Blanche Le Bihan

Similar and Yet So Different: Cash‐for‐Care in Six European Countries’ Long‐Term Care Policies

CONTEXT In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. METHODS A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. FINDINGS While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. CONCLUSIONS A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require.Since the 1990s, cash-for-care schemes have been a common trend in social policies, particularly in the field of long-term care (LTC). Instead of services, these schemes give people monetary benefits, which they can use to purchase care services. Most of the literature on this topic concerns the common objectives and possible implications of cash-for-care schemes. One of the main ideas behind cash-for-care is “free choice”; that is, disabled (older) people and/or their families may choose among different kinds of care and care providers, thereby giving them both autonomy and control, which disabled peoples organizations have sought since the 1970s (Glendinning 2008). The resulting competition among care providers also has enhanced the quality and efficiency of care (Kremer 2006) in accordance with a “new public management” perspective (Ferlie, Lynn, and Pollitt 2007). Another objective is the recognition of (formerly unpaid) informal care, since many cash-for-care schemes allow beneficiaries to compensate or employ their relatives (Ungerson 1997). Finally, cash-for-care schemes can be seen as opportunities to offer LTC policies that are less expensive than traditional services. A closer inspection of cash-for-care schemes in various European countries also reveals some striking differences among them. First, the strict regulation of cash-for-care schemes has strongly influenced the “commodification of care” (Ungerson and Yeandle 2007), as well as the development of specific forms of care work and informal care (Da Roit, Le Bihan, and Osterle 2008). Moreover, besides some exceptions (Lundsgaard 2005), researchers have tended to focus on cash-for-care schemes as specific policy instruments separate from more general LTC policies. The aim of this article is, on the one hand, to extend the discussion about the diversification of cash-for-care schemes and, on the other, to place them in broader institutional frameworks, namely, as part of general LTC policies. We claim that only when looking at the diverse institutional contexts in which these new schemes developed and the specific regulations that they entail can we understand them. We first consider the policy and institutional context in which cash-for-care schemes have been introduced in Sweden, the Netherlands, Austria, Germany, France, and Italy, particularly the degree and forms of development of previous LTC policies and the specific policy debates concerning each. We then address the specific regulations of the schemes and their different visions of informal care and care work. Finally, we discuss three LTC patterns that emerged from our analysis.

Cash for Care Schemes and the Changing Role of Elderly People's Informal Caregivers in France and Italy

In response to the ageing of the population and increasing care needs, long-term care has become a key policy issue in all European countries. The introduction of cash-for-care schemes — allowances provided to elderly dependent people and their families which they can either pass on to informal caregivers or use to employ a paid caregiver — has represented a key instrument and a common trend in European countries since the 1990s (Ungerson, 2005a, b; Ungerson and Yeandle, 2007). Various factors have been identified in the literature to explain this common evolution, such as the incapacity of the traditional welfare state to meet individuals’ needs, the trend towards marketization or the recognition of (formerly unpaid or cheaper) informal care (Ungerson, 1997, 2005).

Diversification of care policy measures supporting older people: towards greater flexibility for carers?

Originally part of the private domain of families, care of the older people is now the concern of public policy. Yet, in the European context of cost containment, it is not easy to make a case for increasing public support and the caring function of families remains prominent in social policy. In this paper, the authors question public policies around care of the older people in relation to both the needs of old people, but also those of adult children, mainly women, who work and provide care for their old parents. We investigate the interactions between public support in long-term care and the caring function of families. The paper presents some results of a comparative research study based on the identification of the policy measures which have been implemented in different European countries in the sector of care of the older people, and on the detailed analysis of care arrangements set up by a sample of 86 family carers in these various national contexts. We argue that in a context of cost containment, whatever the usual patterns of care and the role given to the family and public authorities, the policy measures which have been introduced since the 90s aim to support family carers in various ways with the common objective of giving them the flexibility they need in the organisation of care arrangements, combining various resources (formal professional care, unpaid informal care, semi-formal care). Different patterns of flexibility can be identified according to the regulation of the policy measures.

Public Child Care and Preschools in France: New Policy Paradigm and Path-dependency

In France, childhood was considered quite early to be a ‘common good’ and a source of human capital, mainly because of the demographic challenge that the country was facing at the beginning of the twentieth century. At that time, children were the expected results of a probirth family policy. Then new social problems emerged, new public debates took place and new political measures were implemented throughout the century. Indeed, family policy is not restricted to child care. It also includes many other issues: civil law, women’s rights, social and gender equity, support for disadvantaged households, same-sex couples, etc. Depending on the priorities, different periods can be identified (Commaille and Martin, 1998). But if we consider public child-care policies specifically, what about these changes? How can they be defined? Do they correspond to what Peter Hall calls ‘third-order change’, marked by radical changes and associated with ‘paradigm shift’? Or to ‘normal policymaking’, that is, a process that adjusts policy without challenging the main objectives of a given policy paradigm, which defines firstand second-order change (Hall, 1993)? In this perspective, can these changes be defined as a ‘path dependency process’ (Pierson, 2004)?

The development of integration in the elderly care sector: a qualitative analysis of national policies and local initiatives in France and Sweden

ABSTRACT Due to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries – France and Sweden – where various policy measures aiming at developing and delivering integrated care can be identified: at the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double – local and national – approach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected.

Similar and yet so different

CONTEXT In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. METHODS A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. FINDINGS While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. CONCLUSIONS A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require.Since the 1990s, cash-for-care schemes have been a common trend in social policies, particularly in the field of long-term care (LTC). Instead of services, these schemes give people monetary benefits, which they can use to purchase care services. Most of the literature on this topic concerns the common objectives and possible implications of cash-for-care schemes. One of the main ideas behind cash-for-care is “free choice”; that is, disabled (older) people and/or their families may choose among different kinds of care and care providers, thereby giving them both autonomy and control, which disabled peoples organizations have sought since the 1970s (Glendinning 2008). The resulting competition among care providers also has enhanced the quality and efficiency of care (Kremer 2006) in accordance with a “new public management” perspective (Ferlie, Lynn, and Pollitt 2007). Another objective is the recognition of (formerly unpaid) informal care, since many cash-for-care schemes allow beneficiaries to compensate or employ their relatives (Ungerson 1997). Finally, cash-for-care schemes can be seen as opportunities to offer LTC policies that are less expensive than traditional services. A closer inspection of cash-for-care schemes in various European countries also reveals some striking differences among them. First, the strict regulation of cash-for-care schemes has strongly influenced the “commodification of care” (Ungerson and Yeandle 2007), as well as the development of specific forms of care work and informal care (Da Roit, Le Bihan, and Osterle 2008). Moreover, besides some exceptions (Lundsgaard 2005), researchers have tended to focus on cash-for-care schemes as specific policy instruments separate from more general LTC policies. The aim of this article is, on the one hand, to extend the discussion about the diversification of cash-for-care schemes and, on the other, to place them in broader institutional frameworks, namely, as part of general LTC policies. We claim that only when looking at the diverse institutional contexts in which these new schemes developed and the specific regulations that they entail can we understand them. We first consider the policy and institutional context in which cash-for-care schemes have been introduced in Sweden, the Netherlands, Austria, Germany, France, and Italy, particularly the degree and forms of development of previous LTC policies and the specific policy debates concerning each. We then address the specific regulations of the schemes and their different visions of informal care and care work. Finally, we discuss three LTC patterns that emerged from our analysis.

Similar and Yet So Different: Cash-for-Care in Six European Countries’ Long-Term Care Policies: Six European Countries’ Long-Term Care Policies

CONTEXT In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. METHODS A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. FINDINGS While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. CONCLUSIONS A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require.Since the 1990s, cash-for-care schemes have been a common trend in social policies, particularly in the field of long-term care (LTC). Instead of services, these schemes give people monetary benefits, which they can use to purchase care services. Most of the literature on this topic concerns the common objectives and possible implications of cash-for-care schemes. One of the main ideas behind cash-for-care is “free choice”; that is, disabled (older) people and/or their families may choose among different kinds of care and care providers, thereby giving them both autonomy and control, which disabled peoples organizations have sought since the 1970s (Glendinning 2008). The resulting competition among care providers also has enhanced the quality and efficiency of care (Kremer 2006) in accordance with a “new public management” perspective (Ferlie, Lynn, and Pollitt 2007). Another objective is the recognition of (formerly unpaid) informal care, since many cash-for-care schemes allow beneficiaries to compensate or employ their relatives (Ungerson 1997). Finally, cash-for-care schemes can be seen as opportunities to offer LTC policies that are less expensive than traditional services. A closer inspection of cash-for-care schemes in various European countries also reveals some striking differences among them. First, the strict regulation of cash-for-care schemes has strongly influenced the “commodification of care” (Ungerson and Yeandle 2007), as well as the development of specific forms of care work and informal care (Da Roit, Le Bihan, and Osterle 2008). Moreover, besides some exceptions (Lundsgaard 2005), researchers have tended to focus on cash-for-care schemes as specific policy instruments separate from more general LTC policies. The aim of this article is, on the one hand, to extend the discussion about the diversification of cash-for-care schemes and, on the other, to place them in broader institutional frameworks, namely, as part of general LTC policies. We claim that only when looking at the diverse institutional contexts in which these new schemes developed and the specific regulations that they entail can we understand them. We first consider the policy and institutional context in which cash-for-care schemes have been introduced in Sweden, the Netherlands, Austria, Germany, France, and Italy, particularly the degree and forms of development of previous LTC policies and the specific policy debates concerning each. We then address the specific regulations of the schemes and their different visions of informal care and care work. Finally, we discuss three LTC patterns that emerged from our analysis.