According to the introduction by two of the three editors, Fernández and Gori, the main purpose of this edited collection is to analyse the range of solutions adopted across the Organisation for Economic Co-operation and Development (OECD) about how to organise, regulate and fund long-term care (LTC) services in response to the growing needs of ageing societies, with the key aim being to ‘draw key lessons from salient policy reforms across all OECD countries’ (p. 2). In this context, such ‘reforms’ include both major changes introduced with explicit policy goals to alter the design of LTC systems significantly, as well as those incremental changes that have the effect of redefining those systems.
To a great extent these ambitions are realised in this collection, which covers a wide range of OECD countries. The themes covered are broad ones and are addressed by a group of internationally recognised LTC experts. The volume provides a valuable compendium not only for LTC scholars but also for policy actors and practitioners, including those at the organisational level, with the chapters written in a logical and accessible way. All the chapters provide much valuable access to available data and analysis, particularly useful for cross-national comparison. The book is organised into four main parts: funding, models of care, carers (both paid and unpaid) and institutional actors. Each of the chapters, with the exception of two devoted to the demand for care and support, highlight the main policy models and international reforms in the selected countries, provide a critical evaluation of their success and draw out a set of recommendations for future LTC policies.
For me, there were particular chapters that stood out. In Chapter 3, ‘Cash-for-care Benefits’ by da Roit, le Bilan and Österle, the authors set out a useful typology of the policy logics that underpin different cash-for-care systems: market-based, citizenship and conservative/familiaristic logics. While the policy rhetoric of choice underpins all seven European systems that are the basis of comparison, the authors make the very relevant point that satisfaction with user-oriented care is very much shaped ‘by the nature of available and affordable choices’ (p. 155). This observation, together with their point that there is little evidence to support the assumed link between user choice and quality care outcomes, offers an important and critical corrective to much national LTC policy rhetoric. The useful comparison on the outcomes for workers under the different cash-for-care schemes also highlights that while in some countries such schemes have supported the development of a grey market, this outcome is not inevitable. Indeed the authors’ conclusion that policy makers have to confront directly the risks inherent in many cash for care schemes that might undermine the quality of work relationships and the quality of care is a salutatory and important one.
The two chapters in the section on carers were also extremely interesting, Chapter 9, by Columbo and Muir, deals with developing a long-term skilled LTC workforce and Chapter 10, by Schnieder, Sundström, Johannson and Tortosa, addresses policies to support informal care. The chapters provide careful cross-national analysis and critique of the two key underpinnings of the LTC system: formal carers (workers) and informal carers (family). It might have been useful to also include a chapter that examined the overlap between these twin pillars and particularly of those carers who occupy the ‘liminal space’ between family and formal care (e.g. Daly and Armstrong Reference Daly and Armstrong2016). I would have also liked to see some discussion of the increasing informalisation of formal care work in many OECD countries. Nevertheless, both chapters provide useful starting points in the discussion taking place in many countries about sustainable LTC systems. In particular, Columbo and Muir's analysis of how best to develop a skilled LTC workforce provides valuable updating of much of the analysis and data in the earlier OECD-produced Help Wanted (Colombo et al. Reference Colombo2011). Importantly, the authors tackle not only the pressure to meet the burgeoning demand for care workers but also touch on the often ignored issue of worker job quality in LTC systems. Columbo and Muir also argue there is a lack of robust evidence on the link between service and job quality. However, in my view, there is now growing evidence of the negative links between poor service and poor job quality (e.g. Hussein and Manthorpe Reference Hussein and Manthorpe2014), which requires direct and urgent policy attention in LTC. I would have also liked to see more discussion of, or perhaps a separate chapter on, migrant care workers, given the increasingly significant reliance on migrants, including temporary and undocumented migrants, in many OECD countries.
One of the challenges faced by the editors and the authors is the quality and availability of comparative data on LTC systems. This is particularly acute in respect of workers employed in the sector – many of the comparisons in the book, and indeed in available OECD LTC data, are constrained by the available data on the majority non-professional LTC workforce. While the authors do the best they can within these constraints, the inadequacy of available national and comparative data raises the issue more generally of why this continues to be the case. One cannot imagine that in what are seen as ‘productive’ areas of the economy, such as manufacturing or resource extraction, that national governments would show a similar disinterest in ensuring the collection and dissemination of finely grained comparative industry and employment data.
