Moving Towards Participatory Senior Care. Explaining Cross-National Differences in the Participatory Rights of Senior Care Recipients

In recent years the demographic change and rising number of senior citizens put the health and care sector of many mature welfare states under pressure. New welfare state policies were introduced to shift the responsibility back to the individual and community, emphasizing citizen participation. Regarding senior citizens, stronger participation refers to the enhancement of choice and autonomy as well as to the overcoming of dependency. Even for seniors in need of care participatory measures like re-ablement or user involvement in decision making processes were increasingly supported. Nevertheless, there are considerable differences between the countries concerning several dimensions of participatory measures.

Therefore, this paper poses two questions: in how far do European welfare states differ regarding the participatory rights of senior care recipients? How can the differences between the countries be explained. The main aim is to build a typology to identify different participation regimes based on a multi-dimensional analysis. The dimensions include the generosity of social rights towards care provision, different forms of co-production and rights to activating measures (e.g. re-ablement) as well as the basic principles concerning the responsibility of care provision (state, market, community). To explain the differences between the countries the role of the relevant political actors and cultural ideas concerning the role of the welfare state as well as the cultural ideas about citizen participation of care recipients are analyzed.

The empirical study is based on a document analysis of the legal framework and a structured content analysis of government papers and party documents concerning care policies of Denmark, England and Germany. Those countries are chosen because they all represent different types of welfare and care regimes. The analysis shows that all countries represent different types of participation of care recipients due to their welfare regime type and cultural ideas towards care.