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labour market
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health policies
Aging
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anziani
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The italian journal of social policies
last issue
Long-term care policies in Europe
National systems and reform processes compared
N4
2011
October - December
Description
Scritto da:
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.
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Introduction
Reforms of Long-Term Care Policies in Europe
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.
Change and inertia in family care systems
Policies for Long-Term Care in Italy: A Case of Gradual Change without Reforms
Italian long term policies have not been reformed in the last decade.
Inertia characterized the public orientation towards this policy field as
the main support measure for Ltc, created 30 years ago and still in
place, has not been revised in spite of the evolving demographic and
socio-economic panorama. This lack of action may also explain the
emergence of a huge private care market. Despite this, important
transformations have occurred around care issues in the country. This
article will focus on the factors that can explain why gradual – if partial-
institutional change has taken place even in a condition of apparent
paralysis.
Keywords: policies for dependent people :: institutional inertia :: Institutional change :: care needs :: private care market ::
Policies for Long-Term Care in Spain: A Hybrid System of Family Care and Institutionalized Risk
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.
Change and recalibration in universalistic systems
Policies for Long-Term Care in Sweden: Trends, Moving Forces and Consequences
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).
Paths for Change in Long-Term Care Policies in Denmark
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.
Long-Term Care Reforms in the Netherlands
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.
Long-Term Care Reforms in England: A Long and Unfinished Story
The paper presents the main changes that have been introduced in the
English Ltc system in the last two decades. After a general description of the structure of the long term care system as it has historically developed
in England in the last 50 years, the essay addresses the main
changes that occurred as a consequence of the 1993 community care
reforms and of the following new programmes that have been introduced
after that, aimed at empowering consumer choices, at better
recognising the rights of disabled people, and at offering a new cash
for care programme. Finally, a review of the role played by social and
institutional actors in the revision of the system is presented.
Change and slow development in insurance-based systems
Institutional Change and Gradual Development in Obligatory Insurance for Long-Term Care in Germany
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.
The French Path towards a Policy for Long-Term Care: Specific Features, Nature of the Process and Subjects Involved
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.
The Reform of Long-Term Care in Austria: A New Pillar of the Welfare State Emerges and Develops
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.
Conclusions and comparisons
Demand, Measures and Systems of Long-Term Care in European Countries: A Comparative Picture
The contribution contextualizes the analyses carried out in the other
studies in this number of the Rivista, offering a general reference
frame for Ltc policies in Europe. If the other essays offer an analysis
of the processes and quality of what is happening in the field of policies
for the non-self-sufficient, here there is a useful quantitative basis
that can provide a comparative view of the various countries under
study against the more general background of the changes in social
demand and institutional responses. The essay is structured around
four themes: the characteristics and changes in the demand for care
for the non-self-sufficient; the organization of informal care; the organization of public supply; and the effects of the various «care regimes» on the users and on their informal carers.
The Reform Process in Long-Term Care Policies in Countries of the European Union: An Attempt at Interpretation
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.
Features
Observatory Europa
Observatory Europa
In this number of Observatory Europa we illustrate some of the most
significant passages in the recent European debate. The first reference
is to economic governance: in October the European Council identified
the strategy for making the defence of monetary stability more effective.
From the point of view of the government of the Euro area,
the main modifications concern the nomination of the President of
the Euro Summit. Another important point concerns the reinforcement
of the European Financial Stability Facility (Efsf), and the introduction
of the European Stability Mechanism (Esm), a sort of European
monetary fund. In this number we reconstruct the stages between
June and October that produced these institutional proposals.
In the second part we analyse the main interventions on social policies:
the redefinition of the so-called «Monti-Kroes Package» on
services of general interest, the revision of structural funds and the
European cohesion policy, the question of food aid to the poorest
European citizens (still deadlocked) and the question of the social responsibility of business, which has been the object of a communication
from the Commission.
Keywords: social responsibility of business :: Monti-Kroes Package :: food aid :: economic governance ::
Other issues
Housing Matters: Ageing, Housing Policies and Innovation
The rapid, widespread ageing of the population is imposing on welfare
systems the search for strongly innovative policy solutions. In the large
urban centres, in particular, the need to deal with the phenomena of isolation,
solitude and impoverishment of social relations frequently experience
by the elderly is leading to new investment in social housing, the
encouragement of the capacities of senior citizens, and the extension of
solidarity. In this essay, after reviewing the main housing solutions for
the elderly adopted in some of the major European countries, the
authors present the first results of an in-depth study of the experiences
of senior co-housing in Sweden, Denmark, Holland and Italy
Social Rights in Europe after the Lisbon Treaty
Tracing the historical process that, with the Lisbon Treaty, has at last
led to the affirmation of an explicit guarantee of fundamental social
RPS
rights at the level of the European Union, the author reflects on the
limits of a protection that is essentially entrusted to the maieutic
properties of the so-called «dialogue between the Courts», in the absence
of an adequate strategy of European social policy, and underlines,
on the other hand, the need for a fresh political drive, and in
this sense of a «re-politicization» of the social questions that the present
dramatic crisis has once again placed at the centre of public debate
in the member nations.
incoming happenings
Roma, 24 e 25 Novembre 2011
Azione di sensibilizzazione promossa da «la Rivista delle Politiche Sociali»
