Changes in long-term care policy: striking a balance between sustainability and universalism

This chapter reviews recent transformations in long-term care (LTC) systems, highlighting trends and issues within 13 exemplar OECD countries. Our findings show that, across countries and regimes, there has been a development towards more national, distinct LTC systems. Though this growth has been halted by financial and health crisis, there has nevertheless been overall expansion over time in social rights and in caring for LTC needs. Yet, we argue that LTC policy face substantial resource challenges because of a fundamental dilemma between sustainability and universalism. The difficulty in balancing these competing aspects paves the way for current general trends towards stricter access to marketized and informalized LTC, thereby increasing the tendencies towards privatization and re-familization of LTC systems, and eventually contributing to rising inequality.