2 Social exclusion and family carers
3 Welfare state architectures, gender ideologies and their impact on family carers
4 Design and effect of German care benefits
5 Design of the Swedish welfare benefits
6 Characteristics of family carers and care situations in Germany and Sweden
7 Findings of marginalisation of family carers in Germany and Sweden
7.1 Dimension of labour market participation
7.2 Financial dimension
7.3 Dimension of carers health
7.4 Dimension of social relationships
7.5 Dimension of spatial availability of services and institutional coverage of demand
7.6 Institutional exclusion
The general framework of informal care differs significantly between Germany and Sweden. The present paper analyses these differences and their impact on family carers situation based on the multidimensional concept of social exclusion.
Elder care in Germany is provided within the framework of a Bismarkian, conservative corporatist welfare state. The design of the German supplemental care benefits results in familialism, particularly for carers of lower socio economic classes. Its strong male bread winner model and strong traditional gender role expectations constitute a high risk of marginalisation for women.
The swedish welfare system is considered to be social democratic. De-familializing strategies, comparatively weak traditional gender role expectations, a weak male breadwinner model and comprehensive public care provision minimizes the risk of marginalisation for carers. The results of recent European surveys support the hypothesis of a lower risk of marginalisation for carers in Sweden: Swedish carers face a far lower risk of exclusion from the labour market, a lower risk of financial marginalisation, are less likely affected by health impairments and face a lower risk of social isolation compared to German carers.
As society ages in three different ways (cf. TEWS 1994: 42f.) major social developments are brought along: a growing number of people are at risk of becoming in need of care. Demographic changes are on the other hand associated with a declining number of people who provide for care for elderly in two terms: instrumental care (such as nursing) and the social security contributions (such as pension payments of employees). In addition to this development, the increase of mobility, the transformation of traditional family structure and the rising labour market participation of women cause a decline of potential care resources (WHO 2008: 3f.). Germany and Sweden are coping quite differently with the burden of their aging populations. Both ways are accompanied by different impacts on family carers1 and the extent of their exclusion from society.
2 Social exclusion and family carers
The terminology of social exclusion appears in many contemporary discourse about deprivation and poverty. There is a need of enumerating the exclusion concept in order of heterogeneous usage (cf. BÖHNKE 2006: 90). KATZ (1993: 440 cit. in KRONAUER 1997: 31) suggests to understand “exclusion” as kind of a cognition generating metaphor of social transformation. It is associated with the terms “centre” and “periphery” (l.c.: 32). The former indicates a concentration of power and resources, the later a lack of both (KRECKEL 1992: 41. ff. cit. in KRONAUER 1997: 32). However “exclusion” has not to be seen as a static condition but as a process which represents a progressing shift of power at the expenses of one party (KRONAUER 2002: 149). The idea of “marginalisation” refers to this process and allows to dissolve the dualism of “in” and “out” in favour of a more specific determination of position (BÖHNKE 2006: 55). Marginalisation might progress to a state of entire exclusion (LUHMANN 1995: 148 cit. in KRONAUER 1997: 39). To be excluded means to survive only under the condition of being supported by the welfare state (welfare dependency) or working in the informal economy (KRONAUER 1997: 32). Another important basic assumption beside the relativity of the concept is, that deprivations are getting accumulated within several dimensions. Consequently persons who are concerned might suffer from social isolation (l.c.: 39). KRONAUER (1997: 39-43) distinguishes six central dimensions of social exclusion: exclusion from labour market, economic exclusion, cultural exclusion, spatial exclusion, institutional exclusion and exclusion in order of isolation from society. Some scientists criticise the concept of being incomplete and suggest to recognize gender and health for the analysis of social exclusion, too (cf. ANHORN 2008: 41; BÖHNKE 2006: 82). As WHELAN and WHELAN (1995) pointing out, it is not enough to identify several dimensions within social exclusion occurs. “Poverty” for example can be a consequence of “illness” and vice versa. A more differentiated understanding is required to clarify ambiguous causality. Despite further criticism (cf. e.g. SEN 2000; ANHORN 2005) the concept of social exclusion became more and more popular (THEOBALD 2008a). BLACKMAN et al. (2001) transferred the concept to the situation of the aged and the question of an sufficient provision of care. According to them
”Social exclusion exists because access to a resource - including both material and social resources - is prevented by economic, political, and social barriers. These barriers are constructed by a mechanism of exclusion controlled by people with more power than those who are excluded. Exclusion for some is created by the actions, words and beliefs of other” (BLACKMAN et al. 2001: 162).
An EU funded project called “CARMA” tied in with BLACKMAN’s work, but focussed mainly on the situation of elderly care dependent people. Consideration of carers’ situation was minor (cf. THEOBALD 2008a). There is no extensive research on social exclusion of family carers. The following analysis is based on three parts: As social exclusion results not from personal failure but from external social barriers I shall begin with structural conditions. The central question is, whether the architectures of the German and the Swedish welfare states constitute barriers excluding family carers from labour market, economy, culture etc. or rather recognize social rights and enable them to participate. Where the first part is based on an meta level, the second goes deeper into detail and seeks to illuminate single elements within the overall welfare architectures which having impact on family carers’ situation. Theoretical findings are finally tested by quantitative and qualitative data of recent European surveys. Thus, the methodology of my research follows DENZIN’S triangulation approach (cf. FLICK 2008: 11f.).
3 Welfare state architectures, gender ideologies and their impact on family carers
Germany and Sweden are both members of the European Union. This raises the question whether the EU has an impact on the situation of family carers. Social policy within the EU is national responsibility (STUCHLIK/KELLERMANN 2008:4). However, the EU has an impact on national social policies by launching the Open Method of Coordination (OMC). The exchange of member states within the OMC intends to stimulate the debate about common social problems and transferance on of innovative strategies (cf. HEMERIJCK 2002: 210f.; KERN/THEOBALD 2006). However, the basically open exchange has certain limitations: Social policies are intended to support the European market expansion since the Lisbon strategy aims to enhance the economical competitiveness of the European economies. The central panel of economic coordination ECOFIN (Economic and Financial Affairs Council) executed fundamental impact on political agenda and expansion of OMC topics (STUCHLIK/KELLERMANN 2008:14). Moreover the EU has an impact on carers’ situation by carrying out research projects. Within the 5th framework programme for instance the so called “EUROFAMCARE-project” studied 6.000 family carers in six European countries. EUROFAMCARE made a mayor contribution in creating a new carers’ NGO organisation of Carers on the European-level, called “EUROCARERS”. It intends “to establish a European network of carer’s organisations and researchers in this field” (DÖHNER et al. 2007: 13).
However, social policy competences on the national level leads to a great diversity of care landscapes, but certain patterns can be distinguished. On a very basic level one can question who actually produces welfare (for the aged). EVERS (1990: 8) for example suggests three sectors: state, economy and households. However, the identification of different institutions and the allocation to one predominating welfare provider (e.g. Sweden to the state) does not take into account the complexity of welfare provision options and the process of policy change. ANTTONEN, SIPILÄ and BALDOCK (2003) created a dynamic model to describe “dimensions of change in social care” which is able to capture further complexity. It is based on the assumption, that care systems are not differing between countries in general but that their variations result from a different level of development. Their approach suggests, that progress occurs within three bipolar trajectories (progressive pole named last): the first trajectory comprises selective, discretionary entitlements vs. universal entitlements, the second, familial benefits vs. individualized benefits, the third and overall dimension captures domestic economy vs. public economy. Shift within the first and the second trajectory occurred synchronous in the past, but can be distinguished analytically: Public care benefits were linked with preconditions, such as absence of family to protect the poorest. So the recipients of welfare benefits were individualized originally. But development of poor law resulted in familial benefits: On one hand benefits aimed at strengthening the family, on the other hand household income (as opposed to individual income) was taken into account by authorities granting benefits. In opposition to these are the entirely universal and individualized benefits. The third and overall trajectory describes the historical development from a private provision of care towards an entire public solution, including state, market and third sector apart from family. Changes towards “going public” including “shift in locus of care, in the process by which it is resourced and delivered and in the agency that takes ultimate responsibility for it” (l.c.: 174).
German Long Term Care Insurance (LTCI) guarantees individual and universal entitlements which is why benefits have to be regarded as being progressive within first and second trajectory. However, with regard to the overall dimension Germany’s elderly care system emerges to be rather regressive: in terms of “agency” the state carries the ultimate responsibility. But the family’s responsibility is emphasized to a great extent due to the principle of subsidiarity. The motto “ambulant ante residential” reflects legislators intention to stimulate carers’ willingness to care for their aged family members (MEYER 2006: 42) and indicates favourization of domestic solutions, commonly known as “aging in place”. Finally families are burdened in terms of “process” (who carries the costs for care), as they bear costs for care to a great extent. In contrast the Swedish care system appears to be progressive within the second and third trajectory:
“The underlying philosophy in the Swedish system is that public support should target the person in need for care. The aim is to promote maximum independence (from others, the family and next of kin), even if you need service and care for your daily living” (JOHANSSON 2004: 18).
There are shifts towards an informalisation and market orientation (SZEBEHELY 2003: 275; THEOBALD 2008b: 265). However, services are still rather provided by the state, shifts towrad private provision have been only minor. But the number of means tests has risen, which has to be interpreted as a development away from universal towards selective benefits (SCHARTAU 2008: 41). Besides, regarding Germany’s and Sweden’s elderly care systems as representing different levels of development there is good reason to examine differences with as static approach. ESPING-ANDERSENs (1990) well known typology of “the three worlds of welfare capitalism” suggests, that we are living in different welfare state regimes. While the American welfare architecture is considered to be “liberal” the European architecture is characterised to be “conservative corporatist” and “social democratic” respectively. The former of the two European regimes goes back to Bismarck and is found in Germany, France, Italy and Austria. It aims at maintaining the status differences, traditional family structures and corporatism at a low level of de-commodification, low redistributive effects, familial benefits, social insurance system and privileges for members of the civil service (Beamten). “On the supply-side it is a welfare state built on traditionalist conservative and catholic principal of subsidiarity, meaning, that women and social services (outside health) belong to the domain of family” (ESPING- ANDERSEN 2008: 28). By contrast the social democratic welfare state regime, which is found in Scandinavia, is highly de-commodified. It goes back to Beveridge and is financed by taxes. Its guiding principles are universalism and solidarity which are expressed by the promotion of equal welfare benefits of the highest standards. „Perhaps the most salient characteristic of the social democratic regime is its fusion of welfare and work. It is at once genuinely committed to a full-employment guarantee, and entirely dependent on its attachment“ (ESPING-ANDERSEN 2008: 28). Scandinavian women benefit double from extensive and highly de-commodified welfare benefits in two ways: “social services both allow women to work, and create a large labor market in which they can find employment” (l.c.: 159).
There are two relevant points of criticism towards ESPING-ANDERSENS typology: From the feminist side it is argued, that the gender perspective is missing (cf. ARTS/GELISSEN 2002: 147f). LEWIS (1992: 3) for example argues, that the approach of de-commodification refers primary to the nexus of paid work (which is mainly generated by men) and welfare.
1 There are various conceptions about what is going to be considered as “care” (cf. PFAU-EFFINGER/OCH/EICHLER 2008: 89). In this paper the term “care” refers to a wide range of activities, such as medical tasks, support in daily life, and emotional support. Therefore family carers, or informal carers are carrying out these tasks for their dependants.