Introduction

In response to increasing care needs, the development of long-term care (LTC) systems has become a prominent policy concern across the OECD (OECD, 2011). At the same time, since the 1990s, but even more so with the economic crisis started in the second half of the 2000s, cost containment has become a major preoccupation of governments. Policy measures in LTC have therefore progressively aimed at facilitating care arrangements combining formal and informal care and/or fostering market-based provision of care. In this context, the development of cash-for-care programmes – which provides people in need of care and/or their family caregivers with cash transfers so that they can organise their own care arrangements – is a common trend in many OECD countries, whatever the initial care model. This chapter analyses the development of such programmes, exploring the ideas behind the programmes, providing an overview of the different options for this type of intervention, and, by looking at the context in which cash-for-care schemes are embedded, discusses the realities of the different programmes.

The chapter first discusses different conceptualisations and ideas behind cash-for-care programmes, with specific attention paid to the ideas of choice, consumer direction and family support, leading to three ideal-typical logics of cash-for-care programmes: a market-based approach, the citizen perspective, and a conservative-familialistic perspective. Different policy designs on which cashfor- care schemes are based are subsequently presented. Following a set of criteria that distinguish cash-for-care programmes, we delve into the LTC programmes of various OECD countries. In particular, we look at the situation in Austria, the Czech Republic, France, Germany, Italy, the Netherlands and the UK, with some information on the US. These countries were chosen for the significance of cash-for-care programmes within their LTC systems and for their belonging to different welfare and care regimes. The reality of the different approaches to cash for care is then discussed in the broader context in which the programmes have been established, and with a view to the objectives underlying cash for care. It is argued that context, timing and the specific regulation of the schemes entail different visions of care and of care work. The discussion focuses on effects in terms of users’ satisfaction, on informal caregivers, on care workers and care labour markets, and on public LTC expenditure. The concluding section summarises the main policy messages emerging from the previous analysis.