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

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.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