Negotiating care in the context of Finnish and Italian elder care policies

Abstract

Negotiation is an integral part of all elder care, which by definition involves a relation between at least two people. In this article, we analyse negotiations concerning elder care in the context of Finnish and Italian elder care policies. At the macro level negotiations on elder care are shaped by elder care policies and at the micro level by individual skills and resources. Our focus is on the negotiations on eligibility that take place when elders attempt to access care. The data consist of qualitative interviews with Finnish and Italian elders in need of care. The analysis of individual experiences of care negotiations reflects the practical consequences of elder care policies to older people. The results indicate that the most negotiated eligibility criteria when seeking access to elder care are need, money and social relations. These criteria are negotiated when seeking eligibility to different sources of care: informal care, grey market, market-based, non-profit and public services. In Italy, negotiation is particularly crucial when accessing grey market care. Cash as the main Italian elder care policy tool tends to enhance the role of and need for negotiation. In Finland, a greater part of elder care is provided by the public sector and therefore the process of negotiation is more standardized than in Italy.

People with memory illnesses and their spouses as actors in the hybrid care model

“…These results concur with arguments that the Finnish welfare system is increasingly becoming a self-service system, forcing citizens to be active or needing family members to help them (Aaltonen et. al., 2021;Anttonen & Karsio, 2017;Jolanki et al, 2013;Zechner &Valokivi, 2012). When a person is in a vulnerable position and has multiple health and social problems, it is understandably difficult to 'fight their own corner' and this clearly goes against the whole idea of welfare services (Eskola et al, 2022;Halonen et al, 2021).…”

“…Care is provided by family members and friends in a vast proportion of the populations in different countries and the estimated monetary value exceeds public funding for care (Colombo et al, 2011). The forms and the degree of support provided for family carers varies considerably, and Northern European countries are an example of wide coverage of public care services, whereas Southern European countries rely heavily on informal care as public spending on old age care services is scant with most countries having different care-mix combinations (Kröger & Bagnato, 2017; see also Zechner & Valokivi, 2012). However, the overall trend in Europe has been from formal care to informal care and increased reliance on families to take on care responsibilities (Kröger & Bagnato, 2017).…”

“…In Finland, family care has become an established part of formal elder care through care allowances, home care services, and respite care arrangements, all provided by municipalities (Ministry of Social Affairs and Health, https://stm.fi/omaishoito). Although families' roles in assisting older adults and even giving daily care has always been important, it can be argued that Finland has joined many other European countries in 'activating' policies that encourage citizens to take responsibility for their own wellbeing and care, and take on care roles (Geissler, 2005;Zechner & Valokivi, 2012). Comparative studies have shown that Norway and Finland favour family care more than other Nordic countries (Rostgaard et al, 2022).…”

Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth

“…In Finland and Sweden, supporting family carers via home help services and combining work and family life are widely supported in the analysed documents. Despite the legislations' emphasis on the responsibility of the municipalities, the actual responsibility of family members is strongly interwoven into the care of older adults with care needs (Zechner and Valokivi, 2012). Families carry out most of the care responsibilities (Ulmanen and Szebehely, 2015), and there is reason to assume that the relatives of older people with great care needs must put significant efforts into organising and delivering their care.…”

Analyses of welfare-state reform policies towards long-term senior care in a cross-European perspective

“…Zechner and Valokivi (2012) found that in Italy, where the care relationship is mainly organised on the basis of cash-for-care programmes, negotiations are the main factors in determining the care relationship. In Finland, where care is mainly organised on the basis of public services, there is clearly less need for or possibility of negotiation over care relationships.…”