Living on social assistance with chronic illness: Buffering and undermining features to well-being

Anneli Marttila,Eva Johansson,Margaret Whitehead,Bo Burström

doi:10.1186/1471-2458-10-754

Abstract

BackgroundIn Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.MethodsSeventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.ResultsThe study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.ConclusionFrom this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.

Highlights

In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension
In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living with sufficient income, either through sickness benefits or through disability pension, based on the principle of income replacement [1]
Contextual features like the prevailing welfare system including rights to benefits and benefit levels, access to and responsiveness of services as well as social relations and networks could buffer or undermine individuals’ strategies and their well-being as a whole

Summary

Introduction

In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living with sufficient income, either through sickness benefits or through disability pension, based on the principle of income replacement [1]. As the system is designed to cater for those who have worked for some time, there is a proportion of the population who do not qualify for such benefits Their last resort is social assistance, provided by the municipal social services. Social assistance is considered to be a temporary resort but in 2009 over one third of all recipients were classified as long-term recipients (had received social assistance for at least 10 months). [5]

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