The Mediterranean care model in the crisis

This paper investigates how the economic and fiscal crisis is likely to affect the reorganization of the LTC sector in countries that have undergone the most significant fiscal consolidation. In these countries, central governments’ financial allocations to local authorities have been reduced, entitlements have been restricted, and eligibility criteria have been tightened as components of a public deficit reduction, leaving regions with the difficult task of maintaining their service provision programs with greatly reduced resources. Because of weak social protection systems, impoverished families are experiencing severe difficulties in compensating for cutbacks in funding. Our focus is on Italy and Spain, two countries that have recently begun a process of public involvement in LTC. We want to investigate whether recession-induced reductions in family incomes and austerity-induced reductions in care funding have slowed down, or even reversed, the process of public involvement in LTC, and whether this retrenchment has induced a process of re-internalization of care. We also study whether a reduction in the ability of families to pay is likely to affect their choice between legal and irregular care, thereby boosting demand for cheaper, undocumented carers. Finally, we analyse the likely consequences of the reshuffling of tasks between the state, the family, and the market for migrant carer employment. Since the crisis is still unfolding, the evidence of its effects in terms of the substitution of paid by unpaid care, migrant by native-born carers, and legal by irregular care workers is still limited; however, continuing income and fiscal austerity is likely to favour these regressive substitutions, leading to a stall in, or even a reversal of, the latest trends in LTC.