Changing long-term care provision at the local level in times of austerity – a qualitative study

Abstract

In the first decade of the century, long-term care (LTC) policies for dependent older people in Italy were improved with respect to both the availability of public funds and the quality of services. At the turn of the decade, however, cost-containment and austerity measures were imposed as an overall priority for the public sector and this goal also affected the LTC sector. This article explores the effects produced by cost-containment policies, which widened the gap between care needs and available public funding, on the provision of LTC services at the local level in Italy during the economic crisis. The study is based on 34 semi-structured interviews with services managers employed in Italy's publicly funded LTC system. Data were analysed with the framework analysis method and six cross-cutting thematic categories were identified that depict, according to the interviewees, the main transformations that occurred in the provision of LTC at the local level as a consequence of cost-containment policies. ‘Uncertainty’ refers to the inability to predict what direction the LTC system is going to take in the foreseeable future. ‘Short-termism’ illustrates the pressure to focus excessively on day-to-day service delivery at the expense of a medium- to long-term view of their future. ‘Endangering quality’ describes the risk of not being able to maintain the level of quality of care achieved so far. ‘Allocative tensions’ refers to the tensions due to the increasing requirement to ration the provision of public LTC services. ‘Unequal re-familiarisation’ represents the very different impacts of the trend of re-familiarisation depending on families’ financial situation. ‘Inappropriate care’ depicts the rising number of older people receiving public care interventions that are not appropriate to meet their needs.

Cash‐for‐care payments in Europe: Changes in resource allocation

“…They are delivered as individual rights exclusively according to care needs. Thus, CfCs differ from the system of services in kind, generally ruled at decentralized level and provided not as entitlements but—to various degrees—on a discretionary basis, conditional upon budget availability and upon claimants' economic circumstances (Gori, ). The Netherlands confirms here its role as an “outlier” in our surveyed countries, with CfCs that play a “residual” role, both in quantitative (% of users) and historical terms.…”

Regulating the delivery of cash‐for‐care payments across Europe

“…In both countries, in fact, regulative and allocative issues are considered to be different parts of a single issue: the possible reform of CfCs. In this context, the high level of disagreement on possible changes to the eligibility criteria has been a stumbling block for any possible reform of CfCs, including regulatory issues (Barbabella, Chiatti, Di Rosa, & Gori, ; Comas‐Herrera, Wittenberg, & Pickard, ; Glendinning, ; Gori, ).…”

“…In this context, the high level of disagreement on possible changes to the eligibility criteria has been a stumbling block for any possible reform of CfCs, including regulatory issues (Barbabella, Chiatti, Di Rosa, & Gori, 2013;Comas-Herrera, Wittenberg, & Pickard, 2010;Glendinning, 2017;Gori, 2018). Table 3 recaps the evolution of the CfCs regulative frameworks for each country, highlighting the policy trends and associated dimensions.…”

Long-term Care Financing: Inserting Politics and Resource Allocation in the Debate Comment on "Financing Long-term Care: Lessons From Japan"

“…The "why" question concerns policy legacy, cultural norms, institutional frame, social and economic context, role of political and social actors, broad political context and so on. A glance at both the various national trajectories in LTC financing occurred since the nineties across OECD -mentioned above -and the different reactions to recent times of austerity [16][17][18] highlights the importance of the political variable. In brief: an extensive knowledge on how to collect public resources should be matched by an equally extensive understanding of the reasons why politicians aim (or not) to devote more resources to LTC.…”