Since the 1990s, long-term care (LTC) policies across Western countries have undergone major transformations, notably toward marketization, aging in place, and recognition of informal caregivers. Despite this convergence, the normative and ideational dimensions of these changes remain understudied. Drawing on scholarship about the role of policy ideas in welfare state reform, the workshop invites contributions on three interconnected themes : the influence of international organizations and transnational networks on policy convergence ; the impact of shifting cultural norms around gender, family, and intergenerational solidarity ; and the concept of autonomy as both a normative framework and a practical tool for comparing LTC systems. 

Argument

Since the 1990s, most Western industrialized countries have undergone significant transformations in the policy regulation of long-term care (LTC) for older adults and people with disabilities. These changes have affected multiple dimensions : financing mechanisms, the nature of rights and entitlements, the instruments structuring LTC organization, and—most often—the relationship between formal care services and informal caregivers. Scholars have analyzed the welfare implications of these shifts, focusing on the evolving nature of social services (Anttonen and Sipilä, 1996), the changing balance between formal and informal care provision (Bettio and Plantenga, 2004 ; Le Bihan et al., 2019 ; Pfau-Effinger and Theobald, 2025), and the widespread adoption of cash-for-care schemes that align with the marketization of LTC (Ungerson and Yeandle, 2007).

Beyond a general trend toward marketization, several other points of convergence have emerged across LTC policy systems : the prioritization of aging in place (Charette, 2025), the recognition of family carers’ contributions, often incomplete attempts to improve coordination between medical and social care, increased attention to older citizens’ dignity and choice, and the growing longevity of persons with disabilities, which raises questions about age barriers in LTC. These policy shifts reflect both instrumental changes in service delivery and deeper transformations in how societies conceptualize care, loss of autonomy, dependency, and aging.

Despite these widespread changes in the goals and instruments structuring LTC policies across many countries, surprisingly little attention has been paid to their normative and ideational dimensions. This gap is particularly striking given the broader social context. Over the late 20th and early 21st centuries, increased human longevity has been accompanied by improvements in health, income, and living conditions for older people. At the same time, governance contexts over recent decades have contributed to widening social inequalities, including among older populations. In this context, issues of rights, human dignity, choice, and autonomy have moved to the forefront of policy debates, shaped in part by disability rights movements and evolving conceptions of citizenship in old age (Rummery, 2024).

The workshop Framing Autonomy : Ideas and Policy Dynamics in Long-Term Care addresses this gap by examining the transformation of policy ideas in the domain of LTC. We seek to understand how ideas about autonomy, choice, dignity, and care have circulated across national contexts and influenced policy development. In policy analysis, the role of policy ideas has received increasing attention since the late 1980s (Hall, 1989 ; Rein and Schön, 1996). Vivien Schmidt, in her work on welfare state reforms (social and labor policy), highlighted the capacity of policy ideas to coordinate policy actors and address public opinion (Schmidt, 2008). Scholars have further explored the mechanisms through which policy ideas influence various dimensions of policymaking—decision-making, steering, implementation, and more—particularly in the context of welfare state reform (Béland, 2019).

Previous research on the influence of ideas on LTC systems has identified stable “paradigms of long-term care” and a common trend toward domiciliary provision and marketization (Timonen, 2005). Other analyses have emphasized the importance of transnational policy transfers combined with domestic factors (Theobald and Kern, 2011). Stimulating research has also underscored the significance of specific cultural ideas related to LTC : the welfare mix (provision), the state-market relationship (provision and funding), and dominant cultural ideas of social justice (redistribution between societal groups) (Pfau-Effinger, 2004).

Several interconnected dynamics warrant further investigation. These reflect the issues on which we specifically invite contributions to the workshop :

• Institutional and transnational factors : How have international organizations (the UN, WHO, European Union) and transnational expert networks shaped policy convergence ? What role has the internationalization of LTC debates played in diffusing particular normative frameworks ?
• Cultural and social transformations : How have shifting understandings of gender equality, family solidarity, and intergenerational obligations influenced LTC policy design ? What is the relationship between evolving norms about the respective roles of state, market, and family in care provision and concrete policy choices ?
• The concept of autonomy in long-term care arrangements : In France, for example, LTC policies have been framed in terms of autonomy since the early 2000s. This notion opens both normative and practical discussions about autonomy in concrete LTC situations (Collopy, 1988). It can also serve as a comparative framework for LTC policies by distinguishing various dimensions of regulation related to autonomy (Och et al., 2024).

While we observe relative convergence in European LTC systems, significant variations persist in how autonomy is framed and prioritized. Understanding these dynamics requires examining not only policy outputs but also the ideational processes that shape them.

Submission guidelines

Timetable :

• Please send abstracts of 20 lines or so to the following address by June 1st : olivier.lipari-giraud@cnrs.fr
• You will hear from us by June 22nd.
• You will be asked to submit a full paper or at least an extended summary presenting a clear argument by October 20th.
• The workshop will take place in Paris on November 19 and 20 2026.

Steering committee

Daniel Béland (Montréal), Marie-Victoire Bouquet (Paris), Alexandra Charette (Montréal), Olivier Giraud (Paris), Patrik Marier (Montréal), Barbara Lucas (Geneva), Blanche Le Bihan (Rennes), Catherine Needham (Birmigham), Birgit Pfau-Effinger (Hambourg), Loïc Trabut

References

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Béland, D. (2019) How Ideas and Institutions Shape the Politics of Public Policy. Elements in Public Policy. Cambridge : Cambridge University Press.

Ben-Ishai, E. (2012) Fostering Autonomy : A Theory of Citizenship, the State, and Social Service Delivery. University Park, PA : Pennsylvania State University Press.

Bettio, F. and Plantenga, J. (2004) ’Comparing care regimes in Europe’, Feminist Economics, 10(1), pp. 85–113. doi : 10.1080/1354570042000198245.

Börner, S., Bothfeld, S. and Giraud, O. (2017) ’Editorial : Sozialstaatlichkeit und Autonomie : Historische, soziologische und wohlfahrtsstaatstheoretische Perspektiven’, Zeitschrift für Sozialreform, 63(3), pp. 333–353. doi : 10.1515/zsr-2017-0016.

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Charette, Alexandra. 2025. ‘Autonomy and the Governance of “Ageing in Place”’. Social Policy and Society, 1–14. doi :10.1017/S1474746425000260.

Collopy, B.J. (1988) ’Autonomy in long term care : Some crucial distinctions’, The Gerontologist, 28(Suppl.), pp. 10–17. doi : 10.1093/geront/28.Suppl.10.

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Och, R., Pfau-Effinger, B. and Eggers, T. (2024) ’Development of the concept of autonomy in care policies of the German welfare state’. Paper presented at the ESPAnet Annual Conference, Tampere, Finland, 5–7 September.

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Pfau-Effinger, B. and Theobald, H. (2025) ’The changing relationship between formal and informal care work’, in Ranci, C. and Rostgaard, T. (eds.) Research Handbook on Social Care Policy. Cheltenham : Edward Elgar, pp. 250–261.

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Rummery, K. (2024) ’Care poverty and conflicts in social citizenship : The right to care ?’, in Kroger, T., Brimblecombe, N., Rodrigues, R. and Rummery, K. (eds.) Care Poverty and Unmet Needs. Bristol : Policy Press, pp. 15–28.

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