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Welfare reform on the Web (January 2007): Care of the elderly - Overseas

The discretion and power of street level bureaucrats: an example from Swedish municipal eldercare

A. Dunér and M. Nordström

European Journal of Social Work, vol.9, 2006, p.425-444

As street level bureaucrats, care managers in this study develop various techniques so that they can make decisions on assistance for older people in relation to the limits placed on their discretion by contradictory demands. They balance the limited resources of the organisation against the needs, demands and wishes of elderly applicants. Even though managers in Swedish eldercare have relatively wide discretion, they use it to only a limited extent. Instead of using their structural power, they allow themselves to be controlled by organisational and administrative guidelines when deciding whether to grant assistance. They use their knowledge of legal and organisational guidelines and sift information about the range of available services to persuade elderly people to adapt to applicable interventions.

Global social justice for older people: the case for an international convention on the rights of older people

K.-L. Tang and J.-L. Lee

British Journal of Social Work, vol.36, 2006, p.1135-1160

This paper argues that, in the light of population ageing, the introduction of an international convention safeguarding the rights of older people is overdue. Such an international convention should contain comprehensive and legally binding provisions which would require ratifying states to promote older people’s rights. It should be reinforced by a strong monitoring system that would involve key members of the international community.

Local culture, globalization and policy outcomes: an example from long-term care

G. Wilson

Global Social Policy, vol.6, 2006, p.288-303

The population of New Brunswick, Canada is ageing at the same time as the supply of family caregivers is being reduced by outward migration and falling birth rates. Instead of investing in home care services, the provincial government opted to encourage the building of more nursing homes, although publicly funded residential care is more expensive than domiciliary services in the long run. The article identifies three sets of influences working against rational policy choice by the provincial government: 1) the unpopularity of transfer of funds from rich to less prosperous Canadian provinces; 2) falling tax revenues due to below average incomes in the province; and 3) a local tradition of self-sufficiency and independence which worked against collective action.

Long term care financing in four OECD countries: fiscal burden and distributive effects

M. Karlsson, L. Mayhew and B. Rickayzen

Health Policy, vol.80, 2007, p.107-134

This paper compares long term care systems in four OECD countries. In the UK, provision is means-tested, so that out-of-pocket payments depend on levels of income, savings and assets. In Sweden, where the system is tax financed, provision is free at the point of use. In Germany and Japan, provision is financed from recently introduced compulsory insurance schemes, although the details of how each scheme operates and the distributive consequences differ somewhat. This paper models the impact of introducing the other three countries’ systems for financing long term care into the UK, focusing on both the distributive consequences and the tax burden. Results suggest that all three of the alternative systems considered would imply increased public expenditure and thus higher taxes. The impact of the alternatives on individuals is variable, although all favour women.

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