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Changing long-term care provision at the local level in times of austerity: a qualitative study
- Author:
- GORI Cristiano
- Journal article citation:
- Ageing and Society, 39(9), 2019, pp.2059-2084.
- Publisher:
- Cambridge University Press
This article explores the effects produced by cost-containment policies and austerity measures, which widened the gap between care needs and available public funding, on the provision of long-term care (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. (Edited publisher abstract)
Regulating the delivery of cash‐for‐care payments across Europe
- Authors:
- GORI Cristiano, LUPPI Matteo
- Journal article citation:
- Social Policy and Administration, 53(4), 2019, pp.567-578.
- Publisher:
- Wiley
The article aims to understand how governments across Europe have modified the regulation of the delivery of cash‐for‐care schemes (CfCs) to dependent older people since the beginning of the century. In our terminology, the regulation of the CfCs delivery defines the norms, rules, and practices that public actors adopt to manage how beneficiaries can use the benefits. To discuss the regulation of CfCs delivery, an original framework is employed that take three analytical dimensions into account: the degrees of freedom in benefits' utilization (“CfCs utilization” dimension), the provision of information/orientation/advices/counselling to older people and families (“professional support” dimension), and the relationship between the delivery of CfCs and the delivery of the other publicly funded long‐term care inputs (“care system” dimension). The analysis adopts a comparative perspective, looking at six countries—Italy, Austria, the Netherlands, France, Germany, and England. Among various findings, the main one consists in showing that there has been a shared and increased interest in consolidating the regulation of CfCs delivery. This trend has been mostly directed towards the new policy aim of strengthening the professional support, a goal underestimated in the past, when this dimension was not a major topic of both debate and practice concerning CfCs across Europe. (Edited publisher abstract)
Home care in Italy: a system on the move, in the opposite direction to what we expect
- Author:
- GORI Cristiano
- Journal article citation:
- Health and Social Care in the Community, 20(3), May 2012, pp.255-264.
- Publisher:
- Wiley
In Italy, the public system of home care for older people is underfunded and mostly cash-oriented; a system, thus, relying almost entirely on informal care provided by the family. This article analyses how the provision of home care in Italy has changed in the last decade. It discusses the reasons behind the increased uptake of the Indennità di Accompagnamento (IA), a “companion payment”. It examines an increase in the needs and demands of older people; the traits of the Italian welfare system; and the peculiar features of the companion payment itself. The article then looks at why services in kind rose to a lesser degree, pinpoints the main reason as being based on the politics of social care at national level, and finally focuses on the challenges that the Italian home-care system has to face within the changed policy environment with respect to quality of care, carers’ conditions and support for older people with high-level needs.