Transformation by stealth: the retargeting of home care services in Finland

Abstract

This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth.

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

“…With population aging, need for care increases, however, often older people may not depend on a single source of support (family/public/private) but on a combination of several of them (Kröger & Leinonen, 2012). In Nordic countries, families have less obligation to take responsibility over the older people's economic and social welfare than in other European countries (Daatland, 1997;Haberkern & Szydlik, 2010).…”

Welfare, Work and Migration from a Gender Perspective: <i>Back to ‘family settings’?</i>

“…We started our article with a statement of hollowing out of the Finnish welfare state (Julkunen 2006(Julkunen , 2008Jokinen et al 2011;Kröger & Leinonen 2012). This has been accorded with the precarization of labour market and society .…”

“…Consequently, the concept of the welfare state has been replaced by the idea of a welfare society. (Julkunen 2006(Julkunen , 2008Jokinen et al 2011;Kröger & Leinonen 2012) The theory of welfare regimes (Esping-Andersen 1990) presents the Social Democratic Nordic countries as an example of well-functioning states, where by the means of public policy, welfare is redistributed between all the members of society in a more or less equal way, according to the principal of universalism (e.g., Anttonen & Sipilä 2002). A similar kind of state regulation was implemented in the Soviet Union, where from the point of view of the individual, the state functioned as a welfare state.…”

“…In many places, the waiting lists for municipal elderly care homes are so long that family members have to evaluate how much care for the elderly person they can provide themselves, and whether there are any services produced by the market sector available. According to Kröger & Leinonen (2012), the change of character of the services is connected to three recent trends in the organization of social services: the fusion of home-based social and healthcare services, the marketization and emerging privatisation of care and the integration of informal family care into the formal care system. These changes represent weakening defamilisation, which we call 'back to the family settings' -ideology.…”

“…These changes represent weakening defamilisation, which we call 'back to the family settings' -ideology. As Kröger & Leinonen (2012) point out, especially in the elderly care, this means decreasing public responsibility and increasing the reliance on family carers.…”