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