From care in homes to care at home: European experiences with (de)institutionalisation in long-term care

Stefania Ilinca, Kai Leichsenring, Ricardo Rodrigues

The path to deinstitutionalisation, the hallmark strategy of social and care services for individuals with limited autonomy, has been marked by idiosyncratic developments across European countries. The present Policy Brief capitalizes on this cross-country variability in order to draw lessons from experiences and strategies, which proved to be effective, and proposes a set of core principles for successful deinstitutionalisation. 
We build on a well-established typology of long-term care regimes and propose four case studies to exemplify the main barriers and drivers to deinstitutionalisation. Austria, the model country for the Standard care mix regime, illustrates the importance of developing strong support systems for informal carers and strengthening home-based care provision. At the same time, its limited success in reducing institutionalisation rates can be traced back to a stringent need to improve care integration. Sweden, typifying the Universal-Nordic regime, has made great strides towards deinstitutionalisation by promoting coordination between care providers and aligning incentives across care settings. However, the coverage and cost of services will soon become unsustainable unless appropriate support for family-based care is provided. Italy and the Czech Republic (representing the Family-based and respectively, the Transition regimes) represent situations where the rates of institutionalisation are relatively low and current policy is challenged to contain future growth. Both systems offer significant support to informal and family carers, but this historic over-reliance on household contributions to care is leading to a widening gap between supply and demand, which needs to be addressed through the strengthening of community-based services.
The Policy Brief concludes with a discussion of the core principles for reaching a sustainable balance between different long-term care settings. Among them we emphasize the necessity to support the development of alternatives to residential care both in the family and in the community, the need to integrate and coordinate across settings and the importance of appreciating the complexity inherent to deinstitutionalisation - as no single policy measure, in isolation, is likely to be sufficient.