Assisted housing and user pathways: Risks and promises

Population ageing is a challenge for all welfare states but preferred solutions differ as established institutional settings and viewpoints are different. Some find the main solutions in the state, others in the family or private sector. Scandinavia is the main example of a model for public care services whereas the rest of Europe emphasizes family responsibility. The Scandinavian model is considered quite robust, whereas the Continental model put strong demands on the family and women, which are difficult to combine with demographic developments and women's demands for equal rights. OECD countries can expect long-term care needs to more than double over the next forty years. As the two main protagonists in long-term care are the family and the welfare state, interventions tend to be aimed in these directions: as efforts to contain public costs on the one hand, and as strategies to sustain family care on the other. Assisted housing may play a key role here, as this service is expected to reduce the costs of institutional care, and are sites where family care is expected and indeed encouraged. Assisted housing comes in many forms, but all are forms of (independent) living in-between traditional institutions and ordinary housing. Considering the top priority given to these facilities, we know remarkably little about them and how they interplay with other services. Our research aims to fill some of these gaps, by mapping out the character and role of assisted housing in Norwegian municipalities, and studying the implications for families and care quality. Assisted housing has particularly targeted younger age groups. While Sweden and Denmark have deinstitutionalized and shifted to assisted housing, most municipalities in Norway and are still prioritizing nursing homes and use assisted housing as a supplement but not an alternative service. Municipalities choosing a model emphasizing assisted housing are typically medium sized and reach more people with use of fewer resources. The smallest and largest municipalities prioritize institutional care, reach fewer, with limited alternative services. The strengths and weakness of the different models are discussed. Allocating responsibilities. Norwegian elder care between national ambitions and local implementation (Thesis Christine Thokle Martens): This thesis investigates the relationship between national ambitions and local implementation of policies in the field of elder care. The purpose is to contribute to the debate regarding the Nordic welfare model by providing an in-depth analysis of the correspondence between municipal service provision and national policy goals for the elder care sector. This is investigated by linking policies, legislation, and funding of the municipalities at the national level with policies, autonomy and implementation at the municipal level. The thesis builds upon three scientific articles: Eldercare policies in Scandinavia in 1993 and 2014: increasingly facilitating family caregiving? Submitted for publication 2016. Nordic Journal of Social Research Postcode lottery or systematic differences in Norwegian elder care provision? Submitted for publication 2016. Scandinavian Journal of public administration. Ageing in which place? Placing housing for the elderly between housing markets, the welfare state, and individual responsibility. Submitted for publication 2016. Journal of housing for the elderly. The main findings indicate that Scandinavian countries have strengthened the legal right to public care services between 1993 and 2014. However, individual rights to care services depend on municipal provision. There are few, if any, truly work-family facilitating policies in the Scandinavian countries. Although employees have gained a stronger right to short-time absence due to care provision in all three countries, the existing schemes do not facilitate a combination of employment and long-term care. They enforce the family caregiver to choose. Caregivers have to take potentially large punitive costs into account when choosing between employment and caregiving. Over time, the discrepancy between policies at the national level and municipal service provision has increased. Using Norway as an example, findings show that ageing in place is an expressed policy goal at the national level, which is not consistently followed through in municipal plans. A minority of care plans state the individual responsibility for housing in old age, and contain an overview of the housing market. This indicates that the municipalities do not connect their role as a care service provider to their role as a corrector of the housing market. Policy makers have to be aware of the ambiguity and complexity inherent to the concept of "ageing in Place". Unless properly operationalized, local governments are likely to implement ageing in place policies differently from the national government's intent.

OECD countries can expect long-term care needs to more than double over the next fourty years. As the two main protagonists in long-term care are the family and the welfare state, interventions tend to be aimed in these directions: as efforts to contain p ublic costs on the one hand, and as strategies to sustain family care on the other. Assisted housing plays a key role in these policies, as this service is expected to reduce the costs of institutional care, and are sites where family care is expected and indeed encouraged. Assisted (special, sheltered) housing is a form of (independent) living in-between an institution and an ordinary home, and is normally reserved for residents with quite extensive care needs. Considering the top priority given to this service the last 15 years in Norway, we know remarkably little about it beyond the age and sex of residents. We know even less about how assisted housing work together with other major parties in the care system such as the family and the nursing home. T he proposed project aims to fill these knowledge gaps by mapping out the character and role of assisted housing in Norwegian municipalities, and by studying the implications for families and care quality. May indeed assisted housing reduce needs and costs of institutional care without risks for care quality, and without undue pressure on hospitals? Can assisted housing encourage informal care, without enforcing burdens on women and the family? The project is broken down into four work packages with the m apping out of assisted housing in centre, and implications for families, nursing homes, and hospitals as supplementary work packages. Multiple data soures are employed, including municpality and user level statistics about services and users (KOSTRA, IPLO S), interviews with persons aged 18-79 in selected municipalities (NorLAG), and qualitative data via case studies and interviews with key informants in a smaller number of municpalities.