Abstract

Background: Long-term care policy of Finland is a paradox: on the one hand, Finland has been one of the first nations to start building modern home-based care services for older people and Finnish policy is still officially adhered to the Nordic welfare model and its universalist aspirations but, on the other hand, Finnish provisions have remained below the general Nordic level and, especially since the beginning of the 1990s, policy development in Finland has been characterized by the central state’s constant avoidance of responsibility.

Objectives: This chapter aims to map the twists and turns in the development of long-term care policy in Finland since the start of the 1990s. Various policy changes have taken place during the last three decades. The main argument of the chapter is that these changes have to a large part been motivated by what is called here ‘demographic panic’, that is, fear of consequences of population ageing to the public purse.

Methods: First, the paper analyses the development of the age structure of the population in Finland as well as the volumes of main long-term care provisions from 1990 to 2015, based on social care statistics. The main part of the paper analyses five different and even contradictory long-term care policy developments that have taken place in Finland: decentralization, recentralization, deinstitutionalization, refamilisation and marketization and looks for their common denominator.

Results: Since the early 1990s long-term care in Finland has experienced many changes. Governance of the care system has been reformed first using decentralization and now recentralization, both in order to curb the growth of expenditures of care provisions of local authorities. Traditional institutions have become replaced by service housing and overall the coverage of residential provisions has considerably decreased. The gap left by reduced institutional care has not become covered by a corresponding investment in home care. On the contrary, the coverage of home care also dropped radically in the 1990s and has never recovered since. The main goal of Finnish long-term care policy has ever since been to minimize institutional care and to keep older people at home as long as possible. Access to both institutional and home care has been made more difficult and older people are increasingly pushed to look for support from their families and from the emerging market of for-profit care services.

Conclusions: The overarching motivation for the different long-term care policy changes in Finland has been the wish of policy-makers to avoid responsibility. Long-term care policy-making has been based on demographic panic as the authorities have focused their attention to find ways how the public sector can escape from facing the real needs of ageing citizens and their family members. De/recentralization, deinstitutionalization, refamilisation and marketization have all been used primarily in order to cut down public responsibilities for long-term care and curb the anticipated growth of care expenditures. At the same time, no real effort has been made to make a progress in meeting long-term care needs of the ageing population.