Long-term care (LTC) is a rapidly evolving policy field. The ageing of population, increasing health care demand and costs, higher female labor force participation and the contraction in the provision of informal care are pushing forward a policy field that has become one of the central elements of social investment strategies.

Although with different rhythms and forms, most developed countries have been shifting from a traditional poor-relief oriented set of care services towards a more universalistic system of LTC. Such reforms have affected multilevel governance arrangements (MLG), and reforms have been eased or hindered by those arrangements. Traditional poor relief care services are usually local and fragmented, and while some reforms have focused on redefining the role of local authorities, others have set up new centralized systems. MLG arrangements are not always the same for health and social care, both of which are involved in LTC.

The impact of this growing complex interrelationship of LTC policies, from a territorial and institutional point of view, seems to be ambivalent. Indeed, fragmented authority may discourage or slow down reforms due to veto and cost-shifting strategies, ease retrenchment and increase territorial inequalities. But it may also support the development and endurance of social programs. The “layering” of governance levels is crucial: a clear attribution of responsibilities and resources among levels of government (“virtuous layering”) can allow for coordination and local adequacy. Poorly framed inter-institutional relations (“vicious layering”) may cause multiple problems.

This panel addresses the problems of MLG in the field of LTC policies (for instance dependent elderly people and adults with disabilities). We welcome papers that focus on models of multi-level governance in this field (single case studies or comparing countries), and on their effects and impact and recent trends in the wake of the ongoing great economic recession.

Stream convenors

Marco Arlotti - Laboratorio di politiche sociali, DATSU, Politecnico di Milano, [log in to unmask]