuses on Spain and the United Kingdom, two national case studies that have very different cultural and policy trajectories. Although legislation and measures supporting parental leave, child care services and care for older people were introduced in both countries in the 1990s and 2000s, austerity measures following the financial crisis of 2008 have disrupted those policy directions. Both countries lack a strategic and sustainable approach to gender equality in care. In Spain, family solidarity mechanisms have resumed, with forced re-familisation and co-habitation. In the United Kingdom, the national deficit reduction plan has cut local government budgets for care services to older people and children. These changes have interrupted the ‘policy transformative potential’ brought about by programmes and legislation supporting care services during the previous two decades. As a consequence, in both countries, women’s access to well-paid jobs and professional development remains a challenge, in the context of insufficient and superficial gender equality legislation.
Social services are a social policy field with a rapidly growing political and theoretical importance in Europe. These services enhance human welfare and the overall well-being of people, but in different ways and through different mechanisms. In this chapter, social services – with specific attention to care for older people – are evaluated from three perspectives. First, social services are examined in connection to risks people meet during their life course. Becoming old and fragile is one of such risks. However, there is a large variety in the ways life-cycle risks are taken into account by national care service policies. Second, the universality of service provision – or lack of it – is considered. From this perspective, a general weakening of universalism is observed throughout Europe. Finally, there is a distinctiveness in social service provision related to the complexity and complementarity of these services. Complexity and complementarity are at the same time strengths and weaknesses in social services provision and might explain the low status these services exhibit even today.
Kateřina Kubalčíková, Gábor Szüdi, Jaroslava Szüdi and Jana Havlíková
The chapter focuses on the implementation of de-institutionalisation in care for older people in the Czech Republic and Slovakia. The principles of de-institutionalisation were incorporated in the national strategic documents of both countries after the 2004 accession to the European Union. First, the question of how this concept influenced the Czech and Slovak national strategies, legislation and organisation of social services for older people is tackled. Subsequently, the chapter looks at the ‘responses’ of regional and local authorities and providers of care services for older people. Two case studies are then presented, which illustrate the ambivalent nature of the de-institutionalisation process. Particular attention is paid to the new role played by domiciliary care since this service form takes a central role as a ‘substitute’ for outdated or expensive institutionalised care. The chapter highlights how, even though a de-institutionalisation strategy was introduced at the national level in both countries, it was implemented without guaranteeing a constant and steady flow of financial resources, and the transition of national policy priorities to a ‘new’ conception of care for older people at the regional and local levels has been rather slow. As the case studies suggest, the implementation of the national strategy can actually lead to the exact opposite outcome than originally intended, with significant policy implications.