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| Subsidiarity curve - number of users/ hours of needed formal care per month |
Subsidiarity threshold is the point
on which someone relies on formal care instead of only care provided by his or
her own means including the means of his own
and immediate social network.
In other words: one asks or applies
for formal help when his or her resources to help him- or herself are
exhausted.
The threshold is up to certain point
individually set. Its height depends on:
- Amount of ‘spontaneous’ help or care available in his “natural” support or social network. i.e. from the relatives, friends, neighbours and others. Such help can be direct – help, support and care activities, favours and informal service. It can be also indirect – e.g. relative pay for the helpers on the market. Probably most important moment that determines subsidiarity threshold is thus social capital.
- Amount of ‘personal capital’ one has on his or her disposition. This can mean that a person has enough knowledge, skill, ingenuity and other personal traits (modesty, endurance etc.), so he or she can organise his or her life that in spite of distress needs less help. It can also mean that he or she has enough resources (income, property) to hire help – be it in his or her immediate environment or on the open market.
- Stigma perception and handling. One can perceive asking for formal help as a (self)stigmatising deed and this can influence the decision whether to ask for formal help. The degree of fear of stigma (shame, covering stigma) can be related to personal beliefs, attitudes and morality, expectations and attitudes of the immediate environment or general cultural patterns (we can assume that fear of stigma is lower in the universalistic welfare regimes than in the authoritarian, conservative ones of subsidiary nature). Subsidiarity threshold is in a way also a stigmatisation threshold.
- Social response to distress. Crossing the subsidiarity threshold is on one hand an individual decision or event, on the other is also socially determined. The height of the threshold depends on the degree of seamlessness of the response, its invisibility and thus less stigmatising. Measures to alleviate poverty, promoting solidarity, enabling social life) lower the threshold as well as community actions of solidarity and mutual help (communal transport, housing and care cooperatives, time banks, service and goods exchange etc.).
While the threshold is of an
individual nature at lower intensities of need, we can assume that there is a
statistical absolute subsidiarity
threshold. This means that while there is on the end of low intensity of
needed care great variability of individual threshold, the variability
diminishes with the increase of needed care until it comes to the point that
almost everybody, vast majority needs some external, formal help. A very rough
empirical estimate (based on the Austrian figures for long-term care) would be
for this absolute threshold to be just a bit over hundred hours of support
(help, care) per month. Beyond this intensity, virtually everyone is in need
for formal care.
Distribution of care can be seen on
the receiving end as the tail of a normal distribution. We can presume,
speculate that most the people have an equal share of receiving and providing
care and help. At the extremes of this bell curve, we have a receiving end,
people who receive more than give, and providing end, people who provide more
care than receive. Usually in discussion of care provision, we give full
attention to the former and little to the latter (and none of it to the
middle). If we want to deal with the process of care as whole and take into the
consideration informal care provision, we need to consider also the middle and
providing part. First in having in mind the mutual help in the informal
networks across the whole population; second, in giving the attention to the
needs of carers as well as of the care procurement.
There are other moments that lower
the subsidiarity threshold:
- Economic reasons – e.g. unemployment, exhaustion and exploitation, lack of housing, lack of time available to help;
- Social and cultural – changes in patterns of care in conjunction with demographic trends – increasing rate of dependency, inversion of receiving and giving care ratio;
- Exposure to violence (family), increasing isolation and loneliness, poor social networks;
- Inappropriate professional intervention – stigmatisation, counselling when material support is needed and, opposite, too hasty referral to intensive forms of care (e.g. institutional care) because of lack of adequate services, etc.
- Inappropriate social and health services system: haphazard and unplanned response, not based on the needs of users, too many out of head solutions and aprioristic initiatives (dominance of some forms of care – e.g. self-help groups, day centres, group homes). Insufficient community participation and lack of community orientation.
