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The conditional cash transfer programme (CCT) for poor families was terminated in Mexico in 2019. CCTs seek to fight poverty under a social investment logic by promoting the formation of human capital through the compliance of behavioural conditionalities. The programme – the first of its kind introduced at national level – accomplished several achievements and was maintained and developed by three successive federal administrations. As the backbone of anti-poverty policy for more than two decades, its achievements included delivering positive results to a significant proportion of the population; and triggering the expansion of social policy beyond social insurance. As a result, it was emulated by governments across the globe. A programme of these characteristics would have been expected to generate path dependency and policy stability, yet it was swiftly terminated with practically no opposition. This article applies a framework of historical institutionalism to analyse the feedback effects developed during the duration of the programme from the perspectives of beneficiaries, in order to contribute to the explanation of its termination. The research is based on qualitative empirical data from interviews with former beneficiaries. Our findings show that self-undermining mechanisms linked to a ‘hard’ design and implementation of conditionalities counterbalanced the self-reinforcing mechanisms derived from the benefits supplied by the programme, causing beneficiaries to become apathetic towards its continuity or termination. Conclusions yield theoretical insights that might serve to examine policy feedback in similar contexts, as well as lessons for policymakers regarding the design and implementation of social programmes.

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An International Comparison

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Technology is quickly becoming an integral part of care systems across the world and is frequently cited in policy discourse as pivotal for solving the ‘crisis’ in care and delivering positive outcomes.

Exploring the role of technology in Europe, Canada, Australia and Japan, this book examines how technology contributes effectively to the sustainability of these different care systems which are facing similar emergent pressures, including increased longevity, falling fertility and the consequences of the COVID-19 pandemic.

It considers the challenges and opportunities of embedding technologies in care systems and the subsequent outcomes for older and disabled service users, carers and the care workforce.

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This final chapter provides a summary of the main issues identified within each of the selected nations covered in the book. It emphasises key points of convergence across these nations, including the array of care ‘systems’, internal diversity and fragmentation of such systems, prevalence of sustainability discourses, the ‘ageing in place’ agenda, precepts of ‘choice’ and ‘control’, the digital divide, and divergent and variegated responses to the COVID-19 pandemic. The chapter and Policy Press Short conclude with recommended priorities for policymakers and practitioners and identifies areas requiring further research within the field.

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This introductory chapter reviews and positions this edited book’s underpinning concepts of care, technology and sustainability. It defines the editors’ and contributors’ cross-national, comparative analytical approach to characterise the ‘state-of-the-art’ within each nation and evaluate thematic areas of policy and practice divergence and convergence. It concludes by presenting nations included in this volume (England, Australia, Germany, Canada and Japan) and justifying their selection with reference to contemporary research on their orientation to care regime and welfare regime typologies.

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This chapter explores Japan’s demographic changes, the shifting role of the family and related pressures on care provision. The author outlines the country’s approach towards introducing technology into the long-term care (LTC) system, including in residential care settings and for those living in their own homes. The integration between LTC and technology-based services reflects great hopes and possibilities to overcome various challenges related to the ageing of Japan’s population.

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Germany is facing significant challenges in meeting the demand for care against the societal background of advanced population ageing. The use of assistive technologies is considered an important element in solving care worker shortages and in enabling older people to ‘age in place’. Today, 80 per cent of Long-Term Care Insurance (LTCI) beneficiaries are being cared for at home. In this light, the lack of a clear government strategy on Assistive Technologies (AT) for home care is amazing. Various central government departments work with varying, partly conflicting objectives. While social care is strictly regulated by legislation, AT are only beginning to make their way into legal frameworks. Three prerequisites for a successful integration of AT into home care delivery are identified in this chapter: 1. nationwide fast and reliable Internet access; 2. a clear central government strategy for integrating AT into legislation governing social care; and 3. co-creation of AT by scientists/engineers and their intended user groups.

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This chapter begins by setting out the context of the English adult social care system, including funding and policy, key statistics, and the hopes invested by the government and local authorities in the use of technology to cut costs while improving the quality of life of older adults.

The deployment of digital technologies intended to facilitate the delivery of care is then examined, including telecare and telemedicine devices; robotics and information and communications technologies (ICT); consumer electronic devices, apps and websites; and ICT infrastructure and data. The impact of the COVID-19 pandemic on technology uptake and use is also discussed. The next section presents recent research evidence on the use of different technologies in English social care, including studies of telecare as well as other digital technologies.

The chapter concludes by setting out several key challenges facing the effective implementation of technology in the care sector in England.

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This chapter focuses on policy and practice related to care and technology in Canada. The authors highlight that the federated government structure (a central federal government and thirteen semi-autonomous provincial/territorial governments) results in overlapping jurisdiction over continuing care services, and the lack of a legislated mandate to provide these services means that Canada lacks a national social/long-term care (LTC) ‘system’. The chapter then describes how technology is harnessed in the delivery of care in Canada, with a focus on four key areas: 1. care management/coordination; 2. smart homes; 3. outdoor tracking; and 4. communication technologies. Recent empirical evidence related to technology and care in Canada is also explored.

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Australia’s major aged care policy reforms in 2013 introduced a consumer-directed care (CDC) funding model as a core component that sits within the policy framework of ageing in place. CDC is intended to provide older people with choice and control in their living and care arrangements through access to needs-based, means-tested home care packages (HCPs) that specifically allow for the purchase of technology to provide support to remain in one’s own home. Available evidence indicates technology use (assistive/digital) can support older adults’ independent living and improve physical well-being, self-care and social connections. This chapter provides an overview of Australia’s policy framework around aged care and ageing in place, and reports on our research studies identifying issues related to knowledge and use of technology (scoping reviews, interviews), including the role of health professionals. Recommendations are made for advancing research along with strategies enabling professional support for older adults’ use of assistive/digital technologies.

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This paper presents learning and insights drawn from the Fulfilling Lives (FL) programme – an eight-year programme funded through the National Lottery Community Fund (NLCF) and delivered across 12 sites in England. The programme aimed to improve services for people facing multiple disadvantage (MD) and was delivered by 12 partnerships, each led by voluntary sector organisations (VSOs).

The findings were supplemented by interviews carried out with delivery partners, stakeholders and people with lived experience (LE) from one of the 12 projects, Birmingham Changing Futures Together (BCFT). The review and supplementary interviews were conducted as part of a ‘scoping exercise’ designed to help the author shape and refine research questions at the outset of her doctoral study.

The focus of this paper is the involvement of people with LE in the delivery of the NLCF FL programme. The research questions explored the mechanisms used to involve people with LE of MD, the impact that their involvement was found to have on effecting ‘systems change’ and some of the limiting factors to this involvement. The paper sets out the conditions needed to facilitate better involvement and considers what these insights offer for the future design and delivery of services for VSOs seeking to develop their approach to involving people with LE.

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