Aging and changes in family arrangements and female employment have brought about important policy developments in long-term care (LTC). Southern European countries have relied for a long time on family care and residual social care for the dependent elderly.Two paradigmatic cases, Italy and Spain, have shown two apparently different trends during the last 15 years: while in Italy, reforms seem to have been persistently blocked, in Spain, an ambitious reform has fallen short of expectations.Based on data on services and institutional arrangements, the article shows that a complex and inconsistent allocation of responsibilities across government levels, a sort of "vicious layering" of multilevel governance, may be playing a key role in this situation. The article discusses the dysfunctional effects of such arrangements, namely territorial inequalities, cost-shifting between government levels and towards users, and misallocation of resources.We suggest that the development and reform of LTC in Southern European countries must address these problems if they want to avoid getting marooned by a complex network of vetoes and resource allocation problems.
PurposeSpain departed from the Southern European tradition of residual long-term care services with the 2006 reform. The paper aims to present the main traits of the reform and its implementation, explores the reasons that may explain why the reform happened and to which extent and why it fell short of expectations.Design/methodology/approachThe article draws on available literature on the reform and on administrative data to present a complex and nuanced view of the reform process and its limits.FindingsThe reform was actually a measure to enhance and rationalize a preexisting process of social care services development, rather than the creation of a completely new care system. A rapid increase in female labor market participation since the 1990s and the looming demands of a late baby-boom and the subsequent fertility crash appear to be two key factors that explain both the previous development and its bolstering by the reform. The budgetary constraints of the Great Recession and governance problems, linked to a complex and sometimes dysfunctional multilevel governance arrangement, help to understand why the reform bogged down. Nevertheless, the overall balance is more nuanced, and significantly more services are provided 12 years after the reform.Originality/valueWhile many assessments of the reform have been negative, putting it into a larger context of social care development, the 2006 Dependency Act has contributed to a significant increase in expenditure and coverage. The impact of budgetary restrictions has been important, but other factors, such as governance arrangements, may explain more of the problems of the implementation.
1 Este artículo es una versión corregida del capítulo del mismo título publicado en Miguel Laparra y Begoña Pérez (eds.), El primer impacto de la crisis en la cohesión social en España, Madrid, Fundación FOESSA y Cáritas Española, 2010 Gainkarga gertatzen ari dira gizarte-zerbitzuen alorrean krisialdiak sortarazi dituen ekonomiamailako herritarren zailtasunak. Arazo horietako batzuek orain horren larriki azaldu arren, krisialdiaren aurreko arazoen ondorio dira. Arazo horiek zerikusia dute Espainian nahi izandako Estatu sozial modernoaren gizarte-zerbitzuak ezartzean gertatutako hutsegitearekin, eta geldiaraztearen erantzule da, baita ere, ongintzan indartutako eredua eta laguntza jasotzeko sarbide izateko arautu gabeko babes ekonomikoaren kudeaketa. Egoera hobetzearren aurkezten dira zenbait proposamen, adibidez, gizarte-zerbitzuen eta laguntza sozialaren funtzio propioak bereizten, edo gertutasuneko laguntzearen aldeko espazioa eta ekintza komunitarioa indartuz. Hitz-gakoak:gizarte-zerbitzuak, bazterketa, gizarteratzea, pobrezia, laguntzea. Las dificultades económicas de muchas personas ocasionadas por la crisis están suponiendo una sobrecarga para los servicios sociales. Parte de los problemas que se presentan de forma especialmente aguda en estos momentos, sin embargo, derivan de problemas anteriores a la crisis. Dichos problemas tienen que ver con el encaje insatisfactorio de los modernos servicios sociales en el Estado social en España, con el peso del modelo tutelar de la beneficencia y con el colapso del espacio de la incorporación y el acompañamiento bajo el peso de la gestión de una protección económica discrecional. Se proponen vías de salida de la situación, como la diferenciación de las funciones propias de los servicios sociales de las de asistencia social, y la apertura de espacios para el acompañamiento desde la proximidad y la acción comunitaria. Palabras clave:servicios sociales, exclusión, incorporación social, pobreza, acompañamiento.
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