DOI: 10.1111/j.1468-2397.2010.00759.

x Int J Soc Welfare 2010: :

I N T E R NAT I O NA L J O U R NA L O F SOCIAL WELFARE

ISSN 1369-6866

Caring and the generation of social capital: two models for a positive relationship
ijsw_759 1..9

Johansson S, Leonard R, Noonan K. Caring and the generation of social capital: two models for a positive relationship Int J Soc Welfare 2010: : 2010 The Author(s), International Journal of Social Welfare 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used for care work. When there is inadequate funding of aged care services by the state, then social capital may be seen as a substitute for economic and human capital. Caring, therefore, is seen as a drain on capital. However, this does not have to be the case. Aged care services, if thoughtfully designed, can not only consume social capital, but also generate it. Two models of elder care, one Swedish and one Australian, have been identied which specically address the generation of social capital. In each case, the services and facilities have been developed by third-sector organisations with a strong community development focus, often in the face of resistance from state-run or medically oriented services.

Stina Johansson1, Rosemary Leonard2, Kerrie Noonan2

1 2

Department of Social Work, Ume University, Sweden Social Justice and Social Change Research, University of Western Sydney, Australia

Key words: social capital, caring, volunteering, elderly care, community care, Australia, Sweden Stina Johansson, Department of Social Work, Ume University, SE-901 87 Ume, Sweden E-mail: Stina.johansson@socw.umu.se Accepted for publication August 18, 2010

Introduction When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used for care work. When there is inadequate funding of aged care services by the state, then social capital may be seen as a substitute for economic and human capital. Caring, therefore, is seen as a drain on capital, whether it be economic or social capital. However, this does not have to be the case. This article discusses two models of care, one from Sweden and one from Australia, which specically address the generation of social capital. Social capital is the most commonly used term to reect the collective benets of community engagement. It refers to the resource that is created whenever people cooperate. Because the term social capital has been used widely and rather loosely, we need to explain how it is dened and used in this research. Following Putnam (1993: 167), social capital is often dened as those features of social organization, such as trust, norms and networks, that can improve the efciency of society by facilitating coordinated actions. Bourdieu

(1986: 248) dened the concept as the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance or recognition. For Bourdieu, social capital was a core strategy in preserving and transmitting the cultural capital of the elite. Because all forms of capital can be converted into other (primarily economic) capital, social capital was simply one way of preserving class advantage. However, other theorists, including Coleman (1988) and Putnam (2000), saw social capital as a resource (often the primary resource) that is open to all groups and communities. Like other forms of capital, social capital can be realised in tangible outcomes that are quite different from the activities that created the capital in the rst place. Evidence is mounting that associates high social capital with many desirable outcomes, such as lower crime rates, fewer school dropouts, higher productivity and economic development (Leonard & Onyx, 2004; Putnam, 2000). Certainly, there is evidence that social capital is capable of producing a variety of positive outcomes beyond economic advantage, such as improved health and wellbeing (Halpern, 2005).

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Critiques of social capital While the concept of social capital is growing in popularity, it faces a number of severe criticisms. Most of these criticisms are focused on the macro- or economicdevelopment approach where the emphasis is on the functioning of whole societies or nations (e.g. Putnam, 2000; Woolcock & Narayan, 2000). Critics, such as Foley and Edwards (1999), have argued that it is incorrect to extrapolate from engagement in local community activities to the state of a whole nation. Such an extrapolation ignores social divisions whereby there may be strong social capital within groups based on class or ethnicity, although the society or nation may be severely divided. In focusing on power generated at the local level, it ignores economic analyses such as a Marxist emphasis of power based on controlling the means of production. At the macro level, social capital lacks a theoretical mechanism to describe how and when such an extrapolation from the local to the national might validly operate. The macro and developmental approaches are also criticised for taking a normative position that social capital is a social good, ignoring the possibility that high levels of social capital within groups might be either a cause or a symptom of social division and exclusion. The methodological critique is that emphasising the national level often leads to generalisations based on averaging attitudinal data from surveys that were not designed to measure social capital. A prime example is the use of the question Do you agree that most people can be trusted?, which is used in the US general social survey and sometimes adopted as a proxy for social capital without considering the different interpretations of most people and the ability of the most privileged to interact only with safe people (see Lin, Cook & Burt, 2001 for a critique). A similar methodological critique can be directed towards Putnam (2007) who, from analysis of census data, drew the conclusion that in the short run, immigration and ethnic diversity tend to reduce social solidarity and social trust. In contrast to the macro and developmental approaches, the micro position (e.g. Lin et al., 2001) focuses on specic networks and the benets that accrue to the people within them. There is no assumption that social capital is always a social good, because in the micro approach the outcomes are a matter of empirical investigation; for example, Portes (1998) found pressure for cohesion in migrant communities that restricted the opportunities for their members. In the micro approach, methods emphasise the identications of networks, behaviours and tangible outcomes rather than attitudinal data which are usually rejected as too subjective (Adam & Roncevic, 2003). There are a number of theories that could be applied to social capital within a specied group or network. For 2

example, Lin et al. (2001) applied social exchange. Other relevant theories are social identity theory (Tajfel, 1982) and community development theory (Kenny, 1994). A feminist critique of social capital (e.g. Leonard & Onyx, 2004) identied the risk that the valuing of social capital will increase the pressure on women to take on more unpaid community maintenance work. Indeed, Putnam (2000) identied the entry of more women into the workforce as one of four contributing factors to the decline of social capital in the USA. On the other hand, the prominence of social capital also allows for greater public recognition of community maintenance or development work. This is reected in the development in a number of countries of satellite accounts to measure unpaid work. Leonard and Onyx (2004) argued, however, that there is still a risk that the public/private divide will continue and mens community networking will be given more recognition than womens. Social capital contributing to caring When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used to support care work. For example, Beaudoin and Tao (2008) examined the support that carers receive through online chat rooms and how this helps them to deal with stress and depression. Jeppsson Grassman and Whittaker (2007) studied the support given to the frail and dying by their parishes, and found that support was provided only when there was a personal relationship with the minister or inner core members of the church. In analyses of social support, the emphasis is on who a person can call on for help if needed. It is generally assumed that caring for frail, aged and dying people will not contribute to building the social capital of the wider community. There are a number of possible reasons why the reverse relationship has not been widely explored. One is the failure to recognise the possibility that caring can contribute to social capital, because the emphasis in caring research has been on the needs of the carer or the person in need of care rather than on the impact on their local community. The other reasons relate to the impediments to social capital created by certain systems of caring. It involves the recognition that the way caring is usually organised can be a barrier to the growth of networks, voluntary involvement, reciprocity, trust, norms or agency, all of which have been identied as essential elements of social capital (Onyx & Bullen, 2000). First, it must be acknowledged that the building of social networks that are important for social capital may be negatively affected by the restrictions that most care situations place on clients and carers. Care is often

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associated with a reduced ability to engage in the community and develop social networks both for the older or disabled people and often for their carers. Old peoples homes are seen as sad places to be avoided, whether as a worker, a visitor or as a client (Minichiello et al., 2005; Nay, 2004). Unpaid care work within residential facilities for the elderly can be a barrier to community participation for many people, but mainly women. In Australia, Leonard and Burns (2003), in a comparison of different types of unpaid work, found that care work was most likely to be associated with participation in the private, as opposed to the public, sphere and with a low sense of personal agency. Further, Zapart et al. (2007) found that care work had a negative effect on both the carers family and social life. From a study of Bangladeshi women in London, Ahmed and Jones (2008) argued that care work is particularly isolating and disempowering for women of minority cultures, thus reducing their networks and social agency. It is important to note that although people prefer the comfort and familiarity of their own homes, they can be quite lonely and isolated with only the visits from service providers for company. The restrictions on carers are also likely to be greatest when the person being cared for is less able (Sand, 2000). Services for the care recipient, such as access to day care, community transport and home help, as well as respite services are all important for relieving the carers isolation, but the demand for services is much greater than the supply. Although Australian governments report a steady increase in funding for services for people to stay at home, these increases have not been as great as the increase in costs, and so there is a high level of unmet need which has now reached 50 per cent (NCOSS, 2008). Sweden, too, has identied a high level of unmet need with 25 per cent of elderly care recipients receiving less than 40 per cent of the services indicated by their needs assessment (Socialstyrelsen, 2005). According to a recent study by Ahnlund (2008), paid home-care workers often felt bored and isolated when left alone with clients who were unwilling or unable to leave their homes. However, for those who went out regularly there were good networks amongst neighbours, local shopkeepers and community nurses. Paid workers in institutions generally reported good relations amongst their fellow workers, but relationships beyond the institution were limited for both the clients and themselves in their work role. At the most negative, they were too busy to talk to the clients or to each other and had not taken a client out for a walk in a long time. A positive experience that could potentially build social capital was contacting relatives to help construct the story of the clients life (Ahnlund, 2008).

Limited social norms of care work The second barrier to the generation of social capital through care work is when there are no social norms to encourage care work in general. Such norms are discussed within moral philosophy where caring and an ethics of care based on moral responsibilities in personal relations have been foregrounded. The argument is that caring for each other is an important part of life, and as human beings we need to both give and receive care. Relations in which people have to take care of another person or where reciprocity is shown help us to develop our moral capacities (Wrness, 2007). Early theorising, for example Noddings (1984), focused on the values of love and reciprocity, even if Noddings also restricted her focus to an intimate caring circle. With greater recognition of the complexity of modern society, the theories about care work have become more multifaceted. Contemporary discussions on the ethics of care include values such as gender equality (Cancian & Oliker, 1999; Larrabee, 1993) and diversity (Torres, 2006). Although this ethic of care is presented as an ideal, with no one pretending that all care work conforms to this model, such a norm must be accepted to a certain extent to foster a climate of caring. By emphasising interdependence rather than independence (Kittay, 2005), such an ethic runs counter to the ideology of liberal individualism which dominates many Western societies (Augoustinos, Walker & Donaghue, 2006). Working at the ethical level also deals with the difcult dimension of reciprocity. Reciprocity is seen as an important element for social capital (Leonard & Onyx, 2004) but, clearly, frail or terminally ill people will not reciprocate the care they receive. Sometimes, however, care of a parent may be seen as reciprocating care received as a child. When care is viewed in more general terms, carers often recognise that they may be the beneciaries of a more caring community, such as in the common phrase What goes around comes around, an attitude that is congruent with a general ethic of care. In Sweden, high expectations are directed to publicly nanced care. There are strong social norms supporting womens engagement in paid work to prepare for their own old age, while care for the elderly or inrm should be provided by tax-based services. There is a weak public recognition that family norms to care for each other still exist (Johansson, 2006). Nonvoluntary activity is not social capital A third and somewhat contradictory issue is that the pressure to care may be a barrier to the requirement that social capital is generated by voluntary activity. Because social capital requires trust, activities generated by emotional manipulation or the perception that there is no alternative are problematic. The pressure to 3

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care is likely to increase, however, and despite 30 years of feminist critique of the exploitation of women (e.g. Baldock 1998; Waring, 1988), most of the carers are likely to be women. The increase is likely because of the combined effect of ageing populations, the deinstitutionalisation of care and a decrease in governments ability to fund services. In Australia, for the years 19962007, governments have had a right-wing agenda of decreasing peoples expectations and reliance on social services. A major incentive for the move from institutional to community care has been nancial. There are 2.3 million people in Australia who, as a primary activity in their life, provide long-term care to a loved one. Carers contribute over A$20 billion to the Australian economy, and this unpaid workforce is estimated to be about ve times the paid workforce in terms of full-time equivalents (Palliative Care Australia [PCA], 2004). In Australia, in contrast to Sweden, there seems to be a double standard, with women being expected to manage both caring and paid work (e.g. Leonard & Johansson, 2008). It is not uncommon for caring to be the reason women leave the paid workforce. In Swedish society, volunteering was not well accepted and people had learnt to rely on their taxation system and high tax rates (Lundstrm, 1995). Recently, however, cutbacks have been so heavy (Palme et al., 2002: 7578) that public services have become standardised (Blomberg & Petersson, 2007) and impersonal (Andersson, 2008), and fewer people receive home help services (Szebehely, 2003). In the wake of these cutbacks, the government is trying to change the norm of publicly nanced care and increase the expectation that the healthy pensioners will contribute to the care of their peers in need of support, emphasising the risk that healthy pensioners will become lonely and ill if they do not contribute by helping other elderly persons (Johansson, 2007). This change in attitude seems to be having an effect, as the interest for voluntary services in elderly care in Sweden has increased in recent years (i.e. Frivilligcentraler [centres for voluntary work], see Leonard & Johansson, 2008). There are also signs that when elderly people receive fewer services, Swedish women feel pressured to do informal care work, which means that women of working age may choose to reduce the time spent doing paid work, with negative consequences for their income and pension. Some work a double shift with negative consequences for their health (Sand, 2004). A further barrier to the generation of social capital through care work arises from the increased standardisation of care. The effect of top-heavy medical models is that the people in need of care and their families experience a loss of agency which is necessary for generating social capital. This trend is particularly marked at the very end of life when palliative care 4

services are needed. Stjernswrd (2005) argued that there has been an overemphasis on medical interventions and that meaningful palliative care requires a combination of socioeconomic, cultural and medical solutions. The cultural and socioeconomic factors are equally, or even more, important to the experience of dying than the purely medical. Additionally, a growing number of recent reviews have noted that future policies and clinical practice need to focus on empowering family members and providing community education concerning end-of-life care (Gomes & Higginson, 2006; Tang, 2003). Organisation for the generation of social capital Despite the obstacles, it is possible for care work to be organised in such a way as to develop social capital. Although there may be many ways to grow social capital through care work, the two examples presented here have been developed from a community development focus. Community development focuses on both personal growth and change or development of the community (e.g. Kenny, 1994). It has three signicant features: decision making by those most affected by outcomes of the decision; personal empowerment and control by individual citizens over their own life; and the development of ongoing structures and processes by which groups can meet their own needs. As noted by Kellehear (2005: 100), community approaches to end of life care: . . . are not new services. They are community members acting toward each other in new and constructive ways to improve their own capacity for end-of-life care. Any professional rationalisation of these changes into simpler forms of direct services provision is a regressive and important threat to community empowerment. Clearly, the themes of people exercising collective agency and organising themselves suggest a strong parallel between community development and social capital, which will be illustrated in the examples. Example 1, Sweden: eldercare cooperatives At the end of the last decade, a network of nongovernmental organisations together with the Swedish Ministry of Enterprise, Energy and Communications started a rural campaign, All Sweden shall ourish. The focus was on mobilising local people, changing the attitudes of the public and decision makers and improving national rural policies. Village Action Groups were formed to deal with local matters using community development principles. As part of this campaign, at least eight villages started eldercare cooperatives.

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To understand how these cooperatives operate and how they might contribute to social capital, data were obtained from two main sources. First, eld visits were made to two sites in 2000 with observations by the Australian author, introductions to clients and interviews with management committee members. Second, ve telephone interviews were conducted by the Swedish author in 2008 with coordinators. Descriptive data were also obtained by the Swedish author about a variety of sites from the web and other publications (e.g. Folkrrelserdet hela Sverige ska leva [People Movement: the whole of Sweden shall ourish], 2006). The observations revealed lively hostels. One site had a childrens play area with the childrens paintings on the wall. They found a pleasant home-like atmosphere with large en suite rooms for the residents and their own furnishings. The cooperatives were places for the villagers to meet, and in the other site regular concerts were held. They were both placed close to the centre of the village. The environmental consciousness was high, with the growing of organic vegetables, systematic recycling, under-earth heating, high quality insulation and eco-toilets. Both had warm demonstrative staff and interested residents who wanted to learn from the visitors. The strategy of making the eldercare facility a hub for the village was conrmed in the telephone interviews and web data. All the eldercare cooperatives also had facilities for nonresidents, such as lunches for the school, a library, domestic services, catering and takeaway services, thus strengthening the networks with the community. One cooperative had a TV with a large screen display which was used for watching football and as a cinema, as well as an IT studio, a clinic for the district nurse and a hairdressing salon. From the social capital perspective, the integration of people of different ages is important, and the contrast with the isolation experienced in many eldercare facilities was striking. Another way that strong networks and trust were built was by encouraging gifts from neighbours, such as elk meat or cloud berries, or by helping with clearing away the snow. From the social care perspective, the integration of care with a variety of social practices is vital. Some cooperatives formally incorporated volunteering into their functioning, both to reduce costs and to encourage social interaction from the village. Also important for creating social capital was the cooperative structure. Most are based on joint ownership, with the villagers and future residents of the facility having bought shares to raise funds for the cooperative. In one village, everybody bought a share. Networks are strengthened as the members are responsible for the continuation and management of the cooperative. Not only is agency encouraged through the creation of the cooperative, but also through its development and management. As managers, the villagers

could also incorporate the other services which provided an income stream, created job opportunities and would not have been possible in a small village otherwise. From a caring perspective, the trustful personal relation is important. This community development function is also a key strategy in the All Sweden shall ourish campaign. Although many of the cooperatives obtained nancial support from the Swedish state or the European Union to start up, all were now dependent on the favour of the municipal governments which distributed the funding for elderly care hostels by purchasing accommodation. Despite the obvious benets to the older people who can remain in their home village and to the community development of the village, municipalities accept the lowest tender which often favours larger standardised facilities (Turunen & Maruzars, 2010) located closer to major towns and run by either forprot-generating or publicly nanced organisations. One of the cooperatives was under severe threat and one had lost its tender from a municipality. Another challenge comes from the maintenance of national professional standards which are regularly inspected, and at one cooperative the staff were required to undergo education in documentation and IT, and another required a qualied accountant. Despite the pressures of nance and national standards, the cooperatives grow stronger by learning from each other. One of the longest running cooperatives advises others not to depend on one income source but to cooperate with many different partners. Their experiences are also being transmitted globally. One of the cooperatives is often visited by foreign experts (e.g. from Ireland, Iceland, Finland and China), and has developed the model of A House of Activities for All, promoting the importance of activities for all generations, not only for elderly people. Example 2, Australia: the Home Hospice Community Mentoring Programme Home Hospice is a social venture based in Sydney, Australia. It exists to create social change around both experiences and attitudes to death and dying. It offers support to the carers of people who are dying so the terminally ill person can die at home. It has been in operation for 28 years, using the communitydevelopment approach which provides a mentoring programme for carers of loved ones living with a terminal illness. Information about the Home Hospice was obtained from the following sources: (1) Secondary sources, such as Home Hospice publications, and an internal evaluation. (2) Interviews with a staff member and a mentor (audio-recorded and transcribed). 5

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(3) A workshop involving Home Hospice staff, mentors, clients, Board members and Cancer Council representatives (recorded by a designated note-taker). The Community Mentoring model starts with the recognition that 80 per cent of terminally ill people wish to die at home. Although up to 90 per cent spend most of the nal year of their life at home, 70 per cent die in institutions (PCA, 2004). It appears that carers experience both high levels of stress and considerable satisfaction and benets from caring for terminally ill loved ones (e.g. Aranda & Hayman-White, 2001; PCA, 2004; Zapart, et al., 2007). The Community Mentoring Programme (CMP), therefore, works to reduce the stresses of care work so that the carer can experience the benets and the terminally ill person can die at home as he or she wishes. The Home Hospice model, like the Swedish cooperatives, takes an explicitly community-development approach. The model is about education and learning, building community, developing and strengthening the bonds between people such as family, friends and neighbours . . . [and] is about building the capacity of the community to care (Home Hospice, 2008: 6). The programme has two very clear short-term goals: one is to empower and enable carers; the second is to engage, connect and mobilise the personal community of the carers to share the caring experience and familiarise them with dying. If it is able to achieve these two short-term goals, the CMP will achieve its greater longterm goal of more people dying at home and hence more people becoming familiar with dying. The establishment of networks and the development of trusting and caring relations are important goals of communitydevelopment programmes at the end of life (Kellehear, 2007). The programme is designed to complement, rather than replace, other essential services being used by carers and their loved ones, including other volunteer services. The programmes focus is therefore on the informal volunteers who exist, waiting to be mobilised, in the carers personal community. It differs from other models, such as the Neighbourhood Networks in Palliative Care programme in Kerala, India (Kumar & Numpeli, 2005), which has developed a model of community support through training volunteers to work with their community and connecting people with a terminal illness to palliative care services and other health professionals. It provides volunteer community mentors who are trained by Home Hospice and have themselves cared for someone living with a terminal illness. Mentors, once invited by a carer, act as a guide and support person, and the role of the mentor is that of a knowledgeable friend. If and when it is desired by the 6

carer, the mentor will coordinate a meeting of neighbours and friends to enlist their support to help the carer. The mentor helps the carer to make a list of suitable people, then organises the network of friends, family and neighbours, as well as providing education and a context for this personal community to be involved in the care of a person dying at home. The majority of people do have connections with neighbours, friends and family who could help, but people feel they do not want to intrude. One mentor reected that The gathering together of friends something seems to happen after that. It changes something for the dying person as well. The issues around burdening the family tend to settle after these meetings. The way people learn to accept help is important the trust factor. The carers hand over responsibility to the family and friends. On average, these personal networks comprise 14 people and can be as large as 35 people (Home Hospice, 2008). The building of social capital begins when neighbours and friends come together. It is clearly a programme that requires a high degree of trust and existing relationships can be renewed and strengthened when people work together on a project that is as important and emotional as providing a support network for a person who is dying. The programme also aims to create new norms around the care of the terminally ill. Being part of a caring network may bring a wider range of people to a new understanding of caring for dying people and increase the acceptance of dying as part of life, not something to shun. Conclusion Caring is a complex activity, with the potential for deep human connection and personal growth on the one hand, and for depression, isolation and exploitation on the other. Within an ethic of care, there must be attention to the way that caring is organised, supported and recognised, which can make the difference between a positive and a negative experience for both the carer and the terminally ill or frail person receiving care. Social capital may be a good litmus test for contexts of care, because social capital generation requires contexts that are not coercive, involve trustful community networks, trust and shared values around caring and allow for the exercise of agency. These two examples, one home-based and one institution-based, suggest that elderly care does not need to be a drain on social capital, nor does it need to be an isolating experience for either the carer or the older person. Rather, caring can contribute to social capital. In the case of the cooperatives in Sweden, social capital can be generated as the villagers came together to plan and lobby for the eldercare facility, and

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the cooperative structure encourages wide participation and a sense of agency. Further, as they were all centrally located and had activities for other ages as well, they could become a focus of interaction and participation in the town. Even the act of trying to defend the cooperative has been a rallying point in one village. In the Australian example, social capital is generated through the creation of a network of supporters for the carer. It is likely that the seriousness of the work of caring for the terminally ill increases the poignancy of the shared experience of the care network. It is a circumstance that requires a high degree of trust which, if well-founded, will generate stronger bonds. As the network is self-organising, there is room for the exercise of collective agency. A question arises about the exploitation of the mentors who are providing a free service that often requires a high level of skill and resilience. Most services in Australia are started by dedicated volunteers, and only after they have demonstrated their worth is government support provided. Home Hospice may well be on that path. There is, however, a concern within the organisation that government funding requirements would stie the organisations agendas around community development and attitude change. Community-managed centres linked to other activities is one possible model. Networks of volunteers supporting the carer is another. Older people in Sweden are increasingly looked upon as a resource in society, either as taxpayers or as young olds capable of taking part in voluntary work (Eriksson, 2004). There may be a need for more volunteering in Sweden and the development of an ethic of personal caring to improve the quality of life of frail and terminally ill people. However, if volunteering is to become a signicant part of caring in Sweden, then it needs to be supported and given public recognition. Volunteering in the context of the cooperatives can be structured to further build social capital while still contributing to the nancial viability of the organisation. Because the volunteers would be members of the cooperative, they would contribute to the management and decision making, and voluntary activities could be designed so as not to be burdensome to the volunteer. Such cooperatives still need support from their municipalities. With municipalities buying fewer services, employment in caring is becoming insecure and general trust in the welfare system is declining. All the Swedish cooperatives spoke about their vulnerability, as they are now heavily dependent on the municipalities willingness to buy services from them. In Australia, volunteering is lauded in government policy as a contributor to social capital; however, this is not true of all volunteering and it is certainly not usually true of caring for a family member in the home. Rather, in the case of care work, social capital has been

seen as a resource that can be drawn on by frail elderly people and their carers. What Home Hospice demonstrates is that with a little support, caring networks can be much more effective for the carer and potentially contribute to social capital, as the people in the network interact in a meaningful activity. Small rural towns in Australia could also benet from the Swedish model of local centres linked to other community activities. There is a major concern that governments interest in social capital is solely about saving money on service provision. But when states are relying on the social capital of the citizens, it seems reasonable that they should identify and support models that replenish the supplies. The cooperative model and the support network model are, no doubt, only two of the possible ways that caring needs can be addressed in ways that are also likely to generate social capital. Whatever models are developed, there is a need to link the micro and macro levels to bring the resources of the wider society to support individuals and communities. In both Sweden and Australia, there are government-funded alternatives for the elderly and terminally ill, but people have been prepared to go to considerable lengths to set up alternatives. The government-funded options were considered to be too large scale, impersonal and geographically distant. Although it may be more efcient to fund fewer larger facilities, it is not effective if it is not providing the support people require. Government needs to recognise the need for small local and home-based exible services. Any extra expense for such small-scale services can be addressed with creative links to local resources and formal and informal networks, which has the effect of building the communitys social capital. The examples give some insights into the many ways that care can be integrated into social practices. Indeed, Sevenhuijsen (2000) suggested that social policy packages should be designed in such a manner as to assist integration into as wide a range of social practices as possible. Such an integration requires the linking of the micro and macro levels. For example, community development positions or resourcing organisations could be created to provide links between carers and existing services and assist in the development of networks, facilities, organisational structures and new services. People who are doing care work do not have the person resources to access and develop the support they need, but without support carers are likely to be isolated and suffer from burnout. Further, linking the micro and macro levels requires policy makers to have a greater understanding of the relational nature of the ethic of care. As Barnes (2007) has argued, policy makers need to have elaborated insights into the way individuals frame their responsibilities in the context of actual social practices and how they handle the conicting responsibilities of care for 7

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