Institutional Business Power: The Case of Ireland’s Private Home Care Providers

Abstract

The marketisation of European home care has given rise to significant private for-profit providers growth. However, little research has focused directly on commercial companies to examine the mechanisms through which they emerge, grow and shape long-term care policy – this is this paper’s task. Drawing on the literature on business power, the recent concept of “institutional business power” is introduced, defined as the power flowing from the entrenched position of business actors in the provision of public social services. The paper identifies the mechanisms through which private providers have grown and assesses the extent of their institutional power by examining their influence on policy and the support they obtain from relevant home care stakeholders. The limits of providers’ institutional power are also discussed. The paper relies on semi-structured interviews with representatives of public, private and non-profit home care providers.

The Fate of Social Modernity

“…In a context of institutional frameworks opening LTC provision to commercial providers and chains (see Chapter 9), larger sections of both the residential and domiciliary sector have become populated by organisations who are rent-seeking or at least privately owned. As for care and nursing homes, this 'corporatization of care' (Farris and Marchetti 2017) is driven by companies and private equity firms that are operating nationwide or even internationally, in a market that promises a rather secure return on investment (Harrington et al 2017;Müller 2018;Armstrong and Armstrong 2020;Mercille and O'Neill 2023). Among other things, this is due to the overlap between the housing business and residential care, which implies that private providers sell real estate and human services in parallel (for many, see Horton 2021).…”

Home care workers' views of employment conditions: private for-profit vs public and non-profit providers in Ireland

“…Roughly 75% of private providers' income is from the state and 25% is from the private pay market (Mercille and O'Neill, 2021). There is also a growing trend towards “live-in” home care in recent years, and private for-profit providers are starting to capitalise by pursuing their business interests in this area (Mercille, 2023). This article focusses on “formal” home care, which is significant in Ireland, though “informal” (family) carers have traditionally provided most of the care in the home (Daly, 2018).…”

“…The trend in Irish home care is towards concentration of ownership and the large multinational care operators have consolidated in recent years. Private providers have gained “institutional business power” and are now key actors in home care who have significant influence over policy (Mercille and O'Neill, 2022).…”