Between ‘Choice’ and ‘Active Citizenship’: Competing Agendas for Home Care in the Netherlands

Abstract

Choice over home care has become an important pillar in the provision of publicly financed long-term care for people of all ages. In many European welfare states, cash-for-care schemes give care recipients greater choice over home care arrangements by allowing them to pay for care provided by acquaintances, friends and even family members. Paying for such informal care, however, is increasingly contested due to growing care needs, rising costs and the perceived need to tighten access to publicly funded care. Citizens in paid care-giving roles are thus pressured to continue their care unpaid or re-divide their care-giving responsibilities with lay ‘citizen-carers’. On the basis of a Dutch case study, this article examines how paid family care-givers experience this call for greater self-sufficiency in providing care. An analysis of 25 interviews and 21 letters of complaint revealed that care-givers felt trapped between their desire to derive social status from paid work and their inability to reject or re-divide previously paid care responsibilities. In a society where all citizens are expected to work, care-givers feel that their previously paid care-giving is devalued from a public to a private matter, despite the government's attempts to reframe care as an act of good citizenship.

Keywords:

• Long-Term Care
• Choice
• Active Citizenship
• Care Ethics
• Gender

Acknowledgements

I wish to thank Jan Willem Duyvendak, Evelien Tonkens and the two anonymous referees for comments on earlier versions of this article and Takeo David Hymans for editing it.

Notes

¹Sixty to seventy per cent of long-term care responsibilities are shouldered by women in Western welfare states.

²People in the Netherlands usually do not live in inter-generational households.

³The average age of paid informal care-givers in the Netherlands is 45 years (Ramakers and Van den Wijngaart 2005).

⁴Lodging an appeal does not involve costs.

⁵2009 was a transition year when re-assessments took place. For most, the care assessment was reduced or terminated as of January 2010.

Additional information

Notes on contributors

Ellen Grootegoed

Ellen Grootegoed is a PhD student at the Amsterdam Institute for Social Science Research. Her research areas include welfare state transformations, long-term care and family relations. Currently, she conducts a longitudinal study on the impact of recent social care reform on disabled and elderly persons (and their networks) in the Netherlands