Kateřina Kubalčíková

Do social workers avoid the dilemmas of work with cliens

This article is devoted to Lipskys suggestion that the purpose of street-level policies is to establish and justify patterns of behaviour that enable street-level bureaucrats to avoid the dilemmas provoked by uncertain working conditions. Based on a review of relevant literature as well as on case studies in the culture of social work service organisations by the authors, the article suggests that two kinds of street-level policies are described by the research. The first one is consistent with the aforementioned idea by Lipsky and follows the wish of social service workers to avoid the dilemmas of their work with clients without trying to change those uncertain conditions that provoke these dilemmas. The actors of the second kind of street-level policy try to negotiate with relevant partners and to change uncertain working conditions that are at the roots of their dilemmas. Both kinds of street-level policy are described by means of empirical examples and their substantive features are summarised.

Current Developments in Social Care Services for Older Adults in the Czech Republic: Trends Towards Deinstitutionalization and Marketization

ABSTRACT Deinstitutionalization and marketization of eldercare has been delayed by 20 years in the Czech Republic compared to Western Europe, and it takes place in a completely different context, characterized by the legacy of communism, a growing older population, and less generous public subsidies. This study is the first in the Czech Republic to examine how deinstitutionalization and marketization effect implementation of these principles on the availability and quality of eldercare services at regional and municipal levels. A mixed-method approach was used, combining several data sources (policy documents, administrative data, statistics, expert panel, and secondary use of qualitative data). The findings suggest that the support for and availability of home-based care has declined, despite the ever-increasing number of older adults and policy preference for deinstitutionalization. Furthermore, home-based services have failed to adjust to growing care needs of older adults (e.g., inflexible schedules, limited provision of time-demanding care, inadequate staff composition). This situation occasioned an unintended outcome: the emergence of nonregistered, semilegal, for-profit nursing homes offering low-quality care and poor working conditions, and subject to no quality control. The health and even lives of older adults are at risk if they choose such services. Research is needed to study older adult decision making and offer them tools to identify and avoid questionable services.

The de-institutionalisation of care for older people in the Czech Republic and Slovakia: national strategies and local outcomes: Changes, Challenges and Policy Implications for Europe in Times of Austerity

The chapter focuses on the implementation of de-institutionalisation in care for older people in the Czech Republic and in 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 question of what were the ‘responses’ of regional and local authorities and providers of care services for older people are addressed. 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 policy can actually lead to the exact opposite outcome than originally intended, with significant policy implications.