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Blanca Deusdad, Sagit Lev, Charles Pace and Sue Vella

De-institutionalisation of care for older people in Mediterranean countries has not been sufficiently analysed, in terms of policy discourse and implementation. The aim of this chapter is to study and compare both aspects within a cluster of three different Mediterranean countries: Israel, Malta and Spain. Although these countries differ in their historical, geographic and demographic features, they share a number of features. The traditional provision of care by the family has decreased as women’s employment rates have risen and family sizes have shrunk. Despite attempts to counter this through various ‘ageing in place’ policies, in none of the three countries have such attempts managed to fully offset undue institutionalisation due to the lack of family or financial resources, let alone enable the return of older persons from institutions to the community. Despite differences, enough similarities exist to propose a Mediterranean variant of LTC for older persons. This is characterised by ongoing reliance on family care even in the face of rising female employment; by underdeveloped or under-resourced community services; and by growth in private care services including recourse to migrant care labour. These features have implications for older adults who lack family support or financial means, and for the sustainability of care policies in the face of rapid demographic ageing.

Open access

Bettina Leibetseder, Anneli Anttonen, Einar Øverbye, Charles Pace and Signy Irene Vabo

Welfare pluralism, in its initial conceptualisation, sought to bring together the best welfare providers, including families and the community, while lowering expenditures. Ideally, a plurality of providers would ensure better quality, consumer choice, and universal but at the same time more individualized services. In this chapter, we raise questions about recent transformations in the welfare mix, which we call the ‘re-mix’ of social care, based on the empirical material shared within the COST Action IS1102, which points to a high degree of disarray. Compared to earlier decades that had witnessed a stable or growing level of state intervention, the current re-mixing among service providers is characterized by fragmentation and differentiation, while there is no attempt to address the question of how best to provide social care. In the end, we argue that: (1) the current organisation of care services is reinforcing inequalities between less and more affluent users; (2) the current division of responsibility in the provision, regulation and financing of care services is favouring for-profit and self-employed caregivers, without enabling collaboration and synergies among providers; (3) the current re-mixes are hindering both equality among service providers and universal provision.