Resistance to change. The problem of high non-take up in implementing policy innovations in the Italian long-term care system

Abstract

This article illustrates how the implementation of 'interstitial' innovation in welfare policy can be hampered by resistance to change on the part of its intended beneficiaries by means of a case study of a policy innovation in long-term care in Italy: the Home Care Premium (HCP) programme. In a policy area characterised by longstanding institutional inertia, HCP represents an innovative programme which provides a generous, conditional cash-for-care benefit to encourage the regular employment of in-house care assistants. However, the implementation of the scheme was hampered by high non-take up (NTU) rates, i.e. the percentage of beneficiaries who did not claim the cash-for-care benefit for which they were eligible. The article uses a 'mixed method' approach to show how high NTU rates can be explained by individually 'situated' decisions taken by the intended beneficiaries based on cost-benefit evaluations that are deeply rooted in social attitudes and adaptive practices shaped by the existing institutional context. The study also shows how the policy design of the programme partially failed to manage the institutional complementarity of different welfare programs effectively, thus weakening the capacity of this 'interstitial' policy to bring about policy innovation. The results of the case study may therefore be of interest to scholars interested in policy change and the role played by beneficiaries in policy implementation.

The Impact of Micro and Macro Level Factors on the Working and Living Conditions of Migrant Care Workers in Italy and Israel—A Scoping Review

“…Out of the 33 included articles, 18 focused on Italy [ 29 , 37 , 38 , 44 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], 14 focused on Israel [ 23 , 39 , 45 , 48 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], and one article focused on both Italy and Israel [ 34 ].…”

Reputation stability vs anti-crisis sustainability: under what circumstances will innovations, media activities and CSR be in higher demand?

“…On the contrary, innovations are chaos giving birth to later sustainable practices. Resistance to change is a deeply studied topic, especially with regard to the restructuring of business processes and organizational development (Ranci & Arlotti, 2019). The authors study reasons and provide psychological explanations of employees' behavior inside the organization who resist the introduction of new, innovative in essence duties (Javed et al, 2018).…”

Care policies in practice: how discourse matters for policy implementation

“…Implementing actors interpret these policy frames according to their own conscious or unconscious gender, race, and class biases, which express particular norms and values about what care is, what gender is and who should take care of children and frail adults. For instance, common policy frames show that care is interpreted as a problem related to employment (Scala et al, 2019), to family well-being (Plomien, 2019), a private responsibility (Ranci & Arlotti, 2019) or as 'real work' but only if carried out by someone other than the spouse of the person needing care (Dussuet & Ledoux, 2019). The frames used by implementing actors differ in their underlying gender+ norms because of the differential emphasis they place on women as the main actors attributed caring responsibilities, on the goal of achieving greater equality between women and men, and the need to address other inequalities that intersect with gender in the social organization of care (Ciccia & Sainsbury, 2018).…”

“…Actors' resistance is a specific form of contestation that reveals the power of informal gendered norms and practices in hindering transformative change. The article by Ranci and Arlotti (2019) in this special issue shows that policy innovation promoting a shift toward professionalized long-term care in Italy was hampered by the existence of cultural norms and social attitudes which place primary responsibility for care within the family (and migrant care workers within the home). In this context, both the pitfalls of policy design and entrenched resistance among potential beneficiaries led to modest take-up rates of the new scheme.…”