Not all that glitters is gold: Long-term care reforms in the last two decades in Europe

Abstract

This article explores changes that took place in long-term care (LTC) policies during the last two decades\ud in six European welfare states. In this regard, it addresses three issues: (1) why reforms took place, (2) the\ud main actors and coalitions driving this process and the institutional mechanisms at work and (3) the main\ud outcomes of reform processes. In order to analyse the development of LTC policies, the article applies\ud theoretical concepts of historical institutionalism. Our interpretation is that institutional change in LTC\ud policy has taken place through a protracted institutional dynamic in which continuity and discontinuity\ud are inextricably linked and where tensions and contradictions have played a crucial role. With regard to\ud outcomes, the article analyses coverage and citizens’ social rights, working conditions in the care sector\ud and trajectories of de-/re-familization of care. The final impact is that the level of universalism has generally\ud increased in Europe, but that in part it has adopted a new form of ‘restricted universalism’, characterized\ud by universal entitlements to LTC benefits constrained by limitations in provision due to financial constraints\ud and budget ceilings

Nordic eldercare – Weak universalism becoming weaker?

“…In their wide-ranging analysis of changes in long-term care (LTC) in six European countries in recent years, Ranci and Pavolini (2015) found that countries with less developed LTC systems have expanded their coverage and generosity -in other words, universalised -while countries with universalistic LTC models have moved in the opposite direction, towards what they call 'restricted universalism'. Our systematic assessment of the trajectory of change in Nordic eldercare deepens their analysis.…”

Marketisation policies in different contexts: Consequences for home‐care workers in Germany, Japan and Sweden

“…Germany and Japan provide examples of the universalisation of public support in a former residual system. In Germany, the focus is on public support of family care by cash payments, and in Japan (similar to Sweden), the focus is on the provision of publicly financed care services (Ranci & Pavolini, ; Saito, ; see the conceptual part of this article for the institutional dimensions of long‐term care systems).…”

European trends in social services’ systems: towards marketization, user-involvement and professionalization

“…The "New Public Management" approach has been criticized with the arguments that private sector methods, such as the aim to increase produc-tivity, can have a negative impact on working conditions and service quality, while Brennan and collaborators (2012) stress a threat for class based segregation due to limited access to private services. Ranci and Pavolini (2015) point out that application of this method in Sweden led to standardization of tasks and to a larger number of service users per care worker.…”

“…Yet, in many European countries, long-term care needs of citizens are only partly met through public services, while care responsibility also lays with users and their families. Because of this, many countries from Continental, South and Central-Eastern Europe are putting back the focus on provision of family care within their long-term care policies (Ranci, Pavolini, 2015). A comparative study (Rostgaard, 2002) found that most of the European countries researched, understood the invaluable contribution of carers to society, to the processes of decreasing the dependency on residential care (without informal care many care recipients would face institutionalization), as well as the need to ease the burden of care work, especially through provision of respite care services as they enable informal carers to take a break from caring responsibilities, but also continue their work while receiving recognition for it.…”