Long-term care for older persons: an analysis of changing policies in France, Spain, England, Sweden and Germany

This project (part of an EU Framework Five project) analysed policy paradigms in the area of long-term care for older people in France, Spain, England, Sweden and Germany since the mid-1990s, drawing on a total of almost 100 qualitative interviews with policy makers. The study identified three paradigms that do not have much in common and that have not converged in any essential respects.

While the statist paradigm (to which Sweden continues to adhere) and the familialist/individualist paradigm (to which care policies in England and Spain belong) have experienced only minor changes, the ‘state pays, others provide’ (subsidiarity) paradigm to which France and Germany adhere has undergone extensive changes. Contrary to some other recent accounts of the development of social care systems, I argued that there are no signs of significant convergence towards universalisation, individualisation and formalisation in the long-term care policy paradigms in the five countries analysed here.

Despite the absence of significant convergence between the paradigms, there are two common themes that the long-term care policies in all five countries share, namely the emphasis on homecare (domiciliary or ‘community’ care) and the increased inclination to turn to the market as a source of care (marketisation).

This research was funded by the EU and the results were published in ‘Policy Paradigms and Long-Term Care: Convergence or Continuing Differences?’, Peter Taylor-Gooby (Ed.) Ideas and Welfare State Reform in Western Europe, Basingstoke: Palgrave Macmillan, 2005.