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19-21 settembre 2013, Università della Calabria, Arcavacata di Rende (CS)
19-21 settembre 2013, Università della Calabria, Arcavacata di Rende (CS)
In un tempo in cui l’incertezza sul futuro condiziona drammaticamente l’Unione Europea la conferenza si interroga sulla sua integrazione sociale e politica.
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social policies magazine archive
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Long-term care policies in Europe
National systems and reform processes compared
4
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.
To buy this issue go to the italian version
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: Institutional change :: care needs :: policies for dependent people :: institutional inertia :: 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.
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.
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: economic governance :: Monti-Kroes Package :: food aid :: social responsibility of business ::
The Dispossessed
Analysis of the limits and generational imbalances of work, welfare and services
3
2011
July - September
Description
In a period of global economic and financial crisis the youth question is an urgent challenge for the governments of all western countries.The number examines the main subjects on the agenda concerning the youth condition in Europe and Italy, offering detailed pictures of the youth labour market, the brain drain, the serious lack of activity between the end of study and the beginning of work, and the logics that have overseen the recent reforms of the school and university.Many of these analyses bring out the dramatic situation in the South, and all of them are dominated by the question of precarity, which is the “key word” analysed in this number (Standing).There is a discussion of the proposal for a guaranteed contributory pension to cope with the risk of insufficient pensions income from young people whose periods of work are at present discontinuous. The contributions on the imbalances and employment and social policies in many European countries are followed by articles analysing the often difficult and risky work conditions of young people with a job, the processes of transition from school to work, the presence and role of services in encouraging employment of young mother.
To buy this issue go to the italian version
Focus on Italy
Young People and the Labour Market in Italy
Young people find it much more difficult to enter the labour market in Italy than elsewhere. The long transition from school to work is accompanied by low employment levels, high unemployment, and a
growing concentration of temporary jobs, with the risk of being permanently without tenure. The reforms of the last few decades have increased the flexibility of the labour market, above all encouraging short-term contracts, so as to make it easier for young people to find work. This has led to an increase in segmentation, with young people concentrated in temporary jobs. High youth unemployment was reduced up until the crisis, but at the cost of increased job uncertainty. The impact of the crisis on young people was particularly dramatic, because of the large number of short-term contracts. The worsening of the employment picture has eroded the feeble progress registered before the crisis, emphasizing the existing critical factors. Given the uncertain prospects of growth, the persisting difficulties young people experience in the transition to work risk producing worrying longterm effects.
Keywords: labour market :: flexibility :: youth unemployment :: short-term contracts :: job uncertainty ::
Young Talent leaving Italy: Sources, Data and Policies of a Complex Phenomenon
Public interest in the brain drain has grown noticeably in recent years. One of the factors behind the emigration of qualified young people is increased international competition to develop and attract the best talents, whose value is regarded as one of the key elements in the development of advanced economies this century, and this competition is creating serious difficulties for Italy. This article offers a reading of the phenomenon that starts from the scientific literature and examines some national and international data, with special attention to the most critical aspects, including the costs and potentially positive implications of the phenomenon.
NEETs. Territorial Disparity and the Difficulty of Entering the Labour Market for Young Italians
This contribution analyses the worrying phenomenon of young people who are Not in Education, Employment or Training (NEETs) and, more generally, the problem of the great difficulty young people experience in gaining access to the labour market, on the basis of the data of Istat’s Survey of the Labour Force and its ad hoc 2009 investigation «Young people entering the labour market», devised in collaboration with the Eu. The analysis suggested brings out how significant territorial differences in young people’s participation in the
labour market are already visible when leaving the educational system, and how the significant economic and social vulnerability of young people, particularly in the South, makes necessary the creation of suitable job opportuntities, if we are to avoid losing whole generations of young people, who risk permanently exclusion from the labour market despite their increased qualifications.
Recent Reforms of Secondary School and of University in Italy: a Critical Look
The essay looks critically at the recent reforms of the secondary school and university, partly in the light of the July Budget. The impression given by the details of these reforms is that budgeting considerations have prevailed over supposed criteria of improving quality and efficiency. What is certain is the limited funds for both school and university, with ageing, demotivated and ill-paid staff. The educational process is the motor of a community’s development, and also a formidable promoter of social mobility if properly planned and administered. The recent reforms do not seem to be moving in this direction.
European comparisons
Europe. Work and the Young, between Inequality and the looking for a New Sense
There may be varying levels of seriousness in the various institutional and welfare systems, but the generational segmentation of the labour markets in Europe have not only become structural but originate in
policies that are either wrong or, at least, incomplete. For reasons that have not been fully explained – but in the case of Italy may depend on the family’s role as a social shock-absorber – this inequality has not so
far given rise to genuine inter-generational conflict, even though there have been signs of a possible increase in protest movements. Yet it seems unlikely that having a pension and a permanent job can be
what is at stake in this conflict: in western societies, the young have developed a new work ethos and the expectations of change for Generation Y involve the whole relation between work and life and radically new ways of working.
Becoming Adults in Europe. The Footprint of National Societies on Forms of Youth Emancipation
The article illustrates the existence of various social constructions of youth and analyses their main political, economic and cultural foundations by a statistical and qualitative comparison of the family and professional paths of young adults in Denmark, the Uk, France and Spain. The analysis brings out the influence of society on this period of life, differentiating the trajectories and experiences associated with entering adult life: depending on how the state, educational systems and family rules that characterize them intervene, these societies tend to institutionalize various forms of transition to adult age and to generate specific ways of experiencing it.
Poverty among young Europeans: Risk Factors, Persistence, Correctives
This study analyses the factors associated with the persistence of poverty among youngsters in eleven European countries. Apart from the conditions that normally explain poverty and its persistence (low educational levels, living without a partner, leaving one’s original family, and joblessness), it shows the importance of the welfare system in attenuating the main risk factors to which young people are exposed in the process of transition to the adult state. It also shows how leaving one’s original family is one of the main risk factors for young people, while women have a greater probability of experiencing persistent poverty as a result of context variables and, in particular, inequality of opportunity.
How Spanish Young Adults try to Reconcile Work and Family and Achieve Emancipation: Comparative and Gender Perspectives
Working and forming a family is problematic for the Spanish, particularly for the «young adult» population between the ages of 20 and 29. It has become more difficult in recent years for this cohort to achieve emancipation and combine the two factors, due to economic instability, job uncertainty and the deficit of effective social policies in favour of new family units. In this scenario the strategies adopted to reconcile professional duties with the upbringing of children reproduce existing gender differences. This dynamic in turn reinforces familism as a socio-cultural and institutional structure based on women’s limited participation in the labour market and their greater role in the household and in reproduction.
Keywords: familism :: economic crisis :: gender inequalities :: independence :: job insecurity :: reconciliation policies ::
University Students in Transition to Adult Age. Comparing Italy and England
The article analyses the subject of equality of university experience, dwelling on the implications of using various combinations of welfare resources (deriving from the state, the family and the labour market) on
the levels of dependence and stratification of young English and Italian university students. The first section uses Eurostudent and national data to explore similarities and differences in support policies in Italy and
England, and their effects on young students’ transition to adult age. The second section analyses the impact of the reforms of 2010 in the two countries, bringing out, alongside the continuing substantial differences, the recent mechanisms of hybridization between the English and Italian systems, due to the growing role of family resources. The impact of these phenomena will be analysed in the light of the salience of concepts of «meritocracy» and «social mobility» in the national debates.
Research
The Working Conditions of the Young in Italy: Critical Elements and Risk Factors
The article examines the working conditions of the young in Italy from the perspective of the generational question, both specifically and in relation to wider changes in productive and social process concerning
the whole world of work. It presents the results of recent research on critical elements and the main risk factors at work for the young, to understand the reasons for their physical and psychological malaise and their high rates of accidents. The fragmentation of the production chain, the centralization of decision-making powers and the personalization of risk, which characterize both national and international production systems, penalize above all the weakest, starting from the new generations who enter a world of work where rights and protection are being gradually eroded, and are constrained by unemployment and the low quality of job opportunities, while there is a reduction in the power of individual and collective negotiation.
Research, Results and Cues for thought on the Reform of the Apprenticeship System in Italy
The article illustrates the transitions between school, training and work of young, professionally qualified people in the light of the ongoing process of redesigning the system of secondary education and
training. On the basis of information obtained by the experimental use of an inter-regional system of monitoring and evaluating the postqualification results, it analyses the employment position of young
people who have concluded a professional training course as a matter of right and duty. In particular it examines the use of apprenticeships as a means of entering the world of work and some factors that, along
with the educational preparation, lead to more or less successful results in the transitions of young people and their main mechanisms of inter-relation.
Intersections. Bringing up a family: the role of child-care services
The Provision of Childcare in Europe. The Barcelona Targets Revisited
Affordable and accessible quality childcare provision is extremely important for working parents. Throughout Europe, however, the provision, quality and affordability of childcare vary considerably, with each country having its own unique array of childcare arrangements. In this chapter we will provide an overview of the current state of affairs with regard to the provision of child care services in 27 Eu Member States and three Eea countries: Iceland, Norway and Liechtenstein. We discuss the use of child care services, the quality of the services provided and their affordability. The results suggest that the childcare issue will remain an important policy priority in the near future. Despite all the effort and improvements, high quality and affordable childcare facilities are still in short supply in quite a number of European Member States.
Regional Care Services as a Factor Emancipating Young Women. Shortfalls and Imbalances in the Italian System
Many studies on services for small children underline the importance of the availability of these facilities for female employment. This work offers an account of the provision of these services in Italy with the aim of identifying the link between young women’s presence in the labour market and the availability of care services for early childhood and for old age; it also sketches an analysis of the relation between the presence of services and fertility rates. A factorial analysis leads to a geography of local welfare in Italy, the picture that emerges being marked by strongly contrasting levels of provision in different areas.
Features
Discussion
Weak Careers and Expected Pensions: the Possible Correctives to the Contributory System and the Proposal of a Contributive Guara
The main critical factor in the contributory system is its inability to guarantee adequate pensions to those, like many young people today, who may have working careers that are long, but weak in terms of retribution,
risk of unemployment and contribution levels. In the light of this, the article reflects on the ideal policies for tackling these critical factors, evaluating – on the basis of considerations of efficiency and fairness – some of the measures proposed in the recent debate and giving particular attention to the possibility of introducing
a guaranteed pension calculated on length of service and age on retirement.
Key word
The Precariat
The author provides a detailed and committed analysis of the genesis, characteristics and conditions that define the precariat as a product of free trade and globalization. The number and variety of the social figures
involved – including the millions of frustrated, educated young people who do not like what their future holds – have in common insecurity, fragmented lives, professional alienation, oppressive labour and unremunerated activities. This condition can be assimilated to that of the denizen, an individual without full citizenship and with few recognized rights. The forms of inequality that afflict the precariat are structural and have nothing to do with merit or idleness. But they can lead to forms of estrangement from politics, and even populist and neofascist tendencies, which is another reason why a responsible policy should tackle the needs and aspirations of those filling their ranks.
Scenario
The youth Question in the Global Crisis. Roles and Responsibilities of European and National Social Policies
The economic, demographic, social and political trends that became established in the last thirty years and the global crisis that followed are having particularly negative effects on young people and their future,
particularly in Italy, where the backwardness of the production system is worsening the effects of the crisis. The article, which draws on some results of the «Report on the social state 2011» prepared by the author himself, also compares the situations of «fathers» and «sons». The condition of the latter is worsening, although this is not due to any selfishness on the part of the former, but to the worsening of the economic-social balance of the last thirty years, which is not so much ageist, as classist, discriminating against families and specific areas. The analysis of the European and Italian welfare systems is followed by some proposals for defusing the pensions bomb that is developing in Italy and that penalizes this generation of young people
above all.
Keywords: European Union :: economic crisis :: State welfare :: Youth question :: Italian economy ::
Observatory Europa
Observatory Europa. Periodical Note of Information on the Main News Concerning the Eu’s Social Action
The first European Semester (an intrinsic part of the new economic governance presently being activated) ended in June/July 2011. While some progress in coordinating economic policy is clear, concern for the worsening of the global financial crisis has not diminished. Although much of the community’s action is concentrated above all on negotiating a new aid plan for Greece, we are still awaiting some significant
progress. We are faced with a clear inability to deal with the structural problems: both of the integration process and of the development model that should guarantee an end to stagnation for member countries.
Meanwhile the adoption of the six legislative proposals that make up the «packet of economic governance», on which the European Parliament pronounced on 23 June, is progressing, with some difficulty. Announced for the plenary session in July, the vote on the overall package was not put on the agenda due to persistent differences between Council and Parliament. In a context of general uncertainty, which also calls into question the policy of free circulation of persons, the European debate continues, for example through the search for alternative indicators to Gdp.
Keywords: global financial crisis :: economic governance ::
