The vicious layering of multi-level governance in Southern Europe: the case of elderly care in Italy and Spain

Abstract

Aging and changes in family arrangements and female employment have brought about important policy developments in long-term care. Southern European countries have relied for long on family care and residual social care for the dependent elderly. Two paradigmatic cases, Italy and Spain, have shown two apparently different trends during the last 15 years: while in Italy reforms seem to have been persistently blocked, in Spain, an ambitious reform has fallen short of expectations. Based on data on services and institutional arrangements, the article shows that a complex and inconsistent allocation of responsibilities across government levels, a sort of 'vicious layering' of multi-level governance, may be playing a key role in this situation. The article discusses the dysfunctional effects of such arrangements, namely territorial inequalities, cost-shifting between government levels and towards users and misallocation of resources. We suggest that the development and reform of LTC in Southern European countries must address these problems if they want to avoid getting marooned by a complex network of vetoes and resource allocation problems.