The Cheaper Option: How, Why and for Whom? the Politics of Deinstitutionalization in the Field of Long-Term Care

Since the 1990s, and more so after the Covid-19 pandemic, there has been a growing policy emphasis on the deinstitutionalisation of older people with long-term care (LTC) needs, i.e. the reduction of services supplied in residential settings as opposed to those provided in the community or in older people's home. This trend is backed by a set of converging ideas: the need to ensure social inclusion, the preferences of older people and their family members, lower costs of home and community care as opposed to residential care services. The higher cost of residential care has been a particularly powerful argument in supporting cutbacks in the number of beds in nursing homes or in preventing their expansion across countries, also in relation to the overall need to contain public expenditure within LTC policies. Yet, social policy scholars have seriously challenged the idea that home care services are cheaper than residential care services on different grounds.

Based on a review and analysis of the literature, of policy documents, of research output and policy briefs across seven EU countries, the paper highlights the standpoint on the topic across different sets of actors –e.g. researchers, expert communities, policy makers at the European, national and regional level, representative of older people and their family members, representative of care provider organizations and of employees’ organizations –, its knowledge basis and its modes of circulation.

In doing so, the paper offers multiple contributions. It provides a complex understanding of the meaning of costs and of whether different options are “cheaper” in relation to LTC and beyond. It sheds light on the prevailing views and the factors that helped them emerging as dominant and on the possible reasons for the marginalization of alternative views. Finally, it problematizes the relationship between policy-oriented research and policy discourses and policy making.