Sweden has a well-developed system of long term care, based on taxfunded services that are mainly publicly provided. This system has changed significantly in the last few decades. Following the way in which the policy agenda is structured in Sweden, this paper focuses on elderly care, but some of the key interactions between the disability and elderly care systems are discussed, as well as the boundaries between elderly care and health systems. The main trend in provision of elderly care has been, counter to most other European countries, reduced expenditure and coverage of services, but also a very low and falling coverage of cash benefits for family carers. As a consequence of this trend, there has been an off-loading to unpaid family care (informalisation) as well as to privately financed and privately provided market care (marketisation).only subscribers can see the full article

The introduction of Long-term Care Insurance in 1995 in Germany brought a fundamental change in long-term care policies related to social rights, mode of funding and care provision. Before the introduction, long-term care was defined as a responsibility of (mainly female) family members with public support means-tested. The essay examines the principles of Long-term Care Insurance and some significant adaptations since then. It draws on a new-institutionalism approach and analyses the role of actors, their interests and ideas as well as institutional conditions of the reform process. In addition, it considers the reform’s effects. The research reveals both processes of fundamental change and gradual adaptations.only subscribers can see the full article

The essay offers a general interpretation of the changes taking place in long term care (Ltc) policies in the last 20 years in Europe. More specifically, the essay provides three general conclusions. The first concerns the general impact of the reform of Ltc policies in terms of retrenchment, restructuring or expansion. The second is related to the functioning of the political mechanisms and institutional processes through which change has been made possible, notwithstanding financial pressures and strong institutional resistance to innovation. The third is the impact of change on workers and providers in the Ltc field.only subscribers can see the full article

Among the Nordic countries (and together with Norway) long term care policies in Denmark are the most universalist in terms of coverage; further, in contrast to the other Nordic countries, Denmark combines institutional change from below (non-legislative changes) with institutional change from above (legislative changes). The paper describes these changes, that have been oriented towards a marketisation and a better tailoring of services to individual needs. Taken together these lead to contradictory developments towards both standardisation and flexibility. The analysis will show how innovation has two, potentially contradictory sides: it is concerned with both «securing » and «extending» the welfare rights of citizens and therefore encompasses both measures of control and measures of free choice.only subscribers can see the full article

France is characterized by the introduction of a new Ltc program (the Apa, Allocation Personaliseè a l’Autonomie) since 2002, providing a combination of service and cash to the dependent elderly population. The paper describes the factors leading to this reform and the political process that has characterized its approval and following implementation. In recent years there have been new changes, potentially leading to stronger recognition and public support of private long term care insurance. This turn towards the market will be analytically discussed, showing the political process and the actors that have been involved, and looking at the possible social and institutional impacts of the marketization of long term care.only subscribers can see the full article

Every day it becomes clear that the limits to public-sector growth in the social services and the ongoing socio-demographic changes over the last twenty years are forcing us to reconsider, at both national and European level, feasible ways of tackling the care needs of the elderly. The ageing of the population has brought out two main problems: on the one hand, there has been an increase in the number of old people who require public assistance; on the other, there has also been an increase in the financial pressure imposed on traditional intervention programmes due to the additional social demand and to the strain it puts on public resources. It is this contradictory combination of factors that has led to both the difficulties that the various welfare systems find in carrying out policy reform for long-term care that can deal with this new social emergency, and the overall stop-go, if not inertia, of the ongoing processes of institutional reform in the various European countries. As this research shows, these processes are the prevailing feature, along with the widespread recalibrating of existing policies and interventions, both in terms of their structure and what is on offer.only subscribers can see the full article

The article defines the hypothesis and the conceptual tools used to analyze Ltc in Europe. In the first part a definition of the long-term care policy field is provided in order to identify the policy field. As the boundaries of long-term care have been differently designed in each country, this part also aim to identify the main differences occurring in different countries. The second part is focused on the social and political drivers of the institutional changes in this field in the last two decades. Then a specific analytic toolkit is described in order to analyze the institutional mechanisms through which change has developed in this policy field, focusing on the reasons why innovation takes place, the actors that are involved in this change, and the political and institutional mechanisms that are used in order to make innovative decisions and implement them.only subscribers can see the full article

The foundation of the current Dutch long-term care system dates back to the end of the 1960s, when compulsory social insurance to cover the costs of «exceptional medical expenses» (Awbz) was introduced. Since then the system has undergone a continuous process of reform. The essay reconstructs the original logic of the system through a historical and institutional analysis. Then the trends towards reform are considered, looking at how the problem of change has been constructed and at the actors playing a relevant role in this process. All these aspects are described and critically reviewed in order to understand the directions and impacts of institutional change.only subscribers can see the full article

The paper defines the broader context of reforms in long term care in Austria in the last two decades. The essay focuses on the 1993 «cash for care» reform, looking at the content of the reform, at the concrete mechanisms that have allowed institutional change, and at the coalitions of actors who have pushed for change. In recent years a new major reform has been introduced, focusing exclusively on the regularization of personal care in the private household without touching upon the broader Ltc context: the last part of the paper describes this innovation by considering the drivers of the growing migrant care market, the mechanisms that have allowed institutional change, and the role of government, media, and disability movement in this change.only subscribers can see the full article

In 2006 Spain introduced a new public long-term care programme regarding the Promotion of Personal Autonomy and Care for Dependent Persons. The paper develops an analysis of the main social and political factors and mechanisms driving this importantreform. The factors of innovation are identified, by considering cultural changes related to responsibility for care, new facts emerging in the organisation and provision of are, the policy legacy factors. In the second part the institutional mechanism of decision making and implementation is described and the new model of Ltc provision that have been established in Spain is described, focusing on the extension of coverage, the intensity of protection offered, and the sharing of responsibilities between central and local authorities.only subscribers can see the full article