Reforming Home Care in Ageing Societies

How various countries have responded to growing needs for home care, the challenges encountered in the course of reform and the relative success of different reform strategies are the focus of this special issue of Health and Social Care in the Community (volume 20, issue 3, 2012).

Home-based care in nine countries
The special issue documents the responses of nine European countries (Finland, Sweden, Norway, Denmark, Germany, Austria, Italy, England and Ireland) to the challenges of providing greater volumes and intensity of home-based care for older and disabled people.

All but two of the papers are based on LIVINDHOME, a collaborative research project on reforms in European home care for older and disabled people which was jointly commissioned in January 2010 by the French Mission Recherche (MiRe) of the Direction de la Recherche, des e´tudes, de l’e´valuation et des statistiques, Ministere de la Sante´ (DREES) and the National Solidarity Fund for Autonomy (CNSA – Caisse Nationale de Solidarite´ pour l’Autonomie). (More information on the study can be found at: http:/www.sfi.dk/LIVINDHOME).

In this special issue, collaborators to the study have been joined by colleagues from the Netherlands and France, who have addressed the same research questions. We want to thank the Nordic Centre of Excellence, REASSESS, for financing the language editing of all the articles.

Reform of the home help systems in Europe
The aimof the LIVINDHOME project was to identify and compare how European countries have reformed their home help systems in the search for

(1) high quality care which meets increasingly diversified and individualized needs;

(2) efficient and effective provision mechanisms that facilitate cost containment;

(3) a stronger user-orientation in the provision of care;

(4) an optimal balance between formal and informal sources of care; and

(5) the best way to attract and retain home care workers.

Different countries have adopted different approaches to achieving and reconciling these aims; this special issue provides timely analysis of how they have done so, and with what effects.

New governance machanisms introduced
Together, the contributions to this special issue show that new governance mechanisms have been introduced in all of the countries, accompanied by targeting and decentralisation processes and by shifting divisions of work in the mixed welfare economy.

Modernisation of the modalities of organisation and governance of home care systems is evident in all countries, although unique political, historical and cultural contexts shape each country’s approach, as do the different configurations of key actors, such as providers, users and public authorities.

Thus countries differ in the division of competencies and responsibilities between different levels of government; in the types of entitlement that govern access to care; and in the ways in which the delivery of home care services are organised.

However, many questions remain unanswered, including how the process of modernisation has affected the quality of the care and the conditions under which both employed workers and family members provide care; and the longer-term sustainability of reformed arrangements.

Identifying the drivers of change
The contributions to this special issue all focus on identifying the drivers of change and countries’ responses to these, with regard to the organisation, provision, regulation and quality of home care. Each article analyses national policies and experiences of reforming home care for older and disabled people, and identifies some of the resulting tensions that characterize the country in question.