The limits of social investment and the resilience of long-term care

• Published in: European journal of social security 2023-06, Vol.25 (2), p.196-216
• Main Authors: van Hooren, Franca, Ledoux, Clémence
• Format: Article
• Language: English
• Subjects: COVID-19; Elder care; Humanities and Social Sciences; Investments; Law; Long term health care; Neoliberalism; Older people; Pandemics; Paradigms; Private sector; Reforms; Resilience; Segmentation; Working conditions
• ISSN: 1388-2627; 2399-2948
• DOI: 10.1177/13882627231176134

This article investigates the extent to which a social investment paradigm has guided policy reforms in long-term care for the elderly in France and the Netherlands and how this relates to the resilience of the sector during the Covid-19 pandemic. It conceptualizes the theoretical impact of social investment on long-term care policy and analyzes its use to justify reforms since the early 2000s. It concludes that social investment has not played any role in Dutch long-term care reforms and a moderate role in France. Meanwhile, in both countries a neoliberal emphasis on the efficiency of the market has contributed to a rise in for-profit service provision and fragmentation of the long-term care sector. While long-term care provision in both countries proved relatively resilient in the first phase of the pandemic, at a later stage its resilience was undermined by fragmentation and marketization, limiting the government's ability to respond adequately to new challenges and, crucially, to improve working conditions in the sector. The article concludes that a social investment approach cannot resolve these problems and that there is a need for a new paradigm that acknowledges the inherent value of care work and prioritizes the long-term sustainability of care provision.