(Español) Future scenarios in long-term care

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A long-term care model is a combination of elements such as:

  • • a care model (content and characteristics of the services and benefits that people receive),
  • • a prescription model (who decides that someone receives care),
  • • a management model (who hires the professionals) and
  • • a financing model (who pays).

We have identified four ideal types that our long-term care future might look like:

1. In the corporate scenario, the interests of the main organized groups that participate in long-term care and, fundamentally, those of large and medium-sized provider companies (for-profit or non-profit) and those of less qualified and more numerous and organized workers, would weigh more heavily. Reactive services of low added value (technological, economic and social) are offered for relatively captive and disempowered audiences. Social services could be seen here as a complementary business to others (such as real estate).

2. In the consumerist scenario, the public powers and administrations would get rid of the provision (direct or indirect) of services and would be configured as insurers that give money (direct payments, service checks or personal budgets) to each person, based on some (more or less) objective requirements and then individuals and families would go to the markets and buy the different services or supports. It is a historical vindication of some movements of people with physical disabilities or other sectors.

3. The community scenario is the one that defends the community of practice and knowledge. It would be based on a model of preventive and population approach, as well as on technological, social and political innovation. It would be based on the technical and organizational strengthening of primary social care (which generates capacity and legitimacy for technical prescription) within a framework of integrated care.

4. The chaotic scenario would be that of an increase in the informal care economy and inequity in social care and welfare services in general. It would difficult people’s decisions about their future and the intergenerational contract.

Preventive, personalized, integrated, and ecological social intervention

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Instead of considering prevention as the opposite of intervention (understanding that, if prevention is successful, intervention will not be necessary) or as a type of intervention (different from others such as palliative, care or promotional), it is proposed here to conceive it as a castling, a dimension or added value that is always present, desirably, in the intervention. Preventive action is characterized by its precocity and proactivity and it aims to make other interventions unnecessary or lesser, possibly more intense and expensive.

The root of the personalization movements of the welfare services (and, specifically, social intervention) can be found in the independent life movement of people with disabilities or users of mental health services. In the specific field of gerontology, the person-centered model of care identifies as a reference client-centered psychotherapy, the models of person-centered planning (of disability care) mentioned above, the contributions of applied ethics (especially of bioethics, the various professional deontologies or the care ethic), the approaches linked to the concept of quality of life, case management or housing, understood as movement of reform, reconfiguration (and in some cases replacement) of residential care to the elderly.

The focus on the person or personalization of social intervention is consistent with a social intervention of ambitious objectives and high added value, far removed from the social control and traditional segmentation (and segregation). Supported by ethical values and rigorous knowledge, it recognizes the uniqueness and complexity of the situations and trajectories of each and every one of the people in their sexual, generational, functional, and cultural diversities. For this reason, it conceives social intervention (and its main framework: social services) as vertically integrated within the sectorial scope itself (to guarantee continuity and avoid fragmentation in the processes of social intervention, to strengthen attention to diversities in community proximity and avoid the labeling and segregation of people) and horizontally, in integrated intersectoral care, the third of the proposed characteristics.

Indeed, the organization of any activity is traversed by a tension between two dynamics: the dynamics of specialization and those of integration. The dynamics of specialization enables the division of activity between organizational units or, ultimately, people who are (more) able to take charge of each part and the dynamics of integration (coordination, collaboration or unification between those parties in processes and macroprocesses) seeks control, synergies, scales or interesting competitive positions. Technology, understood as the standardized and knowledge-based (scientific or other) way of carrying out the operative activities of each link of the value chains is a determining factor in the processes of specialization or integration.

Of course, a social intervention that wants to abandon the residual positioning of a social assistance in charge of social exclusion is ethically and technically obliged to propose a solvent model of addressing social complexity. At present, he paradigm that is being imposed internationally in this regard is that of an integrated care. Integrated intersectoral care is the appropriate framework for modulating, with elasticity and flexibility, the process by which social intervention becomes focused on its purpose and recognizing in (or proposing to) other interventions (health, labor, residential or others) its own purpose (as in the Housing First model, in which the accommodation of accompaniment is differentiated). At the same time, in the institutional framework of governance for territorial and social welfare, development and sustainability, the challenge of integrated care helps to see the importance of the fourth characteristic that we attribute in this section to social intervention: its ecological nature.

We speak of an ecological approach, a population approach or a structural approach from the moment we have understood that it is essential to intervene with individuals but also to influence their family, community and social environments in general. The territory (proximity) is a key reference because human beings are bodies embedded eco-dependently in physical spaces, although a questioning of the ‘community’ is necessary in its exclusively spatial/territorial dimension. The logic of space is replaced by the discourse of information flows, influence and networks of relationships. Be that as it may, both in the territorial proximity and in the digital layer, it is fundamental to analyze and deal with the social structures (macro, meso, and micro) that guide the activities, relationships, decisions, emotions, and knowledge of the people.

(Find here, please, the full text of the article in Psychologist Papers.)

Social Policy Design: a new book in Spanish

Diseño de políticas sociales

The book contains a series of timely and necessary analyses and thoughts on social policy. Its author, Fernando Fantova, has extensive experience in the field of social welfare programmes, not just as an analyst and academic of social provision theory, but also, and for many years, as a front line proponent and instigator of actions and initiatives designed to improve people’s quality of life.

The approach adopted by the book to the issues dealt with is described by the author as “universal, comprehensive and community-based”. The aim is to merge the interests of the academic and research world (focused on social policy) with those of the political and technical sphere, i.e. the world in which those responsible for adopting and implementing social policy decisions live and work.

The observations made by this sociologist from Bizkaia are particularly useful because his suggestions for improvement, which are based on well-founded, empirical evidence, are much more than a mere abstract academic exercise, however necessary said exercises may be. The ideas and thoughts presented in this book are imbued with an overriding sense of applicability and a strong dose of effective pragmatism. For this very reason, the book will be of interest not just to university lecturers and social researchers, but also to professionals working in the field of social policy planning and implementation.

(Excerpt from the prologue, written by Luis Moreno. More information: here)

Fiscal, occupational and social welfare: trends and opportunities for reshaping welfare system in the Basque Country


In a recent book (Diseño de políticas sociales, in press) I have worked in a theoretical framework for social policy, identifying some opportunities and proposals for reshaping welfare system in our context. I have found some of these opportunities and proposals in the field of new ways of structuring the financial flows from the citizens to the State (taxes and contributions) and from the State to the citizens (benefits). The structure of these economic flows must be coherent with occupational rules (about occupational flexibility, for instance), welfare services provision (health, education, social services, among others) and assumed relational perspective (type of relation between social policy and community networks).

Unlike most other autonomous regions in Spain, the Basque Country (each of one of its three provinces) establishes and collects its own taxes and then pays an agreed sum to the central government. The Autonomous Region of the Basque Country has a health service and education system, as well as an employment service and his own minimum income scheme. The Basque Country also has exclusive devolved power in the field of social services. The different political composition of different levels in this multilevel government scheme allows interesting comparisons.

It should be possible to compare different political and economical decisions and paths and we should be able to identify balances and unbalances between taxes and benefits, between benefits and services and between State and community, in order to propose new ways and tools for fiscal, occupational and social welfare. I think that there are, here and in other European countries, opportunities for innovating in social policy and that we can lead our Welfare state to a more universal, relational, person centered, efficient, sustainable and supported status. Evidence based policy and social innovation must work in order to help in making it possible.

Benefits against poverty in the Basque Country

Income Guarantee

Currently, benefits are set at 88% above the minimum professional wage, although in 2012 they were cut by 7%, a reduction that will hopefully be recovered in the future once the economic situation improves. Depending on recipients’ housing requirements, the size of their family or other circumstances, the sum in question can be as high as 200% of the minimum wage. In this sense, the situation in the Basque Country is far superior to that of the majority of Spain’s other autonomous regions, and this has led to some criticism from certain sectors (employer organisations, for example) that claim they are too high and act as a disincentive for people to look for work. The coverage rate for all recipients (both direct recipients and users) per one thousand inhabitants is very high in the Basque Country (71) when in other regions it reaches figures as low as 2.89 in Extremadura or 3.17 in Murcia. In 2010, the Basque Country accounted for 42% of all expenditure in Spain related to these programmes, despite the fact that it had no more than 2.6% of the population estimated to be living in poverty.  Today, due to much greater cuts in other regions than the Basque Country, the data for the Basque Country are undoubtedly even more favourable, with data for 2012 indicating public expenditure on these programmes of over 432 million euros.

As regards the impact of these actions, we should highlight that, at least until the middle of 2012, the poverty rate remained similar to those recorded during earlier years characterised by a much higher level of economic growth in the region. Moreover, this rate is clearly lower than that recorded from 1986-1996 (the period prior to the economic crisis and recession). Largely thanks to its protection system, the situation in the Basque Country is clearly different from that of the rest of Spain, even when we take into account other areas of comparable economic development, such as Catalonia. Unlike this last region, which currently has comparatively high poverty rates within the European context, the Basque Country is at the other extreme, and is counted among those regions with the lowest risk of poverty.

Furthermore, and as stated earlier, the unemployment rate is not as serious in the Basque Country as it is in Spain as a whole. However, this was not the case in 1988, prior to the establishment of the income guarantee policy, when the Basque Country’s unemployment rate was “2.7% higher than the Spanish mean, 3.7% higher than in Catalonia and 6.7% higher than in Madrid”. Again this could indicate that the minimum guaranteed income policy has had some influence.

Currently, nearly 60,000 households receive benefits and income support. Nevertheless, the latest change to the law (2011) established stricter access criteria (as the result of a proposal by the Popular Party, accepted by the Socialist Party). The main difference is that while previously, recipients were only obliged to have been registered with a town council for one year before applying for benefits, they are now required to have been on the register for three years and to prove actual residence (although not legal residence).

Read the whole article here.

Social Policy Against Poverty and Political Autonomy in the Basque Country


The Basque Country has used its devolved powers to develop a noticeably more robust and ambitious anti-poverty policy than the other autonomous regions in Spain, and indeed the central government itself. This policy has, in general terms, enjoyed a broad consensus among the region’s leading political parties, and has never been the subject of large-scale controversies or corrections. Even in moments of intense political tension caused by debates on national identity (and particularly in relation to the terrorist acts committed by ETA), the fight against poverty has remained a firm regional policy and a clear area of consensus.

Alongside other social and cultural policies and initiatives to foster economic and industrial expansion and research, development and innovation activities, the fight against poverty has become a hallmark of Basque society – a society that enjoys a high level of cohesion and which has a more competitive economic model than the majority of other Spanish autonomous regions. It is perhaps important to point out here that the Basque Country is characterised by firm family and community values and a strong sense of solidarity, with definite Christian roots (common to all parties to a certain extent), which may partly explain the emergence of certain other phenomena also, such as the large-scale cooperative movement located in Mondragón.

Whatever the case, we can see it is vital to improve coordination between the minimum income guarantee policy and other social policies (social services, pensions, employment, etc.), and it is necessary to recuperate and reinvent the role of the family and community networks in social protection and development at different scales. It is also very important to strengthen continuous (and accurate) assessment, participatory governance (with the Third Sector) and effective management (making efficient use of technology), so as to ensure that policies designed to fight against poverty avoid the risks of clientelism and paternalism, and are as flexible and stimulating as possible.

You can download full article here. If you are interested in the whole book, write to fernando@fantova.net. More information  here.

Health and Social Care and innovation: the way ahead


The health and social care and innovation strategies emerge in the context of a remarkable increase in the number and types of social and health care needs in many countries of the world. By ‘social and health care needs’ we mean the convergence of health care and social care prevention, assistance or intervention needs of individuals in long-lasting, strong, close or connected ways in situations like ageing, disability, chronic disease or dependency.

Social and health care and innovation must be oriented toward individuals and their health, autonomy, coexistence and wellbeing. The social and health care approach assumes that response systems (social and health care services) should be flexible and versatile enough to focus on individuals all the time, adapting responses to needs rather than people to structures. This should be done while taking into account the fact that structures are essential and must be strengthened and developed, and that they are still asymmetrical (health care systems are currently much more developed than social services in European most countries).

We must, also, embrace the community model, understood as the model strengthening relational ties and citizen participation in response to people’s needs, and the promotion and protection of people’s health, integration, autonomy and wellbeing in their usual geographical and social environments (without getting out of our own house and neighborhood, if possible). That means to be committed to social and health care and innovation in disability, ageing, depending or chronic disease situations enhancing the responsibilities and roles of the people involved or affected by these situations, their families and informal networks.

Public institutions must promote social investment towards the synergy between technological innovation (knowledge-based innovation in standardised ways of doing things) and social innovation (improvements in social structure and dynamics with an impact on collective wellbeing). We need a strong political and public leadership in order to reinforce and reinvent our welfare state and social and health care and innovation strategy must be at the heart of this leadership.

Documents in Spanish in fantova.net/Social policies and issues