The policy field of home care for older people is increasingly important as countries address the care needs of the ageing population. It is a difficult area to research cross-nationally, with a paucity of international statistics. Home care crosses the boundaries of formal and informal, micro and macro, public and private, medical and social care, and raises important gender issues. The authors approach the ambitious task of analysing the governance of home care across nine countries: Germany, Sweden, The Netherlands, United Kingdom (UK) and United States (US), and, less frequently examined, Estonia, Italy, Japan and New Zealand. They draw on international and national literature, research visits and contributions from local experts.

The first three chapters formulate a theoretical framework that draws on the social policy literature. In Chapter 1, use of the concept of ‘governance’ is justified as broader than ‘public policy’, in its reference to a range of institutions, ideas and actors and to the interactions between them. After an introduction to the comparative context of governance and convergence theory, the selected countries' contrasting systems and contexts are summarised. Chapter 2 develops the framework for the analysis. This aims to map systematically the governance of home care and to explore the influence of institutions and ideas on governance. The framework for mapping the agents and agencies (state, associations, market and family) and instruments (delivery, funding and rules) of home-care governance is set out. The concept of social care and social-care models and clusters used in comparative studies are reviewed and the public policy literature is examined, covering home care as a policy sub-system, institutions and ideas, the explanation of policies, and feminist literature on gender culture. Chapter 3 reviews the contexts of governance and the ideas and institutions that influence home care. The predominant models of gender culture in each of the countries are summarised. Four models of institutions are identified: public service, family care, means-tested and subsidiarity, depending on the level of state support for formal care, informal care and women's participation in the labour market.

The next four chapters analyse thematically the governance of home care in four substantive areas. Chapter 4 examines formal care services and highlights the tension between integration and fragmentation in the governance of home care. It examines governing arrangements through provision, funding and rules. In governing the delivery of services, a double fragmentation is identified: between health and social care, and between public and private providers. Variations in the degree and type of fragmentation are related to gender cultures, care regimes and political power over care. Case studies exemplify reforms in formal services: Japan's long-term care insurance; and relations between the national and local levels in Sweden. Chapter 5 analyses the integration of informal care into home care. The support strategies for home care, by provision of formal care or economic support, are examined and related to the four care models; levels and modes of funding of informal care are analysed; and rules related to cash payments are examined. Case studies exemplify modes of integration of informal care: personal budgets in The Netherlands; and employing migrant home-care workers in Italy.

Chapter 6 focuses on paid care workers and the boundaries between workers with different levels of training and between paid and informal carers. The divisions between health-care and social-care work are related to levels of qualifications. Variations in ways of paying care workers and regulation in relation to care workers are discussed. Case studies of reforms in The Netherlands and Germany illustrate different contexts in which workers are re-skilled and de-skilled. Chapter 7 discusses new conceptions of the role of care users, and new care policies with a mix of state and market logics and social rights are reviewed. Ways of increasing user influence are examined; user choice and different principles of funding, and areas of regulation are compared. Case studies review changing definitions of care users in the UK and long-term care insurance in Germany.

Chapter 8 stresses the diversity of home care, identifies central issues and tensions and summarises the findings of the substantive chapters. It concludes that in this policy area there is divergence rather than convergence. It reviews the role of gender culture in policy development. The authors recognise that the analytical framework cannot be applied uniformly across nine countries and that contextual factors affect the four areas of governance differently. They conclude that many tensions remain to be resolved in the governance of home care. This study has breadth rather than great depth of coverage of the governance of social care in nine countries. It contains a wealth of detailed information as well as explanations for variations between countries. It provides a valuable basis for further cross-national research and will be of interest to researchers, students, policy makers and practitioners in comparative social and public policy, social gerontology, the sociology of ageing and gender studies.