Social Care and Social Exclusion: A Comparative Study of Older People's Care in Europe. (Book Reviews).
Assuming that the most desirable situation for elderly persons is to be cared for in the familiar surroundings of their homes, then what services are needed, how should these services be provided, and by whom? Tim Blackmen and his colleagues seek to examine these questions by providing contrasting case studies of the cultural norms and institutional means used in six European countries to deliver social care services to the elderly. Social Care and Social Exclusion explores how diverse approaches may encourage, or prevent, social exclusion.
Social care services are personal services such as bathing, dressing, meal preparation, house cleaning, etc. that enable a person with physical/mental limitations to remain independent and active. However, national values, policies, bureaucratic rules, availability of service providers, and costs result in very different social care experiences. Some experiences marginalize the elderly by limiting their access to resources, service alternatives, or the right to make decisions for themselves. These limitations give rise to social exclusion. By examining the values and institutions of Denmark, Norway, United Kingdom, Ireland, Italy, and Greece the authors explore how social exclusion provides insights into social policy and practices.
This work begins by trying to define social care and social exclusion across national boundary lines with different norms, historic traditions, and reporting systems. They suggest that the models employed for defining care are driven by national demographics, economic circumstances, and whether national values define the government or the family as the responsible caregiver.
A discussion of each country's assumptions, administrative structures, costs, standards, quality, and public information efforts is provided beginning with Denmark, which by law is responsible for providing an integrated delivery of social care services through an array of providers authorized by municipalities. Norway also defines the government as primarily responsible for social care but relies on a centralized institutional medical model for providing services. The United Kingdom, while sharing similar traditions and approaches to assessing client needs with Scandinavian countries, does not take responsibility for providing an integrated or comprehensive range of services.
By contrast Ireland, Italy, and Greece assume the family is the primary caregiver and the government plays a small supportive role. The national frameworks enable one to understand the diverse practices reported by social workers and academics from each country regarding the management of four archetypical cases. The cases range from clients needing daily assistance for a few hours due to osteoarthritis to requiring round-the-clock support due to a debilitating terminal illness.
Denmark's model provides a consistent standard of quality care and the least strain on the elderly and their families. This does not mean that the elderly do not experience social exclusion but are less stigmatized and subject to economic exclusion. In less economically developed countries, elderly with children are cared for within the family but this dependency has implications for labor participation by women and negatively impacts low and moderate income households that are hard pressed to provide services directly or pay for private care.
The authors use a qualitative analytical approach to collecting and analyzing data. Beginning in 1997, across-section of academics and practitioners met to review papers on national policies from each of their countries, discussed how the four cases would most likely be managed, explored the basis for governmental intervention, and examined the consequences of these approaches on social exclusion and inclusive services for the elderly. The analysis is held together by a few typological models (e.g., Titmuss, Esping and Anderson) which organize approaches based on who served as service provider, or ideological attitudes toward a welfare state, or the economic circumstances of the elderly.
This study attempts to expand the view of care from primarily an economic perspective regarding who pays for what to a broader view of social relationships and interactions. However, in the last analysis, the critical differences identified between countries have more to do with public expenditures and economic development than with the integration of the elderly in the social fabric of their communities. In part this reliance on an economic perspective was unavoidable since in their case-by-case analysis the authors did not address how a nation's policy agenda and service delivery system fostered social exclusion or inclusiveness.
Despite this limitation, the most intriguing discussion of this collaboration is the variability in services and options described for the four case studies in Chapter 9. It is here one sees how policy impacts service delivery and expectations about family and state responsibilities toward the elderly.
The intended audience for this book is a combination of academics and social welfare practitioners. It was collaboration between these groups that gave rise to the study initially and it is to these communities that this work will be most useful.
The key contribution of this work is in viewing the multitude of ways in which services can be delivered and speculating as to what the elderly would chose if all options were available. Each country strips the elderly of their independence in different ways. Poor countries leave senior social care to relatives, volunteers, etc., relying on family dynamics to guarantee the well being of the elderly. Rich countries leave care to professionally trained decision makers relying on expertise to guarantee an elderly person's well being. Few rights or decisions are extended by either approach to the elderly themselves.
While the descriptions of countries' costs, programs, and practices are tedious they are thorough. The contrast and comparison of individual cases is more interesting but largely the supposition of practitioners and academicians. Despite these concerns, this exploratory study lays a foundation for possible future studies on how much social inclusion the elderly enjoy in their communities and on ways to examine social care services and client exercise of self-determination.
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|Publication:||The Social Science Journal|
|Article Type:||Book Review|
|Date:||Jan 1, 2002|
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