This article compares cash-for-care schemes supporting older people with health-related social care needs, as well as their informal carers, in England and Finland. The meso-level policy analysis drills down into the governance arrangements underpinning cash-for-care schemes, including their eligibility criteria, generosity and territorial variations. It explores their implicit and explicit intentions, function and effects in defamilialising, familialising or refamilialising families’ caring responsibilities. This reveals inconsistencies in the familialising and defamilialising effects of schemes according to individuals’ characteristics, choices and policy restrictions. It also exposes an overarching tendency to familialise or refamilialise the activity of caring for older people, which is exacerbated by austerity-related politics.
As public provision of health and social care to older adults remains fixed or is scaled back, informal care is increasingly emphasised in policy and in practice. This is also the case in the Nordic welfare state of Finland. Little is known about how individual care arrangements are made. In this study, the capability approach is used to investigate the processes from resources to the actual functionings of receiving care of one older informal care recipient across time. The results reveal difficulties, discontinuity and unpredictability that challenge the capabilities to achieve valued beings and doings.
For several decades now, elder care services have been characterised by recurring crises in Finland. In 2006, a political scandal erupted when allegations became public of insufficient staff ratios in Koukkuniemi, the largest unit of institutional care for older adults in the Nordic countries at the time (Yle, 2006). In 2019, a scandal broke when the National Supervisory Authority for Welfare and Health (Valvira) ordered the closure of several care homes owned by private care companies due to severe neglect in the quality of care, and announced that they were investigating several complaints regarding deficiencies in elder care (Valvira, 2019). Valvira’s lawyer described the situation in the first care home as an ‘acute crisis’, which is why it was closed down immediately (Tiessalo, 2019). The situation was described as a ‘care crisis’ by the media, expert commentators and opposition politicians as well as the Regional State Administrative Agencies (AVI, 2020).
Care crisis is understood here as referring to a situation in elder care that has reached a critical phase in relation to the quality of care, also involving public concerns over the quality and conditions of care work. While a crisis is commonly understood as a temporary disruption, for many people in the world, such as older adults in poor health, a crisis can become a lasting, endemic condition. Nevertheless, when a crisis has been identified by central actors in the field, action needs to be taken.
In Finland, a common line of action is routinely suggested as a solution to the crisis of elder care: improvements in the management of care.