L'aide à domicile des personnes fragiles : des régimes de care européens en profonde mutation

Degavre, Florence [UCL] Nyssens, Marthe [UCL]

Over the last twenty years there have been two trends of very different nature in most European countries which, combined, have deeply influenced social policies in the field of home care. The first concerns the phenomenon of “ageing in ageing” that has led, in the space of a generation, to the emergence of new needs in terms of care for people and to an increase related demand for services. The second is the generalisation in terms of governance, of the injunction to “new public management” (Pollitt, 2007). This term refers to the ongoing reforms since the 1980s that were translated in different ways across Europe; with an introduction of market principles within the public sector, such as the client-based approach in public services or the management of services and organisations via an ex-post results’ evaluation (outputs), instead of a management through the ex-ante allocation of funding (inputs). In this context, quasi-markets is considered as an instrument targeted to greater efficiency of the public service. Although the concept of quasi-market is far from being monolithic in the literature (Bode, 2007), it is mainly characterised by a separation between the roles of funder and provider (Le Grand, 1991): the State often continues to assume the financing of services, but it is no longer the single provider. Other providers, belonging to the public or the private sector, whether for profit or non-profit, can provide the service Research question In this context, we want to identify patterns of evolution of contemporary regimes of care in light of these recent changes and, more specifically, in relation with the context of growing marketization. More precisely, we are interested in the following questions: 1. Try to better indentify the forms of marketisation 2. Does the trend of marketisation take a different configuration according to the tradition of care regime? 3. Which type of diversification of care providers (informal, formal, families, public, social enterprises and for profit) can we observe? 4. What is the place, if any, for innovative social enterprises in this changing configuration ? Analytical framework Care regime “brings care (caregiving and care receiving) at the center of analysis of Welfare State”(Knijn and Kremer 1997:328)” It is a general picture of the infrastructure of care” (ibid., 1997:329) and figures out the “caring dimension of the Welfare State” (1997:335). Types and amount of resources mobilised for home care purpose as well as discourses around the State’s prerogatives or around what and how care should be provided (including the care actors) are constitutive of care regimes. Even if the market is the driving force, other logics are, obvioulsy at work in this field. In such a perspective, we follow Polanyi (1944) and a historical and anthropological approach. Without denying the importance of the profit motive characterising the capitalist economy, Polanyi also highlights other economic practices, not oriented towards the accumulation of profit: redistribution, reciprocity and household administration. This Polanyian approach allows us to unfold a global vision of actors and ressources according to the different logics at work. Methodology: The empirical data is based on a research to which the authors have contributed, financed by DRESS –MIRE (France) on the following subject: “Home care to frail adults in Belgium, Germany, Italy and the UK: a comparison of care regimes in a context of deep transformation”. In this context, similar information has been collected in these countries and allow us to operationalize the concept of marketisation according to the different dimensions suggested above. References BODE I., GARDIN L., NYSSENS M. al; 2011, Quasi-marketization in domiciliary care: Varied patterns, similar problems, International of Sociology and Social Policy, (31) – ¾, 222 -235 BODE I. (2007), “La nouvelle donne du marché-providence. Une comparaison internationale des systèmes d’aide à domicile et de leur régulation”, Retraite et Société, n°51, p 207-233. Degavre, Florence; Nyssens, Marthe. Care regimes on the move: Comparing home care for dependent older people in Belgium, England, Germany and Italy, 2012. 281 p. http://hdl.handle.net/2078.1/112096 POLANYI K. (1944), The great transformation. New York, Farrar & Rinehart. POLLITT C. (2007), “Convergence or Divergence? What has been happening in Europe?”, in Van Thiel S., Homburg V. (eds.), New Public Management in Europe. Adaptation and Alternatives, Basingstoke, Palgrave Macmillan, p 10-15.