Change, Choice and Cash in Social Care Policies: Some Lessons from Comparing Childcare and Elder Care
Across the EU, social care policies are being reformed in order to allow those needingcare more 'choice' among care providers and flexibility with respect to how and where care is provided. Some argue this is the key factor underlying welfare state changes. Jenson and Sineau for example, concluded from their analysis of restructuring welfare states in the EU15 in the 1990s that "Maximising 'choice', implementing diversity of services and financing non-public provision are policy options frequently adopted in this neo-liberal era", (Jenson and Sineau, 2001,p.17). Their study was focussed in particular on childcare policies but the importance of increasing choice among policy objectives was noted in recent study of eldercare policies across twelve OECD countries (Lundsgaard, 2005). Care policies lie at the crux of the relationship between public and private both in the sense of private meaning family and private meaning market. These relationships have changed over time and are manifest in the shifting and the blurring of the boundaries between formal and informal care as well as between paid and unpaid care. By the beginning of the 1980s feminist scholars in the Nordic countries were describing developments in childcare and eldercare policies as social reproduction 'going public' meaning that the state was providing more publicly funded care services and women's dependence on the public sector for employment as well as services was increasing ( Hernes, 1984). However by the 1990s in several countries, and in particular Britain, social reproduction was "going commercial as marketisation and quasi-marketisation of services have been of growing importance of welfare provision" (Boje and Leira, 2000, p4) Thus 'private' in the policy debates in the 1970s usually meant informal family care. Twenty years later 'private' meant care services produced in the private market (Waerness, 2004, p96). The 'welfare mix' affecting care policies is changing. It is therefore important to understand under what conditions adequate care is forthcoming both within families as well as in the marketplace and in what ways the state can sustain and support this care in conditions which respect the well-being of both givers and receivers of care. In this paper we will discuss how the value placed on increasing 'choice' is a major factor determining both childcare and elder care policies, focussing in particular on the increasing emphasis on using cash allowances and tax credits or reliefs to achieve greater diversity of provision and better 'value for money'. The use of cash means understanding how families and service providers in the market respond to incentives to provide more care and what choices are important both to those who need care and those who give it. However, as Nancy Folbre has pointed out: "In order to solve the care problems, we need to understand how markets work, but also how they don't work" (cited in Waerness, 2006 p76, emphasis added). We therefore begin by examining first, why the cost of care is increasing and second what happens when care is treated in the market as if it were a commodity like any other. Third, what evidence is there about how the capacity of and willingness to care within families is changing. Does it suggest growth or decline? Does state support for care, especially in the form of cash, substitute for or complement family care? Third, we will examine the circumstances in which 'cash for care' policies offer meaningful choices both to those giving care and those who need it. By comparing childcare and elder care policies and practices and analysing their differences, it is easier to evaluate the consequences of treating care provision as a means to achieving other policy objectives rather than as a worthy end in itself.
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