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Strategies of Care

Strategies of Care: Changing Elderly Care in Italy and the Netherlands

Barbara Da Roit
Copyright Date: 2010
Pages: 220
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  • Book Info
    Strategies of Care
    Book Description:

    This analytic study surveys the transformations of elderly care policies and practices since the early 1990s, by comparing the trajectories of two extremely different care systems: Italy, a familialistic model with no relevant changes in social policies; and the Netherlands, a formal care model under restructuring. The author demonstrates that, in spite of strong policy pressures, the Dutch system remains a formal care model and represents a case of institutional and social resistance to welfare restructuring By contrast, the Italian system has shifted from family-based to a mix of family- and market-based model, despite the absence of substantial policy intervention. She argues that the ongoing changes need to be seen from a micro-to-macro perspective, considering the choices and strategies of the actors that are limited and conditioned by the institutional framework, but also represent possible forces of social change. This title is available in the OAPEN Library -

    eISBN: 978-90-485-1227-0
    Subjects: Political Science, Sociology

Table of Contents

  1. Front Matter
    (pp. 1-4)
  2. Table of Contents
    (pp. 5-8)
  3. 1. Changing Care Systems: An Introduction
    (pp. 9-20)

    The link between welfare regimes and the provision of services has long been recognised as a central one (Esping-Andersen 1990; 1999), but it was only fairly recently that care needs and resources actually became part of the debate regarding the welfare state transformations. Feminist scholars have emphasised the link between the social organisation of care and the position of women in society (Lewis 1992; 1997a; 2002a; Orloff 1993; Knijn and Kremer 1997). However, less attention has been paid to the importance of the social organisation of care and intergenerational relations (Naldini 2006), also in relation to the fact that most...

  4. 2. The Context and Policy Trajectories
    (pp. 21-36)

    European societies are facing the challenges posed by dependence in old age from uneven positions. The nature of these challenges varies greatly in relation not only to different paces and timing of the ageing process, but also to different consolidated institutional arrangements in the domain of long-term care. Existing social, economic and institutional developments contribute to the defining of the specific situation in which each society finds itself, the specific stakes and the social and political construction of dependence as a problem.

    The two cases studied in this book were chosen for their contrasting features: the objective of analysis is...

  5. 3. The Challenge of Dependence
    (pp. 37-54)

    Before we begin to analyse the transformation of how the care needs of the elderly are handled in Italy and the Netherlands, we shall first look at the extent to which dependence represents a challenge for the two societies. We shall further observe the trends in the incidence and distribution of dependence that can be found in the early-1990s to the early-2000s period.

    Longevity has grown considerably in all Western societies over the past decades; people in the West do indeed live increasingly longer lives. But general health and one’s functional abilities tend to worsen with age. Due to the...

  6. 4. Changing Care Packages
    (pp. 55-76)

    According to the literature on welfare models in the domain of care for the more frail among the elderly, the Italian and Dutch cases should fit into two distinct clusters. Italy, given its limited social services for elderly dependents and considering the primary importance of the family as an agent of welfare, represents a residual type of social policy with a familistic bias. The Netherlands lies at the other extreme with its highly defamilised system with universal access to long-term-care services. The transformations that occurred during the 1990s and into the 21st century should nevertheless call into question how much...

  7. 5. Care Packages in Practice
    (pp. 77-106)

    In chapter four, we showed that significant changes occurred in the Italian care system throughout the 1990s, whereas more limited adjustments took place in the Netherlands. This is the starting point for the next two chapters, which will discuss the nature of the tensions in each of the two care systems and the mechanisms underlying change and stasis. A micro-level of analysis and qualitative data are used to look at the stakes connected with long-term care and at the social mechanisms based on which the care packages are constructed.

    The analysis proposed in these two chapters is based on a...

  8. 6. The Creation of Care Packages and the Transformations of Care Systems
    (pp. 107-148)

    Care packages – the characteristics and qualitative differences of which we illustrated in chapter five – may be regarded as the result of the course of action and the choices undertaken by individual and collective actors. In this chapter, we shall concentrate on how specific care packages emerge, by looking at how they are constructed by the relevant actors. The reconstruction of care strategies (Wallace 2002) will then be linked to the transformation paths of the two care systems.

    As Anderson et al. (1994) emphasised when addressing the issue of choices, a crucial distinction has to be made between long-term...

  9. 7. Conclusions
    (pp. 149-156)

    The idea when we began this research study was that the configurations and transformations of care systems cannot be understood by only looking at developments in social policy. While social policy and the changes it undergoes play a crucial role in structuring care systems, they also allow enough space for social – individual and collective – actors to construct their strategies and, ultimately, to contribute to the transformation of the care system itself. Comparing the trajectories of Italy and the Netherlands was empirically interesting and served as an opportunity to explore this working hypothesis. The two cases were chosen as...

  10. Appendix 1 Data and methods of the quantitative analysis
    (pp. 157-163)
  11. Appendix 2 Tables not included in the text – chapter 3
    (pp. 164-165)
  12. Appendix 3 Tables not included in the text – chapter 4
    (pp. 166-172)
  13. Appendix 4 Note on the qualitative study
    (pp. 173-194)
  14. Notes
    (pp. 195-202)
  15. Bibliography
    (pp. 203-216)
  16. Index
    (pp. 217-217)