Expanding Needs and Expenses

What is striking about the eldercare policy in the 1970s is its concern with the demographic and financial pressure on public eldercare. This is a concern vivid in the policy’s continued focus on how to transform public eldercare from being mainly a matter of public nursing homes, to one of public homecare.³⁴⁴ The policy presents what it describes as a troubling increase in public eldercare expenses due to demographic and cultural developments in society whereby more and more elderly citizens are seen to have no recourse but to accept public eldercare and where such

344 B571 1970: 10, 11-12, 13, 21, 22, 24, 26, 27-28, 29-30, 31-32, 42-44, appendix 1, 2, 3, 4; B583 1970: 22-23; B618 1971:

73-76, 78; KL 1971: 14; B630 1972: introduction, 5, 7, 9-10, 12, 13, 19, 28, 31-32, 37, appendix 3 p. 55, appendix 9; KL 1972: 15; Socialministeriet 1972: 4-5; B664 1972: 14-16, 165, appendix 15 p. 330, 247; Socialstyrelsen 1972: 3; KL 1973:

93; B670 1973: 34-35, 48-49; Socialministeriet 1973: 26-27; L333 1974: chap. 3 §§ 9-14, 17-18, 21, 25, sect. IV, §§ 50, 53, 54-55, 58-59, 79; Socialministeriet 1974: 12-15, 18; KL 1975: 116; Socialministeriet 1975: item. 11, appendix 1, 2;

Boligministeriet 1976: 9; Socialministeriet 1976b; KL 1977: 146; Socialstyrelsen 1977: 11; Socialstyrelsen 1977b; KL 1978:

122-123, 127; KL 1979: 157, 158; Socialstyrelsen 1979: 12.

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care has also grown more common and less stigmatizing.³⁴⁵ For example, a 1970 white paper explains how

there are a number of tendencies in the development towards increased needs for public support. First of all, the population trends must be noticed. The number of people aged 65 or over increases from approximately 550,000 in 1965 to probably 720,000 in 1985 or by approximately 30 per cent. It is difficult to say whether the need for support is increasing concurrently with this population trend, but it is more realistic to count on this being the case. ³⁴⁶

The white paper goes on to describe how the demand for public eldercare is expected to increase, for one because ‘more young women working outside the home will tend to mean relatively less support from the family’ and, secondly, because public support is becoming

‘attractive and more common’, predicting that ‘this will increase elderly people’s interest in using the support options’, and how

it will increasingly be perceived as a matter of course that the public sector takes over still more of the tasks that previously … were performed by the family, by paid, private house-help or by elderly citizens themselves. The more citizens receive support, the more citizens will demand support.³⁴⁷

Thus, as demonstrated, the policy presents the expanding demand of public eldercare as a mounting problem of public eldercare.

Moreover, one can note, how the policy continuously describes the main problem to be the expenses related to public nursing homes and calls for less expensive alternatives like public homecare. For example, in 1971 LGDK states that ‘even a very heavy expansion of society’s care work in its broadest understanding will be far less expensive to society and far more

345 B571 1970: 11-13, 21,22, 24,25, 26, 29-30, 32, 42-44, appendix 1, 2, 3, 4; B583 1970; B618 1971: 74-76; B630 1972: 19, 31-32; B664 1972: 14-16; B664 1972: 165, appendix 15 p. 330, 247; B670 1973: 34-35, 37, 48-49, 80; KL 1973: 93;

Socialministeriet 1974: 12-15, 18; KL 1977: 146; KL 1978: 127; KL 1979: 158.

346 My translation: ‘der er en række tendenser i udviklingen i retning af yderligere forøgelse af behovet for offentlig bistand.

For det første må nævnes befolkningsudviklingen. Antallet af personer i alderen 65 år og derover forøges fra ca. 550.000 i 1965 til formentlig ca. 720.000 i 1985 eller med ca. 30 pct. Det er vanskeligt at sige, om bistandsbehovet stiger i takt med denne befolkningsudvikling, men det er mest realistisk at regne med, at det vil være tilfældet’ (B571 1970: 24).

347 My translation: ‘attraktiv og mere almindelig’, ’øge de ældres interesse i at udnytte bistandsmulighederne’. ’mere og mere vil blive opfattet som en selvfølge, at det offentlige overtager stadig flere af de opgaver, som tidligere … blev udført af familie, af betalt, privat hushjælp eller af de ældre selv. Jo flere, der får bistand, desto flere vil derfor efterspørge bistand’

(Ibid.: 25).

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satisfying to the elderly citizen than the establishment and running of nursing homes’,³⁴⁸ and in 1979 it declares that public nursing homes are still ‘the most resource-intensive arrangement’³⁴⁹ and the ‘most personnel-demanding sector’.³⁵⁰ Likewise, a 1972 white paper emphasizes that

‘when one decides whether an admission at a nursing home is needed, all other types of support must already have been considered.’³⁵¹ Furthermore, ‘placement at a home ought not to happen unless the necessary support cannot be satisfactorily provided in the home of the old-age pensioner.’³⁵² The policy even declares its main ambition to be to keep the elderly in their own homes and out of expensive public institutions.³⁵³

Besides such descriptions of a mounting group of elderly in need for public eldercare and descriptions of the ensuing financial pressure on public eldercare budgets, the policy can now also be observed to describes the elderly’s need for eldercare as changing. Although the policy continues to describe the elderly citizens’ as being in need for financial support and accommodation when they can no longer manage on their own,³⁵⁴ the policy also starts describing elderly citizens as a heterogeneous group of unique individuals with individual and holistic needs for care that exceed the two overarching needs. According to the policy of the period, public eldercare must, in order to enable elderly citizens to age in place, meet elderly citizens’ practical, financial, physical, social and mental needs – and must do so in light of each citizen’s unique, specific and holistic life situation.³⁵⁵ This new construction of what the need of eldercare is can notably be seen as new terms appear in the policy, such as ‘integrated holistic

348 My translation: ‘at en endog meget stærk udbygning af samfundets omsorgsarbejde i videste forstand vil være langt billigere for samfundet og langt mere tilfredsstillende for de ældre end etablering og drift af plejehjem’ (KL 1971: 14).

349 My translation: ‘den mest ressourcekrævende foranstaltning’ (Ibid.: 158).

350 My translation: ‘stadig er den mest personalekrævende sektor’ (KL 1979: 158).

351 My translation: ‘Når der skal tages stilling til, om en indlæggelse på plejehjem er nødvendig, er det derfor en forudsætning, at andre muligheder for at hjælpe pensionisten har været overvejet’ (B630 1972: 37).

352 My translation: ‘Optagelse på et hjem bør ikke ske, med mindre der ikke er mulighed for på lige så betryggende måde at yde den fornødne bistand til pensionisten i dennes eget hjem’ (Ibid.: 40).

353 KL 1971: 14; B630 1972: introduction 5 ,7, 9-10, 28; socialministeriet 1972; Socialstyrelsen 1972: 3; KL 1973: 93;

Socialministeriet 1973: 26-27; Socialstyrelsen 1977: 11; Socialstyrelsen 1979: 12.

354B571 1970: 10, 27-29; L227 1970; B618 1971: 78, 79, 80; KL 1971: 14; B630 1972: 2, 5,7, 9, 11, 14, 30-32. 33-36, appendix 9 p. 71; B664 1972: 3, 5, 9, 78, 80; B664 1972: 163-164, 170-171, 197, appendix 15; KL 1973: 92-93, 99, 100,101;

Socialministeriet 1973: 6-10, 24; L333 1974: § 12, chap.16 §§ 74-86; Socialministeriet 1974b; B755 1975: 21-24, 25, 116, 117, 66-68, 112-117, KL 1975: 104, 116, 117; B772 1976: 13-18, 27; Boligministeriet 1976; KL 1976: 159; Socialministeriet 1976: 16, appendix 1 p 25; Socialministeriet 1976b; B799 1977; KL 1978: 126, KL 1979: 155, 157, 161-162;

Pensionsreformarbejdsgruppen 1979; Socialstyrelsen 1979: introduction.

355 B571 1970: 12-13, 23, 45, 46, 55, 71, 74, 77, appendix 6; B583 1970: 33; B618 1971: 80-81; KL 1971: 14; B630 1972:

introduction, 5, 7, 8, 9-10, 11, 12-13, 15, 25, 26-27, 28, 39-40, appendix 3 p. 55, appendix 9 p. 72; B664 1972: 3; B670 1973:

34, 37, 78, 80; KL 1973: 93; Socialministeriet 1973: 26-29; L333 1974: chap. 13 §§ 60, 74, KL 1975: 116; Socialministeriet 1975: appendix 2; B772 1976: 19; Boligministeriet 1976: 29; KL 1976: 159; B802 1977: 12, 13, 19, appendix 3 s. 43-44, 52-53; Socialstyrelsen 1977: 11, 21, 22, Socialstyrelsen 1977b: 8, 10; KL 1979: 157; Socialstyrelsen 1979: 12.

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care’, ‘holistic approach’, ‘joint assessment’, ‘individual’, ‘heterogeneous’ and ‘personal’.³⁵⁶ For example, a 1970 white paper states that:

The group of old-age pensioners is characterized by their receiving of old-age pension … other than this, they are actually a very heterogeneous population group with greatly differing life conditions when it comes to health, financial circumstances, housing conditions, labour market attachment, contact with family, relatives and others and regarding attitude towards life.³⁵⁷

Similarly, a 1972 white paper notes that when decisions regarding the public support to be provided are made, ‘it will be reasonable to consider the situation of the individual old-age pensioner in its totality’,³⁵⁸ and that ‘a joint assessment of the situation of the old-age pensioner is deemed desirable’.³⁵⁹

Thus far, I have shown how the eldercare policy of the 1970s constructs the main problem of eldercare as a mounting financial pressure on eldercare due to expanding needs for individual and holistic eldercare. Next, I show how public total eldercare is constructed as the solution to this problem.