Abstract

Objective: In a context of financial restrictions and increase of the oldest old experienced in most European countries, better coordination and integration appears as a relevant policy answer to support family carers and improve elderly care policies’ efficiency. Aiming at redefining the existing frontiers between social and health care, between the multiple professionals concerned and among governing bodies (national, regional and local authorities), this policy constitutes a main orientation in many European countries. Nevertheless, the formulation of integration and coordination policies on the national level, as well as their concrete implementation for both professionals and care users, are specific in each national context. We hypothesise that their definition and characteristics depend on the way (how, but also when) coordination and integration were put on the policy agenda and constructed as a policy issue.

Data and methods: Focusing on the analysis of the elderly care policy making process to identify the role and meaning of coordination and integration in two European countries – France and Sweden – this communication exposes the first results of a qualitative comparative research on integration policies (POLIA INLOVE – Integrated Long term care for the Vulnerable elderly in Europe Project, funded by the PRES Sorbonne Paris Cité). It is based on both literature review and empirical evidence (semi-directive interviews with experts in the field of elderly care) in the countries studied.

Results and policy implications: Integration and coordination policies refer to different realities in France and Sweden. What stands behind the need for coordination or integration depends on national and also local specificities related to historical local processes having influenced the institutional, organizational and professional settings of elderly care. If the issue of integration is high on the political agenda in the elderly care sector in both countries, the content and the mechanisms of integration differ significantly. In both countries, a first need for coordination emerged as a solution to problems associated with the development of two distinct sectors – health care and social care – organized at different territorial levels and both part of elderly care system. But the distinct orientations taken in the two countries entailed different policies and difficulties, leading to new integration schemes. Several policy initiatives were experienced in the 1980s and 1990s in France to coordinate the various social and health professionals concerned by elderly care. Policy schemes were also implemented to meet the increasing care needs of families. Yet, characterized by the addition of successive measures, the French policy failed to integrate social and health care services and even had the opposite effect – further fragmentation of the elderly care sector. New integration schemes have been promoted since 2008 to rationalize and clarify the system. In a different logic, Sweden implemented a decentralization reform in 1992 aiming at integrating the two distinct sectors – health and social care – at the municipal level. Yet, the marketization process initiated in the 1990s entailed other coordination problems with the fragmentation of service provision. New integration initiative was launched in 2011 aiming at reconciling marketization and elderly care policy.

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