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Social Care is about providing and supporting individuals to enable them to maintain their independence and dignity and also by ensuring that they have choice and control of their own lives (BBC 2008). According to Bell, D and Glendinning, C (2008) p.3, ‘Social care is characterised by uncertainty, inequalities, lack of information, and has vitally important emotional and relationship dimensions (Bell, D and Glendinning, C 2008).
This paper is going to look at how the different European countries (England, France, Germany, the Netherlands and Sweden) finance their social care in the way they do. It is also going to identify how these countries organise their social care services in terms of their approach in organising social care services and why they have different approaches. It is also going to identify the issues surrounding the delivery of social care services and the similarities between these countries.
How European countries Organise and finance their social care.
Financing Social Care in England?
Service users are mostly required to fund their own social care. Those who have assets over £22, 250 which includes their properties, are required to pay their own social care regardless of living in a nursing home, their homes or sheltered accommodation. There is also a means tested system which enables those who fall under the £22,250 mark, to have their social care funded by the state. An individual can have an exception in paying their social care if there is a specific medical condition, which can therefore fall under the NHS service. This will enable those who are entitled to the service able to receive social care free of charge. However most individuals who would require free services through health related needs, are finding it difficult to ensure assessors identify their need for free services (BBC 2008).
In England, Social security and health care are provided in uniform basis in terms of equity whilst social care in particular is difficulty with the approach as for reasons of equity, it can be delivered unfairly. Even though some of the social care needs are targeted by social security cash payments on a universal basis, local authorities provision is a different system as it is through the assessment system and its subject to what assets an individual has and through the means testing system. This usually creates hardships on disabled and older people, their families, professionals and policy makers in terms of managing the interaction between social care and other services such as housing, healthcare and social security benefits (Bell, D and Glendinning, C. 2008).
Financing of Social Care in Germany
In terms of the government’s responsibility on long term care for the elderly in Germany, their Long term care system was more of a traditional informal care led model. However, in 1995, the Germany government introduced a universal programme, which enabled those who required care for at least six months to benefit from the services free of charge. This programme involved a variety of services, which included giving beneficiaries of the system a choice of receiving cash transfers which would help them through paying for professional services or for paying someone who would be responsible for their care. The service users would have a choice between receiving services in a residential care home or at their own homes or receive cash benefits or have a combination of the two services. In 2005, the majority of service users who were receiving social care services at their own homes, registered for receiving cash or a mix (Pavolin, E and Ranci, C 2008).
In 1994, Germany voted compulsory Soziale Pflegeversicherung which in English is translated to Universal long term care insurance. All the political parties and everyone, who was involved in the discussion of financing this measure that was going to be implemented agreed with several points since the beginning of the discussion. They wanted home care to be the first priority over care in a nursing home. The scheme was not to pay for the whole cost of care (Morel, N 2007).
Germany has the Volksversicherung which is the people’s insurance which enables compulsory membership of care insurance for all. This long term insurance delivers benefits for all individuals who are severely disabled of all ages. This scheme was driven by the widespread stigma which was associated with spending down assets in order to be entitled for means tested social assistance for the help of care costs (Bell, D and Glendinning, C. 2008).
Financing of Social Care in France
Policy makers of France began to see long term care for the elderly as an important issue at the beginning of the 1990s. However this was important as they had to have solutions to the long term care issue. Both the right and the left policy makers agreed on a number of points they were discussing (Morel 2007) p. 626, 627. They all agreed that by increasing social contribution as an idea of creating a particular insurance scheme would not be an option as they had to limit the cost of a new benefit. They also had to encourage families to carry on looking after their elderly as it would be a less expensive option than having professionals to look after them and also with the idea that for the government to interfere is not a good idea as it weakens the backbone of family unity (Morel 2007).
The Prestation Solidarite Dependance (PSD) which means Solidarity Benefit Dependency in English was introduced in 1997 for individuals who were over the age of 60. This kind of benefit was a means tested social assistance. When it was introduced, it was criticised and the policy makers decided that reform was needed. They introduced the Personalized Autonomy Allowance (APA) in 2002 to tackle some of the issues which had risen from the Prestation Solidarite Dependance. Although the benefit has been managed at a regional level, everywhere in France, it assures the same benefit levels. Raising the Dependency criteria also increased the number of individuals who were entitled for the benefit. The benefit was now delivered in as a non means tested benefit but there was a reduction on the amount of those beneficiaries with resources above a certain limit (Morel 2007).
When the government saw that the measure they had introduced had produced a positive outcome, the right wing government were committed to reduce the cost of benefits through new reforms in 2003. They introduced cash benefits to allow those who were dependent on the benefit to have the right of choosing the sort of care they require. The government’s shift of policies, was to promote and encourage free choice were the beneficiaries would have the choice of choosing the kind of care they required (Morel 2007).
The Allocation Personaliseed Autonomie which was introduced in France in 2002 is paid at one in six levels of dependency. Individuals with incomes below a certain amount are not required to pay any charges whereas individuals with incomes above a certain amount are required to pay co-payments (Bell, D and Glendinning, C. 2008).
France has its national scale called the AGGIR which enables to determine if an individual is incapable. This is the same as what Sweden, United Kingdom, Germany and Spain use in assessing the needs of individuals. Focusing on a case by case basis, the assessment team has to organise the type and number of care needed, in order of organising a care plan. The United Kingdom is similar to the France in the distinction between a needs evaluation phase and the phase that determines the type of care required. However when it comes to the assessment procedure, the United kingdom is difference to France as it doesn’t use the national assessment scale but it is similar to the Swedish on the account of autonomy entrusted to care managers (Le Bihan, B and Martin, C. 2006) p.31.
Even though France developed child care policies a long time ago, the issue of long term care, began to be looked at seriously in the early of 1990s. Just like other countries, the issue of ageing population, the change of family structure and the idea that more women are into the labour market, affected families. The French policy makers of both the left and the right were all worried about reducing the cost of the new benefit but they all agreed that raising social contributions in order of creating an insurance scheme was not going to happen as the high level of social contributions has been said which led to France’s lack of economic competitiveness. However they also agree on helping the family with incentives to keep on caring for the elderly as this proved less expensive than formal care. They implemented the cash for care for the elderly with the idea of providing cash benefits to dependant so that they can have free choice on what services they would require. They also implemented care as a source of low skilled, low paid employment for young children or for the elderly (Morel, N. (2007).
Financing of Social Care in Netherlands
The welfare state of the Netherlands was mainly a Christian paternalist system to the social-democratization since the middle of the 1960s and then it moved to liberalization from the mid-1980s. Despite the cut backs on benefits, Netherlands’s welfare system has been seen as the most generous system in the world the same as Sweden and Denmark (Becker, U 2000).
Typology can be used to bring order in the sense of differentiating several national welfare systems. Four types of typology which can be used, can be the paternalist type where inequalities can be defined as a matter of fact and life were those who are able should be required to look after those who are unable to help themselves either by voluntary and state action. The liberal type where the society view the market as a dominant element, individuals’ responsibility is central and public provisions is minimum and the idea of equality of opportunity prove more powerful. The social democratic type would be when a combination of the market, individual responsibility and the ideas of social citizenship and of equality proves more powerful. The communitarian type is when the welfare state plays a big role and group norms restrict individuals’ responsibility and market inequality. Esping Andersen used the link between the market and the family. The Netherlands changed its welfare system from the paternalist, to the social democratic and later on went on to the liberal one but without becoming either social democratic or liberal (Becker, U 2000).
During the development of the welfare state in the Netherlands from the late 1940s to the middle of the 1960s, the Dutch society was a conservative one. Public life and politics at this time was being ruled by the Christian conservative organisations and parties. In terms of Social life, this was controlled by classified principles. After the Second World War 2, individuals of the Netherlands were finding it hard to help themselves and this when the development of the Dutch welfare state which was called the ‘Caring State’ began. Later on, the Catholics and Socialists joined forces in order of developing the modern Dutch welfare system. They recognised and accepted the insurance acts for the old age, unemployment, sickness and disability and they implemented children’s allowances. All these regulations, began to be financed by wage earners, the employers, tax funds, the statutory retirement pension scheme of 1957 which further introduced a Universalist, tax financed element to the Netherland’s welfare system (Becker, U 2000).
The Dutch’s welfare system was also aiming at avoiding poverty, by increasing the levels of unemployment benefits especially for breadwinners with children, were earning a little bit more than the other categories and this also reflected that women had to stay at home to look after the children while man go to work to support their families. Because of this, there was a view that there should not be a second income in families as women were only allowed to look after the children at home. The current Dutch welfare system has the mixture of both paternalists, social democratic and liberal principles. Talking about the financing of benefits in Netherlands, they are mainly financed by social contributions, but when looking at the basic pensions, this is universal (Becker, U 2000).
Elder care in the Netherlands took the form of institutional care but over the years, it began to change in order of shifting from institutional care to domiciliary care. The government decided on an experimental basis to introduce new policy which was to support those who wanted to purchase private care in 1991 and it was introduced on a national level in1995. The new policy had set an arrangement of dependent people who were eligible for care allowance to use the allowance to purchase their care services through the Personal budget benefit. The government wanted to create a benefit which would help to move towards delivering care to individuals with the freedom and choices of choosing how best to service their needs. Similar to France and Germany, this was a way of paying carers and to help them move back to employment (Morel 2007).
Financing Social Care in Sweden
In the beginning of the 1990s, Sweden began some major changes on its welfare state. Sweden was going through some financial problems, so the reforming of the welfare state was a way of tackling the problem which the country was facing financially. They began to limit social insurance system and transfer schemes and they also made some cut backs on social care provision and the changes in priority. Because of the changes in priority, many who had been receiving help in their own homes were denied it. This led to less people receiving public care and this also happened when the government was fighting on helping those who were most in need of the care. However this made some of the elderly people to have alternatives of getting the help they required through the market, the family and volunteers (Blomberg S Edebalk PG and Petersson J. 2000).
The traditional social care services for the elderly before all the changes were made, consisted of local authorities financing social care and also publicly funded. However the measures they introduced was to limit the care they offered and they also wanted a system which was strict when it comes to assessing the needs of individuals. The traditional care of Sweden moved towards a mixed model which the family, neighbours and volunteers being more involved and the market forces seeing this as important (Blomberg S Edebalk PG and Petersson J. 2000).
During the year 1992, Sweden organised its social care system in a way that municipalities had to take the responsibility for long term care for the elderly and the handicapped. This reform which was introduced in 1992 for the municipalities to take control of social care was an advantage but this was also expensive. Municipalities began to modernize nursing homes and this was expensive even though there was also money coming from the state grants. However between 1992 and 1996 the municipalities faced demographic pressures. Municipalities targeted those who had higher priorities for the need of nursing. This was done in order of reducing expenditure. Their way of means testing, was to be strict on evaluating the needs of individuals who needed their help. Their strategies on structuring the help for the elderly was to put strategies which would affect the supply of services and also to put strategies which would affect the demand of services by limiting and adjusting the fees to reduce the net costs (Blomberg S Edebalk PG and Petersson J. 2000).
The Scandinavian countries such as Sweden mostly have the same system were the state provides, finance, and regulate welfare services to all the citizens throughout their life time. Esping Andersen’s types are defined by political ideology: social democratic, conservative and liberal. Leibfried (1992) and Bisley/Hansen (1991) cited in Abrahamson, P. (1999 p.33) developed a distinction which added the Catholic, Latin or rudimental model. Nordic welfare societies are those societies which state that every individual in the society has the right to social protection. From a Scandinavian model of welfare, Sweden is a universalistic welfare state. This kind of model has high level of organisation, strong political features, high welfare ambitions, low level of corruption and high level of efficiency (Abrahamson, P. (1999).
France, Germany and the Netherlands have similar logics and trajectories and this can be explained by the shared conservative and corporist traits of Bismarkian labour markets and welfare state institutions and their impact on labour market adjustment possibilities and preferences. The care policies of this countries, have been linked to the employment strategies, and the politics of welfare without work and the attempt of shifting from labour shedding strategy and this went on to explaining the nature and timing of child and elderly care policy reforms in Bismarkian welfare state. The Bismackian welfare state of the 1980s and early 1990s was the reinforcement of the traditional breadwinner model but in the late 1990s care policies began to be used on raising female employment levels. There was a shift from women being only allowed to stay at home to the shift of being allowed to be able to work. This shift bears the imprint of the conservative corporist legacy of their welfare states both in their design of policies and their outcomes. These countries target on promoting free choice led to some women to have much more free choice than others and it helped to reduce certain labour market strictness (Morel, N. (2007).
Esping-Andersen’s 1990 tripartite welfare regime typology, which identified a Social-democratic regime (the Nordic countries), a Liberal regime (the Anglophone countries) and a Conservative corporatist regime (continental Europe, i.e. Bismarckian countries), arrived at this typology by correlating a number of indicators including both causal explanations such as political and historical factors, the institutional design of the welfare states and a number of policy outcomes (mostly in terms of levels of deco modification and stratification resulting from these welfare institutions, but also in terms of women’s labour-market participation) (Morel, N. (2007).
The Bismackian welfare system is based on the idea of social insurance. The idea of social insurance schemes are based on labour market participation and performance, and welfare benefits earnings. The Bismackian welfare is also based on its strong reliance on the breadwinner model and its strong support of the traditional family. This model requires males to work full time whilst the women withdraw from the labour market and their job would be to care full time for the children, the elderly and the disabled. This has shown that women would receive benefits through their husbands and led them to lack individual social entitlements. This kind of welfare regime’s principles is that when an individual is in need of care, the family or local communities should be the first resort or from voluntary associations the state will be the last resort to step in. The principle of this welfare regime is that the family if the best provider of care and the state should not undermine the family so it will be the last resort when the family cannot able to provide care. In terms of financial transfers to families, the Bismarkian welfare usually offer financial transfers to the families in order of supporting them as their role of primary welfare providers but offer little in terms of social services (Morel, N. (2007).
Social assistance of the bismackian welfare is dealt with by local rather than central authorities. This idea of traditions family based on a male bread winner and a female as a care giver and the principles of subsidiarity testify to the catholic and politically conservative origins of this welfare regime. During the 1960s Countries such as Germany and France are different to Scandinavian countries as France and Germany would have workers from other countries instead of letting the women work, thereby reinforcing male breadwinner whereas In the Scandinavian countries, they chose to bring women into the labour market which encouraged the development of child care services and some other policies to help parents to bring together work and family life in the early 1970s (Morel, N. (2007).
Despite policies encouraging women to stay at home, the changes in social values and family structures led to more women wanting to be in the labour market. With more women into the labour market, it brought a conflict of women willing to care for the dependent elderly in countries such as Germany. In terms of child care and elderly care, there is much inter regime difference in terms of public spending on family services and the coverage of the services. The conservative corporatist welfare state is the less generous one than social democratic welfare states and a little more generous than liberal welfare states (Morel, N. (2007).
There are differences between the conservative corporist group and also between countries such as France. France is less generous in terms of public spending on family services than Germany and the Netherlands but offers a wider childcare than the two other countries. In terms of elderly care, Germany stands out with its low levels of home help and institutional care coverage on the other hand; Netherlands has high coverage levels with the same as Sweden. The French’s provision of childcare was due to the existence of the ecoles maternelles or preschools. Childcare policies in France included both day care services for women’s employment and cash benefits which were to encourage women to stay at home. France has also developed family policies which aimed at targeting and favour large families. However in terms of elderly care, their policies have remained undeveloped. From the early 2000, than when France began to develop policies which were aimed at dealing with long term care needs of the dependent elderly (Morel, N. (2007).
Germany and the Netherlands mostly remained to the traditional male bread winner model but recently those women with small children were expected to stay at home rather than work. The principle of subsidiary is still strong and childcare services being provided by voluntary welfare organisations. Germany and the Netherlands recently, began to invest more in child care services. These two countries provided care for the elderly since a long time ago and Germany only set up the fifth of its social insurance scheme aiming at dealing with dependency in 1994. Even these countries has cultural and policy differences, they all followed similar patterns of reform (Morel, N. (2007).
The idea of the breadwinner model in the Netherlands was the strongest but it all changed in the 1980s when the number of working women began to increase. Childcare in the Netherland s began to be developed during the 1990s and this was said to be a solution to the so called the Dutch disease/ problem. Netherlands remained conservative welfare regime on its child care policies and did not translate to the transformation of the male bread winner model. They still consider that care should be provided by the family and they reduced the working time of parent so that they can both care and also work. Netherlands has also remained quite corporatist in its mode of provision. Elderly care has also been developed in the form of institutional care but recently, like other countries, it beginning to shift towards domiciliary care (Morel, N. (2007).
The Nordic welfare states and Sweden have the same problems between two principles; universalism and local autonomy. The implementation of universalism is a responsibility of highly independent local authority or welfare municipalities whereas the nature of universalism is established at a national level. The Nordic countries, in Esping Andersen’s terminology, represent the Social Democratic welfare state regime in which all citizens are incorporated under one universal system but in the social policy literature, the Nordic countries are placed in a special welfare state model which is a universal citizenship based model with a high level of generosity. The Nordic welfare system is based on the provision of high degree of universalism and equality. Another principle is the increasing of the state’s responsibility for the care of the children, the aged and disabled people while minimising the responsibly of families (Trydegård, G.B and Thorslund, M (2010)
The increase of the elderly population is an issue as the need of long term care is increasing in so many countries. The demand and support for long term care, considerations of fairness and equity have increased and this has also put pressure on the long term care expenditures. Furthermore the cost of care and support has also increased. The main issue which is causing long term care expenditure, in so many countries, is the growing number of the elderly in need of services.
Ferna´ndez, J.L and Forder, J. (2010).
The similarities that England, Sweden, Germany and France have, is that they all deliver nursing care, personal care, housekeeping help, technical assistance with domiciliary care, accommodation centres, nursing homes, day-care centres, geriatric hospitals, and psychiatric institutions for either temporary or permanent accommodation. All these countries also have the availability of financial benefits to pay some of the needs of individuals but their significance to the benefits is not the same in all the systems. Sweden’s social care for the elderly is based on the needs assessment which draws up the care package. The United Kingdom allows every individual who submits an application form to be assessed on their needs, services and the management of their circumstances (Le Bihan, B and Martin, C. 2006).
Focusing on the financial contribution of the elderly in Sweden and the United Kingdom, these two countries have the strategy of co-payments whilst France and Germany has the strategy of social assistance in the case of municipal caring. Sweden and the United Kingdom have some similarities in what the elderly has to contribute on their resources and the cost of their care plans and both the municipalities and local authorities establish the guidelines. Germany has the combination extensive system, which is for long term care insurance and supplementary system which is for those on lower incomes (Le Bihan, B and Martin, C. 2006).
To conclude Social Care policies that have been implemented by other countries have differences in the attitudes of the society in terms of uncertainty, inequality, transparency, citizenship and the role of unpaid care. Constitutional and financial arrangements also influences the way different countries develops their social care policies. On top of these differences are Constitutional and fiscal arrangements that influence the way in which social care policy develops in different countries
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