The Routledge Handbook of Social Care Work Around the World

Karen Christensen, Doria Pilling

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780367580926
• eBook ISBN: 9781317043928
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

The Routledge Handbook of Social Care Work Around the World provides both a comprehensive and authoritative state-of-the-art review of the current research in this subject. It is the first handbook to cover social care work research from around the world, including both low- and middle-income countries as well as high income countries.

Each of the 22 chapters are written by experts on long-term care services, particularly for older people and cover key issues and debates, based on research evidence, on social care work in a specific country. They look at perspectives of social care work from the macro level: the structural conditions for long-term care, including demographic challenges and the long-term care policy, the meso level: the level of provider organizations and intermediaries, and the micro level: views of care workers, care users, and unpaid informal carers. Furthermore, they discuss a number of topics central to discussions of care work including marketization, personalization policies, policy implementation under austerity, the provision of social care work whether through public services, or private arrangements, or mixed types, funding, the feminization of social care and the new role that technology, and robots can play in care work.

By drawing together leading scholars from around the world, this book provides an up to the minute snapshot of current scholarship as well as signposting several fruitful avenues for future research. This book is both an invaluable resource for scholars and an indispensable teaching tool for use in the classroom and will be of interest to students, academics, social workers, social policy-makers and human service professionals.

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Part I

Nordic countries

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1

Long-term care services in Norway

A historical sociological perspective

Karen Christensen and Kari Wærness

Introduction

Norway is internationally known for providing one of the world’s most universal and comprehensive long-term care services. According to an OECD report, Norway’s expenditures on public long-term care services are 2.3 per cent of its GDP (OECD, 2013, p. 41), representing the third best position, after the Netherlands and Denmark. Part of this picture is the 90/10 percentage public/private share funding of long-term care services (Colombo et al., 2011, p. 231). This means that only a small part of these services are paid privately out of pocket, the public authorities thereby showing high responsibility. Another aspect adding to Norway’s high standard reputation is the widespread use in international literature of Esping-Andersen’s comparative analysis of welfare regimes (Esping-Andersen, 1999). This analysis places Norway in the Nordic social democratic regime, implying that the welfare state makes efforts to reduce people’s dependence on the market to a minimum, and simultaneously seeks to reduce the dependence on family care. The Nordic countries thereby appear as general forerunners of the development of generous welfare states, although welfare researchers today also problematize this by revealing decreasing Nordic generosity (see e.g. Hooijer and Picot, 2015). However, without doubt, Esping-Andersen’s analysis contributes to the high-welfare-standard picture of Norway, including the long-term care services that are the focus of this chapter.

The main target group of Norwegian long-term care services are older people, either 65+ or 67+ depending on the historical time, and increasingly today also (younger) disabled people and people with mental health problems. We only focus on older people and their main services here. Therefore, user-controlled personal assistance, the Norwegian version of cash-for-care, is not discussed as this is used particularly by younger disabled people as an alternative long-term care service (see Christensen, 2009). Currently, the long-term care services comprise home help in terms of domestic tasks and/or home nursing, institutional care in different variations, including nursing homes, old people’s homes and sheltered housing. They also include new services such as meals on wheels and safety alarms. Our purpose in this chapter is to contribute to the efforts of moving beyond the high-welfare-standard picture by paying attention to the overall development and changes that have taken place ‘behind’ it, thereby aiming at making the nuances of Norwegian long-term care development more known internationally. Although a range of long-term care studies and reviews have presented important analyses of long-term care service provision in Norway (e.g Vabø et al., 2013; Jacobsen and Mekki, 2012; Vabø, 2012; Vabø, 2006; Christensen, 2004; Christensen and Næss, 1999; Næss and Wærness, 1995; Daatland, 1994), it more rarely accounts for the longer historical development, and if so it normally starts in late post-war Norway (see e.g. Christensen, 2005; Christensen, 2004). We will provide a historical sociological analysis inspired by Abrams (1982) of the development of today’s Norwegian long-term care services, tracing it back to its roots in the nineteenth century. We will show how these roots play a role in linking action and structure (Abrams, 1982, p. 3), and how the development is then legitimized by political ideology (primarily about ageing), a development leading to an increasing gap between political ideals of old age and older people’s everyday needs of long-term care services.

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In the following, we briefly outline our historical sociological approach and present the main sources for our discussion. Then we will present our analysis, divided into four historical phases, and finally point out the main challenges of future long-term care services in Norway.

A historical sociological approach

Historical analyses have been a central part of the discipline of sociology since it originated, and they basically take their point of departure in the works of the founding fathers, Marx, Weber and Durkheim (see e.g. Ritzer, 2000). These works are all empirically based and focus on what Abrams calls ‘the problematic of structuring’ (Abrams, 1982, p. ix). Abrams suggests that rather than seeing history and sociology as two different disciplines, they should be understood as deeply connected in the sense that ‘the world is essentially historical’ (Abrams, 1982, p. 3). Taking this approach to the case of long-term care in Norway, it implies that, for example, the early roots of long-term care and legislation changes cannot be treated only as background, but are essentially part of the ongoing process of developing the services. Simply expressed, this is a social process perspective taking into account people and context. It is a perspective viewing the service development as a constant interaction and negotiation between structural and political national factors, organizational implementation directions and care workers’ and welfare users’ practices.

Scott (1986) argues that gender should be a part of the historical sociological analysis. While the minimum version of this is to include women in the analysis, the wider options are related to the alternative viewpoint a gender-sensitive perspective can bring into the analysis. This implies using gender as an analytical category (Scott, 1986, p. 1055). In the case of long-term care, a gender perspective is not only obvious to include, due to the fact that the major part of this work has always been carried out by women, but more important here is that the development of long-term care services is closely related to the changing roles of women over time (e.g. Christensen, 1998; Wærness, 1982). Part of the analysis will also be to use a groundbreaking concept grounded in empirical work within this research field: the concept of rationality of caring (Wærness, 1984). This internationally known concept was developed by the second author of this chapter, on the basis of the perspective of female workers practising care. It states that care work is based on a rationality opposing the dominant instrumental rationality and implies a ‘sentient’ actor (Hochschild, 1975) who combines emotions and rationality in care work. In a historical sociological analysis of long-term care in Norway, this is useful for a critical discussion of the extent to which the development takes into account women’s practices and perspectives.

Both the authors being researchers with a specific interest in elderly care over several decades, our sources consist of our own and others’ (mentioned above) empirical research into long-term care (our own including Wærness, 1992, 1998, 2010; Christensen, 1998, 1999, 2004, 2005, 2012). We also use welfare statistics showing development trends over time, based on national statistics (Statistics Norway, referred to in Otnes, 2015; Mørk et al., 2014; Borgan, 2012; Brevik, 2010) and to some extent also white papers (Meld. St. 29, 2012–2013; St. Meld. 25, 2005–2006), being aware of their political strategical functions rather than mirroring the status of welfare services.

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As every historical analysis is complex, our analysis here will only provide a compressed picture of the development. We will use an analytical model comprising the main actors involved and relevant for grasping interactions and power shifts between them over time. Two main theories of ageing, representing contrasting views, are used: one focusing on withdrawal and disengagement from positions and roles in society (Cumming and Henry, 1961), and another focusing on activity, implying that norms for older people are the same as for middle-aged people (e.g. Atchley, 1977). Analytically, we will apply welfare ‘triangles’, one well known about the state, market and family (Esping-Andersen, 1999), and a less known earlier one (Seip, 1991) about the interaction between state, municipality and local associations and organizations. Our analysis of the early phase is based on Seip’s model.

The roots of municipalization in Norway

The welfare triangle suggested by Seip (1991) includes two public actors – the municipality and the state – and a private actor or actors, primarily at this stage comprising local self-organized groups and associations. The historical role of Norwegian municipalities has its original point of departure in the Municipality Law of 1837 establishing local governments, that is, municipal self-government. This role is maintained until today and is the main reason for municipal variations. The municipalities therefore also play a central role in the development of welfare services, but – important in the Norwegian context – in interaction with the state and local voluntary organizations, the initiators. Seip describes this as ‘almost a symbiosis’ between private associations and the municipality (Seip, 1991, p. 26). That is a strong partnership; the role of the state, very similar to today, being to stimulate welfare activities by financially supporting municipalities. For example, the problem of too many older people in hospitals in cities forced the development of old people’s homes, organized first by voluntary organizations (Seip, 1991, p. 30), then supported by the state through municipalities. This hospital-stay problem was also an important argument 100 years later in the 1950s for developing home-based services for older people (see Nordhus et al., 1986, p. 73). Also, taking place in towns, where the pressure was highest, home nursing initiatives were started in the 1870s by deaconesses (Wærness, 1982), primarily unmarried women, working voluntarily, motivated by God’s calling and based in deaconess institutions. This was the historical beginning of what much later became and still is home nursing services, including personal care, bathing, and medical tasks such as wound care and handing out of medicine, provided by nurses or nurse assistants. However, until the 1960s, non-medical long-term care primarily consisted of institutional care in terms of old people’s homes, the first central type of institution (Komitéen for eldreomsorgen, 1966). It covered older people without a safety net of family and kinship to take care of them, being also among the poorest. Overall, in the nineteenth century, elderly care included arrangements involving the church, charities and primarily the family; all were voluntary or informal unpaid work, based on family ties or moral principles. Municipalities cooperated with these voluntary and informal actors in order to develop local elderly care.

Summed up, the historically specific pattern here concerns the central role of the municipalities and the cooperation between the state, municipality and voluntary organizations in developing long-term care. Unlike the ‘welfare state’, this was an early period with a ‘social assistance state’ supporting only the poorest (Seip, 1979). The historical roots contain issues never leaving this field again: the close relation to women’s work and unpaid voluntary work (associated with low social status), the dependence on informal support from family/networks, and the state option of controlling the costs by regulating what qualifies for state support in municipalities and for which groups of welfare receivers.

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The historical development of home care services can illustrate these points. Comprising domestic tasks such as cleaning and laundry rather than nursing for sick bodies, the threshold for developing them was higher, explaining why they were first developed three-quarters of a century later. The high threshold had primarily to do with the family’s responsibility for their older members, in other words closely related to women’s role in society. Following industrialization, the family became the central unit for reproduction and care, and dependent on a wage earned by the father. A central part of women’s lives until the 1950s was related to the domestic work tradition (Aubert, 1956). Domestic work in others’ families was often a preparation for unmarried women, who then later became housewives in their own family, simultaneously caring for children and older family members in their own households. Due to the revelation of exploitation of domestic workers, a law on domestic work was introduced in 1948 requiring employers to improve working conditions (Aubert, 1956, p. 155). The numbers of domestic workers then decreased significantly, and parallel to this strong decline, the first initiatives to start home help services began.

In a white paper (St. Meld. 25, 2005–2006), the post-war development of long-term care services is divided into three phases: one from 1965 to 1980 called ‘the public revolution’, the next from 1980 to 1995 called ‘consolidation and reorganization’, and a final one from 1995 to 2010 called ‘innovation and effectivization’. We find these phases meaningful, and therefore use them to point out central issues in each phase following the servi...

Table of contents

• Cover Page
• The Routledge Handbook of Social Care Work Around the World
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• List of Contributors
• Introduction
• Part I Nordic Countries
• Part II Northern and Western Europe
• Part III Eastern Europe
• Part IV Between Europe and Asia
• Part V Asia
• Part VI North America
• Part VII Australia
• Part VIII Latin America
• Index