Search Results

This chapter charts the emergence of the predominant forms of home care delivery that unions would have to confront for the rest of the century. The welfare wars that rocked the late 1960s and early 1970s generated not only California’s independent provider system but also solidified the vendor model in New York City, both of which allowed governments to transfer employer responsibility by contracting out the work. The presence of a well-organized and vocal independent living movement distinguished the fight in California during Ronald Reagan’s governorship, resulting in the consumer-directed In-Home Supportive Services. But because individuals could hire family members, IHSS served as a form of income support during a period when new federal welfare rules ideologically and administratively separated AFDC from disability and elder assistance. In contrast, New York moved to contract out and privatize services, funding old community development programs through Medicaid monies, in response to both public employee strikes and the militancy of poor women of color who dominated its Home Attendant Program. At each level of government, neoliberalism and privatization emerged as a continually evolving political tactic, part of the politics of welfare, Medicaid, and elder care.

This chapter discusses SEIU’s massive Los Angeles victory in 1999 in light of the Americans with Disability Act, welfare reform, Clinton’s health care debacle, and managed care. In California, the union assembled all the components necessary for success when it built alliances, especially with the independent living centers, stepped outside the NLRB framework, organized tens of thousands of workers, and created new institutional state structures, particularly the public authority, that enabled union representation on a sectoral, rather than worksite, basis. As in Illinois, home care unionism in Los Angeles was really welfare state unionism beholden to the location of home-based, long-term care in government welfare programs. But, in Northern California, SEIU advanced a health care unionism that organized home-based workers with hospital workers. There a culture of organizing, use of worker centers and popular education, and development of member leaders and rank-and-file participation enhanced citizenship rights for immigrants as well as African Americans. SEIU adapted its model to Oregon, where voters authorized collective bargaining. At the end of the 20^th century, home care promised a non-adversarial unionism that joined the providers and receivers of care together to demand respect, recognition, and rights, but remained dependent on state budgets.

This chapter is concerned with supported housing options for people with disabilities. A broad scope of issues is covered by the heading of disability, including both mental and physical health and illness, learning disability, physical impairment and disability. The chapter follows a similar structure to the previous two with a focus on policy discourses such as the social model of disability, independent living and normalization, followed by a description of policy in each of Britain and Sweden. There follows an evaluation of the forms of supported housing most used for disabled people.

This chapter describes the inequalities between program settings, including Supervised Independent Living (SIL) apartment sites, the SIL administrative office, and the private agency’s business office. Case managers often feel discounted by administrative supervisors, if they don’t feel appreciated in their positions. As such, they are unable to provide comprehensive care to their clients. A general inability to sustain long-lasting and meaningful relationships also hinder care. However, identifying “caring” caseworkers and getting rid of the “uncaring” ones would not improve service provision overall. SIL environments have shaped interactions in ways that have compromised concern, irrespective of any individual worker’s intentions, suggesting that an individualized approach to care will not address the effects of structural inequalities and stigma narratives. Fragmentation within and between bureaucracies compromise the kind acts of participants and limit effective service provision.

The Multisite Evaluation of Foster Youth Programs represents the first attempt to evaluate independent living programs for children aging out of care using experimental methods. The chapter describes the study and its findings. Based on lessons learned from this evaluation, the authors argue that the study demonstrated that experimental methods can be used to rigorously evaluate a wide range of child welfare. At the same time, the authors describe some of the challenges of learning from experimental evaluation in complex areas of human services delivery. Challenges identified include: changes in policy context that lead to changes in the intervention or the counterfactual condition; limited external validity reflecting the unique characteristics of service delivery systems; distinguishing between the impact of “programs” and “practice”; and, limitations of experimental designs for assessing the impact of policy change.

This chapter explores the characteristics, activities and living arrangements of carers of older people in Australia and England, paying particular attention to those who are of working age. It notes the importance of trends towards living alone and independently among older people in both countries and the implications of these for their children of working age when care needs arise. The chapter presents data from censuses and surveys in each country which have collected data about people of working age who provide regular care to their older relatives. The data highlight the nature of the care given and of the tasks involved, the impact caring has on adult children’s participation in paid work, and the challenges and difficulties many carers face in reconciling work and care, an issue of particular importance for women, although growing numbers of men are also affected. Some of the difficulties carers face have been partially addressed in both countries through a range of new policies laws and strategic public policy commitments to extend and enhance support for carers, often under pressure from or influenced by the associations of carers which exist in both countries.