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