La prise en charge des personnes âgées dépendantes en France et en Italie. Familialisation ou défamilialisation du care ?

Chaque système de protection sociale repose sur un équilibre spécifique entre les responsabilités collectives et les responsabilités familiales par rapport aux risques sociaux et aux besoins de care. Dans un contexte de vieillissement de la population et de diminution du nombre d’aidants potentiels disponibles, il est intéressant de s’interroger sur les alternatives proposées par les gouvernements et sur la portée des politiques qui se dessinent depuis la fin des années 1990. Quelle articulation entre l’aide familiale et l’intervention publique ? L’analyse porte sur la situation dans deux pays, l’Italie et la France, où la famille joue traditionnellement un rôle important dans la prise en charge des personnes âgées dépendantes. Elle montre dans les deux pays un phénomène d’externalisation du care grâce au développement de dispositifs de cash for care, mais selon des modalités différentes. Dans un cas comme dans l’autre, cela ne signifie pas pour autant qu’il y ait défamilialisation du care. On assiste plutôt à une transformation des pratiques de care.Every social welfare system is based on a specific balance between collective and family responsibility for social risks and care needs. In the context of an aging population and a dwindling number of potential family carers, it is worthwhile taking a look at the alternatives being proposed by governments and at the scope of the policies adopted since the late 1990s. What is the relationship between family provision and public intervention ? Our analysis explores the situation in Italy and France, two countries where the family traditionally plays a major role in caring for the dependant elderly. It points to a trend in both countries toward an externalization of care through the development of cash-for-care systems, but with different modes of implementation. In neither case, however, does this mean a defamilialization of care but involves, rather, a transformation of care practices

Pitfalls and Pearls in Delusional Parasitosis

Delusional parasitosis is an uncommon psychiatric disorder that manifests as having parasitic delusions. Due to its rarity, delusional parasitosis is a challenging and costly diagnosis of exclusion and proves difficult to manage for many providers. Although this syndrome is frequently discussed in psychiatric and dermatology reports, it is not commonly described in emergency medicine (EM) literature. As a result, best practices for workup and treatment remain unclear from an EM perspective. Patients typically return multiple times for medical evaluation and exhaust numerous resources. In this case report we review the appropriate steps for initial evaluation of patients with suspected delusional parasitosis, differential diagnoses, and increase awareness for prudent treatment strategies

Rescaling Social Welfare Policies in Italy. National report

Downloadable at: http://www.euro.centre.org/rescalingDocuments/files/Italy.pd

Use of Nintendo Wii Balance Board for posturographic analysis of Multiple Sclerosis patients with minimal balance impairment

Background: The Wii Balance Board (WBB) has been proposed as an inexpensive alternative to laboratory-grade Force Plates (FP) for the instrumented assessment of balance. Previous studies have reported a good validity and reliability of the WBB for estimating the path length of the Center of Pressure. Here we extend this analysis to 18 balance related features extracted from healthy subjects (HS) and individuals affected by Multiple Sclerosis (MS) with minimal balance impairment. Methods: Eighteen MS patients with minimal balance impairment (Berg Balance Scale 53.3 ± 3.1) and 18 age-matched HS were recruited in this study. All subjects underwent instrumented balance tests on the FP and WBB consisting of quiet standing with the eyes open and closed. Linear correlation analysis and Bland-Altman plots were used to assess relations between path lengths estimated using the WBB and the FP. 18 features were extracted from the instrumented balance tests. Statistical analysis was used to assess significant differences between the features estimated using the WBB and the FP and between HS and MS. The Spearman correlation coefficient was used to evaluate the validity and the Intraclass Correlation Coefficient was used to assess the reliability of WBB measures with respect to the FP. Classifiers based on Support Vector Machines trained on the FP and WBB features were used to assess the ability of both devices to discriminate between HS and MS. Results: We found a significant linear relation between the path lengths calculated from the WBB and the FP indicating an overestimation of these parameters in the WBB. We observed significant differences in the path lengths between FP and WBB in most conditions. However, significant differences were not found for the majority of the other features. We observed the same significant differences between the HS and MS populations across the two measurement systems. Validity and reliability were moderate-to-high for all the analyzed features. Both the FP and WBB trained classifier showed similar classification performance (>80%) when discriminating between HS and MS. Conclusions: Our results support the observation that the WBB, although not suitable for obtaining absolute measures, could be successfully used in comparative analysis of different populations

Strategies of care: changing elderly care in Italy and the Netherlands

This analytic study surveys the transformations of elderly care policies and practices since the early 1990s, by comparing the trajectories of two extremely different care systems: Italy, a familialistic model with no relevant changes in social policies; and the Netherlands, a formal care model under restructuring. The author demonstrates that, in spite of strong policy pressures, the Dutch system remains a formal care model and represents a case of institutional and social resistance to welfare restructuring By contrast, the Italian system has shifted from family-based to a mix of family- and market-based model, despite the absence of substantial policy intervention. She argues that the ongoing changes need to be seen from a micro-to-macro perspective, considering the choices and strategies of the actors that are limited and conditioned by the institutional framework, but also represent possible forces of social change.Strategies of Care analyseert de veranderingen in de ouderenzorg vanaf het begin van de jaren negentig van de vorige eeuw. Auteur Barbara Da Roit doet dit aan de hand van een vergelijking tussen Italië - een land met een traditioneel, weinig veranderlijk en familievriendelijk model - en Nederland, dat een formeel zorgmodel heeft dat grondig wordt herzien. Het onderzoek bespreekt de trends in de zorgbehoeften van ouderen tegen het licht van de veranderingen in de zorgpakketten. Aan de hand van een analyse op basis van gesprekken met familieleden, professionele zorgverleners en sleutelfiguren in de ouderenzorg geeft dit boek inzicht in de manier waarop zorgpakketten worden geconstrueerd en de logica die daarachter schuilgaat

Negotiating care in the context of Finnish and Italian elder care policies

Negotiation is an integral part of all elder care, which by definition involves a relation between at least two people. In this article we analyse negotiations concerning elder care in the context of Finnish and Italian elder care policies. At the macro level negotiations on elder care are shaped by elder care policies and at the micro level by individual skills and resources. Our focus is on the negotiations on eligibility that take place when elders attempt to access care. The data consist of qualitative interviews with Finnish and Italian elders in need of care. The analysis of individual experiences of care negotiations reflects the implementation of elder care policies. The results indicate that the most negotiated eligibility criteria when seeking access to elder care are need, money and social relations. These criteria are negotiated when seeking eligibility to different sources of care: informal care, grey market, market-based, non-profit and public services. In Italy, negotiation is particularly crucial when accessing grey market care. Cash as the main Italian elder care policy tool tends to enhance the role of and need for negotiation. In Finland, a greater part of elder care is provided by the public sector and therefore the process of negotiation is more standardized than in Italy

Street-level netocracy: rules, discretion and professionalism in a network-based intervention

Purpose: The paper aims to analyse the meaning and extension of discretionary power of social service professionals within network-based interventions. Design/methodology/approach: Empirically, the paper is based on a case study of a network-based policy involving private and public organisations in the Northeast of Italy (Province of Trento). Findings: The paper identifies netocracy as a social policy logic distinct from bureaucracy and professionalism. What legitimises netocracy is neither authority nor expertise but cooperation, the activation of connections and involvement, considered "good" per se. In this framework, professionalism and discretion acquire new and problematic meanings compared to street-level bureaucracy processes. Research limitations/implications: Based on a case study, the research results cannot be generalised but pave the way to further comparative investigations. Practical implications: The paper reveals that the position of professionals in netocracy is to some extent trickier than that in a bureaucracy because netocracy seems to have the power to encapsulate them and make it less likely for them to deviate from expected courses of action. Originality/value: Combining different literature streams - street level bureaucracy, professionalism, network organisations and welfare governance - and building on an original case study, the paper contribute to understanding professionalism in welfare contexts increasingly characterised by the combination of bureaucratic, professional and network logics

Heaviness, intensity, and intimacy

In the Netherlands the recent shift to a ‘participation society’ has led to a reconfiguration of health care arrangements for long-term care. The new long-term care act, scheduled to commence January 2015, forms the political realization of the participation society: people are expected to decrease their dependency on state provisions and instead become self-sufficient or dependent on family and community solidarity. In this Think Piece we argue that the implicit references of policy makers to pre-welfare state community solidarity and self-sufficiency do not adequately consider the historical and social embeddedness of care. Referring to Rose’s concept of ‘politics of conduct’ we argue that in framing care as a moral obligation, the current politics of conduct may obscure the physical and psychological heaviness of intimate care between family members, the diversity of care relations, and their sociohistorical embeddedness