Institutional Change in Long-Term Care: Actors, Mechanisms and Impacts

This final chapter summarizes the main results of the national case studies and gives a general interpretation of the changes taking place in the long term care sector over the last 20 years in Europe. The discussion addresses all the theoretical and empirical questions which were introduced in the introductory chapter. More specifically, the chapter focuses on two general issues. The first relates to the mechanisms and institutional processes through which change has been made possible, notwithstanding financial pressures and strong institutional resistance against innovation. The form of change is analyzed by referring to recent theories of institutional change stressing also the relevance of incremental and implicit innovation. The role played by the main actors, both social and political, is also reviewed. Moreover, a comparative analysis is carried out in order to see if the most common typologies concerning care regimes can be satisfactorily used to better understand the main differences between the European countries considered in this book. The second issue concerns the general impact of the reform of long term care on potential beneficiaries and their families, as well as on workers and on the overall organization of the LTC delivery system. Finally, the conclusion offers a general overview and interpretation of the ongoing reform processes.