Thematic Panel 17: Public administration reforms in long-term care service organisation: de-bureaucratizing, democratising, and improving labour conditions


David Palomera, Institute of Government and Public Policy, Autonomous University of Barcelona

Tine Rostgaard, Roskilde University and Stockholm University

There’s a shared understanding among academia and public officials that the combination of a bureaucratic past and New Public Management (NPM) reforms have brought mixed results in the public administration of long-term care services. In the context of growing care needs and public spending, governments have rationalised and controlled budgets, increased management professionalisation, and extended the evaluation of results based on user satisfaction. However, it has also come at the cost of increased hierarchisation, bureaucracy, and reduced autonomy and professionalisation of care workers. Ultimately, this has led to a rigid and sometimes inefficient organisation of care work, including little participation of care receivers and caregivers in the weekly organisation of care tasks and, therefore, a lack of adaptation to the changing care needs of older adults. This has also rendered low-quality services.

Due to these limitations, governments are growing dissatisfied with how care work is organised and are introducing reforms to improve it. However, despite reform attempts, it is not still clear the direction of innovations. For instance, one organisational model that has received attention is the diffusion of the Buurtzorg model. This model mainly seeks to increase worker self-management and adapt to the care receiver’s needs by creating small, self-managed teams of care workers. 

The aim of this thematic panel is twofold. Firstly, to discuss the implications of past public administration reforms, such as NPM introduction, for care work organisation and governance. Secondly, to understand why and how local governments implement organisational and other innovations that aim to de-bureaucratize, democratise, and increase labour conditions and communitarian participation. Studies that critically analyse the effects and results of recent reforms are also welcomed.  The panel is open to comparative and single case studies and qualitative, quantitative and mixed methods approaches.