NEW MORAL ECONOMIES OF WELFARE: THE CASE OF DOMICILIARY ELDER CARE IN GERMANY, FRANCE AND BRITAIN

ABSTRACT

Currently, deregulation of social welfare provision is underway throughout Western Europe. The major tendency is for disorganisation, together with the emergence of welfare markets. This is also changing the way elderly people are provided with personal and socio-medical services. Focusing on domiciliary eldercare, the paper explores if this is accompanied by a change in what Kohli has termed the moral economy of old age welfare. Departing from a general reflection on the organisation of social services in modern welfare capitalism the paper sketches evolutions in the eldercare system of three major European countries, with a special focus on the role of civic rationales and professional norms in the organisational field under consideration. It is argued that the moral economy of eldercare has become fluid, thus implying a broader transformation in the societal treatment of old age.

Keywords:

• welfare culture
• formal care
• comparative social policy analyses
• professionalism
• governance
• old age provision

Notes

¹Some of the following observations do not apply to all parts of Britain. Recently, social and eldercare services in Scotland, for instance, have developed specifically in some respects. This article, however, will not elaborate on such nuances.

²The concept of moral economy draws upon seminal works such as Thompson's study of collective protest during the 18th century (Thompson 1971), or Polanyi's book on the non-economic foundations of market economies (1941).

³This also includes moral norms shaping those institutions which are often seen as the ‘ugly face’ of welfare states, e.g., by casting social stigma upon certain groups of beneficiaries or welfare programs. For a more elaborate analysis of the moral foundations of old-age provision, see Bode (2007a, chapter 3).

⁴In the post-war settlement, the participation of the voluntary sector in the welfare state often went beyond providing services. In countries such as France, Belgium, The Netherlands, Sweden or Germany, the state co-opted representatives from this sector as administrators of quasi-public bodies. The most evident case is trade unions involved in the administration of welfare systems, based on a firm ‘nexus between the sphere of industrial relations and the system of social security’ (Hemerijk et al. 2000: 107; see also Bode 2003b, 2004).

⁵While the state proved more dominant in Britain than on the continent, there is some evidence that in Britain too ‘there were “partnerships” in the classic welfare state, but (that) non-state partners were clearly junior-partners in the welfare firm’ (Powell and Hewitt 2002: 132, see also Kendall 2000; Means and Smith 1998; Taylor 2002). The moral rationale of these junior partners – e.g., a preference to make local neighbourhoods participate in the process of social care – may not have been visible in the sense that the official norm was a publicly guaranteed provision for all (low income) users. Yet it cannot be denied that the voluntary sector in Britain proved powerful in advocating social policies and designing a range of personal care services on the basis of public grants.

⁶For a broader elaboration of this argument, including evidence from the wider literature, see Bode (2004: esp. 51–7).

⁷See e.g., Coates (2005). The major interest of this literature is upon the respective fitness of varieties of capitalism, mainly with regard to the coordinated market economy or ‘social capitalism’ as opposed to the expanding liberal, Anglo-American model. The discussion focuses on those institutions that are embedding market economies, in fields like education, vocational training or labour law.

⁸There is an argument over how far this evolution has occurred in Europe. Many still distinguish ‘social capitalism’ from ‘the liberal or ‘disorganised’ model of capitalism’ as it is known from the Anglo-Saxon world (Pierson 2001: 432; see also Crouch 1999: 362–3). In countries like France, Germany or the Netherlands, centralized industrial relations have indeed survived; law still considerably shields workers from business power there. Yet at the same time, the key move has been towards reducing the scope of such regulations, together with less substantial contents.

⁹Neither Lash and Urry nor most of the remaining political economy literature have considered this area in greater detail. The organisational underpinnings of economies of welfare have remained widely neglected (or reduced to the mere agency of mainstream interest groups).

¹⁰In the UK, such debates occurred after the report of the ‘Royal Commission on Long-term Care’ in 1999. In Germany, concerns have recurrently been expressed in discussions about the viability of the long-term care insurance, including its performance in terms of service quality. In France, a passionate debate over shortcomings of the care systems broke out after many elderly people failed to survive the extremely hot summer of 2003, leading to far reaching governmental initiatives.

¹¹This research focused on organisational change within typical service providing agencies in Germany, France and England. For this purpose, interviews with managers of locally based service providers in the voluntary sector have been conducted: Some have been arranged as informal conversation in order to approach an organizational reality hardly accessible by official interviews, while others have been based upon an open questionnaire. The questions were addressing various issues, ranging from what the organization was actually doing to how its role evolved in changing environments. Furthermore, organizational media (reports, journals and magazines) have been extensively reviewed. Methods and results are presented in more detail by Bode (2004).

¹²Clergeau et al. (2002: 48) depict the rise of this politique gérontologique, o[ugrave] les services d'aide à domicile occupent une place pivot’ and see this policy as la résultante d'une interaction complexe entre les acteurs privés du champ de l’économie sociale et les acteurs publics de l'Etat central, des organismes sociaux et des collectivités territoriales’. While there was a general tendency to provide services everywhere in the country and for all frail elderly, the supply remained heterogeneous especially because of a ‘système de financement balkanisé’ (ibid.: 59).

¹³Cf. Kendall (2000: 69). As Means and Smith (1998: 315) have put it, ‘the main focus of Age Concern war to be the creation of national publicity about the needs and aspirations of elderly people rather that the service delivery by local committees.’ Yet field studies of Means et al. (2002: 105–9) also show the involvement of Age Concern groups into formal partnerships with local authorities, including ‘joint planning’ and ‘joint finance’ (ibid.: 107) for a range of care-related services.

¹⁴Today, non-statutory agencies provide for two-thirds of the service hours under local authority contracts (personal care mostly), with the private sector representing the lion's share.

¹⁵Clergeau et al. (2002:63) see the organisation field being subject to an ‘ouverture à des logiques lucratives’. In fact, the tax advantages granted to those who engage private employees are a kind of direct payment conducive to a market logic governing the relation between demand and supply.

¹⁶This is an outstanding element of the history of home care in all of the three countries (Grunow et al. 1980; Henrard et al. 1990; Means and Smith 1998).

¹⁷This also pertains to more recent regulations stipulating that the long-term care insurances have to fund special care for people with dementia which, by preference, shall be handed over to lay persons.

¹⁸This ‘Caisse nationale de solidarité pour l'autonomie’ is funding services for the dependent elderly, but also for the handicapped. From 2005 onwards, it replaces existing funds for the provision of professional care. As to the subsidies given to private individual employers, one should note that these do not strictly speaking include paramedical services.

¹⁹It should also be taken into account that ‘a competition for influence in setting agendas and designing policies is … taking place with the for-profit sector’ (Kendall 2003: 177).

²⁰This especially holds if broader dynamics in the eldercare sector are taken into account. In the case of Britain, for instance, health organisations had claimed a strong professional responsibility for taking care of frail people. With the gradual disengagement of these organisations, statutory social service departments and a number of well-organised non-profit providers tried to fill the gap. The far-reaching devolvement of care services on independent providers during the 1990s then led to an ever higher proportion of care work to be accomplished by low-skilled personnel (see Means et al. 2002: esp. 38–40).

²¹It holds true that the role of volunteers did already change during the rise of what has been labelled as ‘organised welfare capitalism’ in this paper. Volunteer work was evolving towards a more complementary or accompanying role in this period. Yet culturally, voluntarism remained a crucial element within the then established public-private partnerships.

²²To some extent, this assertion also applies to the British case where private entrepreneurs that constitute the majority of service providers do not necessarily behave or think in terms of commercial profit-making (see Forder et al. 2004).

²³To be sure: Volatile operative conditions have always existed especially for non-statutory providers of social care. Yet prior to disorganisation, an overall tendency to harmonize organisational practices prevailed whereas nowadays unequal procedures and outcomes have become largely accepted as being something ‘normal’ or even a precondition to service supply.

²⁴The British case is telling: With the emergence of ‘pension fund capitalism’ (Clark 2000), the quite complex system of more or less state-regulated saving schemes has repeatedly come under intense debate in this country. The instigation of a ‘Financial Service Authority’ with a watchdog role and the introduction of poor-people stakeholder pension scheme illuminate the dynamics of the related welfare mix. Arguments over injustices and unequal risks prove important levers of recalibration (see e.g., Ginn 2003). In Germany, the recent introduction of publicly subsidized private pensions will lead to much more diversity within the pension system (Schmaehl 2004).

²⁵Age Concern, for instance, sells life insurances to its members and stakeholders. In France and Germany, trade unions push for collective saving schemes that aim to make private asset management more equitable.