Elderly care in changing societies: Concurrences in divergent care regimes – a comparison of Germany, Sweden and Italy

Abstract

European countries are facing social changes that are challenging their long-term care (LTC) systems in different ways. The ageing population and the decrease of care potential in families have led to different paths of modification to traditional care regime organization. This article compares the LTC policies of Sweden, Germany and Italy, three countries that have traditionally been regarded as representatives of distinct regime types in care regime typologies. The interrelation between policy reforms, changing state support, patterns of care arrangements and the commodification of care work is compared between the three countries. The analysis aims to reveal the basic dimensions of (changing) LTC policies and their effects in these countries; trends of convergence and divergence between the three regimes; and the main characteristics of the changed care regimes. Despite a trend to convergence characterized by a redefined involvement of and a complex mixture of state, market and family resulting in an increased precarization of care labour, the countries analysed still represent different care models. In particular, the amount of state support, the emphasis on family care versus professional services, and the role of different state levels in the governing system and reform paths are the key elements that mark the organization of national LTC.

The discursive politics of marketization in home care policy implementation in Ireland

“…Front line actors encounter the material and discursive logics of marketization, as they interact with market forces that shape their access to resources, conditions of service delivery and governance of occupational roles and duties (Dahl, 2017). Marketization of home care is often analysed using institutional or regime analysis that produces typologies of countries grouped by traditions of state provision and the degree to which market forces shape care policy (Ranci & Pavolini, 2013;Theobald & Luppi, 2018). These analyses establish the broad contours of change yet place little emphasis on care policy implementation or how ground-level implementing actors interpret such changes.…”

Between Migrant Care Work and New Occupational Welfare Tools: Changing Home Care Arrangements in Italy

“…Indeed, less than two years later, a draft national law containing a series of measures to support informal caregivers was presented. Taking inspiration from legislation in other countries (e.g., the Spanish national reform on LTC), this law included a specific definition of familial caregivers and identified tax, social security and work inclusion measures for them [ 2 , 8 , 50 ]. Due to the end of the legislative period, the law was not adopted, but it was a clear sign of the increasing attention paid by the Italian society and its national political representatives to informal care issues and to the need of providing more systemic responses to unmet LTC needs.…”

“…A real challenge, in this respect, is how to extend the room dedicated to home care schemes within OW agreements, by means of measures promoting specialised care services rather than cash or tax-free benefits (U2). The enhanced provision of services, instead of monetary measures, is another challenge for OW schemes as well as for the LTC in Italy [46][47][48][49][50]: a real revolution to this purpose would be accomplished by a greater presence and use of service measures, instead of the tax incentives that are the focus of current strategies (U3).…”

“… Theobald, H.; Luppi, M. Elderly care in changing societies: Concurrences in divergent care regimes–a comparison of Germany, Sweden and Italy. 2018 [ 50 ] …”

Long-term Care Hospitals and Changing Elderly Care in South Korea

“…Its implementation mostly followed neoliberal lines, with its strict eligibility criteria and market-oriented service provision (Yang 2017, 42-3). Typologically, the Korean regime probably sits between Germany and Italy, with a German-style reliance on social insurance for its financing and Italian-style market-based provision of care (Theobald and Luppi 2018), albeit without the latter's exclusive reliance on cash benefits and emphasis on the family as the locus of responsibility for care.…”