A Cross-National Comparison
Chapter 7: Care Users: Between Citizens and Consumers
1 Changing conceptions of the role of the users in social care provision mark a key element of home care reform in most Western societies. Several debates have contributed to the newly defined role of the users in care provision (see Ungerson, 2003; Clarke et al., 2005; Clarke, nd). Debates on processes of individualisation in society question whether existing forms of care provision are responsive to the increasing diversity of needs and wants among the care users. Social and user movements have been raising their voice against dominance and dependency as a characteristic of the traditional relationship between care users (clients) and the professionals in public service provision. Social or citizenship rights related to care are emphasised as a way to expand the traditional male-oriented model of citizenship. Social rights, empowerment, autonomy of the users and freedom of choice within service delivery are catchphrases reflecting the debates. The demands put forward within the debate can be related to competing approaches to care delivery with their emphasis on different logics of governance (see Chapter 2 and Knijn and Verhagen, 2003; Vabo, 2004; Clarke et al., 2005). Laws and regulations introduced and imposed via hierarchy as a part of the logic of governance by the state are emphasised as a starting-point for the establishment of social rights, which aim at supporting an equal treatment of the users on the basis of democratically controlled bureaucratic administrative principles. Here the empowerment of the users on the basis of social rights is viewed as a...
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