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Guest editorial: reforming home care in ageing societies.

In the context of ageing societies, the importance of home-based care is growing in all OECD countries. Home care is widely considered to be a financially sustainable way of supporting the independence and accommodating the preferences of older and disabled people; demand for home based care and support is likely to increase in the future. The number and share of the population aged 80+ will continue to grow in all developed countries and, despite the fact that disability prevalence rates have declined in some countries, greater longevity is likely to lead to an increasing number of people at older ages with severe disabilities and need for long-term care (Lafortune & Balestat 2007). With falling rates of institutional living, growing numbers will rely on home care services; this also means that home care services will have to adapt to coping with higher levels of disability among their users (Jacobzone et al. 1999). The cost of long-term care for people aged 65 and over is expected to rise from the current level of 1% of GDP across OECD countries to between 2% and 4% of GDP by 2050 (Oliveira Martins & De La Maisonneuve 2006). When people under 65 are included, public spending on health and long-term care could rise from the current average level of 6–7% of GDP to around 10% by 2050 (Oliveira Martins & De La Maisonneuve 2006). Societal changes add further pressures for new care solutions. These include increasing female labour market participation, postponement of the retirement age for the workforce in general, changing family forms and in, some countries, changes in attitudes as to who bears responsibility for providing care for older and disabled people. Most countries also face difficulties in attracting and retaining care workers to what is often perceived to be physically and mentally demanding work. Strategies to reduce demand for long-term care workers include the increasing use of information and communication technologies; improved co-ordination between the long-term care and health care sectors; promotion of healthy ageing policies and self-care; and redefining job tasks so that less qualified assistants can carry out simpler care tasks (Fujisawa & Columbo 2009). Some countries have sought to address a shortage of long-term care workers by employing migrant workers in the formal care sector, or by facilitating the private employment of migrant care workers in the home (Simonazzi 2009). Concerns have been raised about both the quality of such care and the working conditions of these carers (e.g. Doyle & Timonen 2010). Strategies to overcome shortages of care workers have in many countries been underpinned by the introduction of cash-for-care allowances, although these are often also intended to facilitate choice by users between different sources of care (Timonen et al. 2006, Burau et al. 2007). These strategies have further contributed to the marketization of care, accompanied by a growing trend towards ‘New Public Management’ (NPM) market inspired reforms. How various countries have responded to growing needs for home care, the challenges encountered in the course of reform and the relative success of different reform strategies are the focus of this special issue of Health and Social Care in the Community. The special issue documents the responses of nine European countries (Finland, Sweden, Norway, Denmark, Germany, Austria, Italy, England and Ireland) to the challenges of providing greater volumes and intensity of home-based care for older and disabled people. All but two of the papers are based on LIVINDHOME, a collaborative research project on reforms in European home care for older and disabled people which was jointly commissioned in January 2010 by the French Mission Recherche (MiRe) of the Direction de la Recherche, des etudes, de l’evaluation et des statistiques, Ministere de la Sante (DREES) and the National Solidarity Fund for Autonomy (CNSA – Caisse Nationale de Solidarite pour l’Autonomie). (More information on the study can be found at: http:/www.sfi.dk/LIVINDHOME). In this special issue, collaborators to the study have been joined by colleagues from the Netherlands and France, who have addressed the same research questions. We want to thank the Nordic Centre of Excellence REASSESS for financing the language editing of all the articles. The aim of the LIVINDHOME project was to identify and compare how European countries have reformed their home help systems in the search for (1) high quality care which meets increasingly diversified and individualized needs; (2) efficient and effective provision mechanisms that facilitate cost containment; (3) a stronger user-orientation in the provision of care; (4) an optimal balance between formal and informal sources of care;