The limits of social investment and the resilience of long-term care
| Published date | 01 June 2023 |
| DOI | http://doi.org/10.1177/13882627231176134 |
| Author | Franca van Hooren,Clémence Ledoux |
| Date | 01 June 2023 |
| Subject Matter | Special Issue: Social services as critical infrastructureGuest Editors: Renate Reiter and Tanja Klenk |
The limits of social investment
and the resilience of long-term
care
Franca van Hooren
Political Science Department, University of Amsterdam, Netherlands
Clémence Ledoux
Laboratoire Droit et Changement Social, Université de Nantes, France
Abstract
This article investigates the extent to which a social investment paradigm has guided policy
reforms in long-term care for the elderly in France and the Netherl ands and how this relates
to the resilience of the sector during the Covid-19 pandemic. It conceptualizes the theoretical
impact of social investment on long-term care policy and analyzes its use to justify reforms
since the early 2000s. It concludes that social investment has not played any role in Dutch
long-term care reforms and a moderate role in France. Meanwhile, in both countries a neoliberal
emphasis on the efficiency of the market has contributed to a rise in for-profit service provision
and fragmentation of the long-term care sector. While long-term care provision in both countries
proved relatively resilient in the first phase of the pandemic, at a later stage its resilience was
undermined by fragmentation and marketization, limiting the government’s ability to respond
adequately to new challenges and, crucially, to improve working conditions in the sector. The art-
icle concludes that a social investment approach cannot resolve these problems and that there is a
need for a new paradigm that acknowledges the inherent value of care work and prioritizes the
long-term sustainability of care provision.
Keywords
Elderly care, social investment, resilience, Covid-19, long-term care policy
Corresponding author:
Franca van Hooren, Political Science Department, University of Amsterdam, Nieuwe Achtergracht, 166, Amsterdam 1012
DL, Netherlands.
Email: f.j.vanhooren@uva.nl
Special Issue: Social services as critical infrastructure
European Journal of Social Security
2023, Vol. 25(2) 196–216
© The Author(s) 2023
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/13882627231176134
journals.sagepub.com/home/ejs
Introduction
The Covid-19 pandemic brought ample attention to the importance of care as a critical infrastruc-
ture. While the initial focus was on hospitals and their overwhelmed intensive care facilities, in its
wake followed accounts of the hardships experienced in long-term care facilities. Amidst reports of
the huge death toll of the pandemic in nursing homes, long-term care workers were praised as
heroes and were listed as key workers. In the aftermath of the pandemic, many of these same
care workers left the sector, sick or frustrated with the poor working conditions, leading to mount-
ing staff shortages across Europe.
1
The Covid-19 pandemic could be seen as a magnifying glass, exposing the strengths and weak-
nesses of existing care systems. In this article we assess what this magnifying glass can tell us about
the resilience of long-term care for the elderly
2
in Europe and how this relates to the social invest-
ment paradigm that has guided both European Union (EU) discourse and welfare state reforms
across Europe in the past two decades (Bouget et al., 2015; Guillén et al., 2022; Hemerijck,
2017; Morel et al., 2012). We compare developments in France and the Netherlands, two contin-
ental European welfare states that have been influenced by the social investment paradigm, while
having a legacy of rather different long-term care systems.
Paradigms are a mix of political ideas, norms –defining how a problem is seen, which policy
objectives are set –and instruments chosen to reach these objectives (Hall, 1993; Hemerijck,
2015). The social investment paradigm prioritizes investment in human capital and capabilities,
‘rather than “repair[ing]”damage after moments of economic and personal crisis’(Hemerijck,
2015). Thus, social policies should contribute to higher employment levels and ‘future improve-
ments in productivity, growth and prosperity’(Hemerijck, 2015). Contrary to traditional welfare
state policies which view social policy as a means of social protection, stabilizing income across
the life course, the social investment paradigm understands social policy as a means of supporting
life course transitions and aims to avoid ‘people being “trapped”outside the labour market’
(Saraceno, 2015: 260).
The social investment paradigm first emerged during the Dutch presidency of the EU in 1997,
and then permeated the EU’s Agenda 2000, leading it to adopt a package on Social Investment for
Growth and Social Cohesion in 2013 (Hemerijck, 2015). During the Covid-19 crisis, the EU
adopted recommendations on the National Recovery and Resilience Plans that were not only influ-
enced by the European Green Deal and the objective of digital transformation, but also by the idea
of a social investment welfare state, showing the persistence of this paradigm on the European
agenda (Guillén et al., 2022). While in 2012, Morel et al. considered this paradigm as ‘emerging’,
not fully established and only beginning to replace the neo-liberal approach (Morel et al., 2012),
this set of ideas seems now to have begun to firmly shape EU and national policies: the policy initia-
tives supported by the EU in Greece and Spain, and in post-communist countries, are illustrations of
this, as are the Netherlands’social activation measures and France’s minimum income protection
for labour market outsiders (Bouget et al., 2015).
1. See e.g.: https://www.socialeurope.eu/health-and-social-care-staff-shortages-critical (accessed 25/03/2023).
2. By long-term care for the elderly, we understand the activities and relations involved in meeting the physical and emo-
tional requirements of dependent adults (inspired by Daly and Lewis, 2000: 286). Care for elderly people makes up a
large share of long-term care and includes care provided at people’s homes and care provided in institutional facilities
such as nursing homes.
van Hooren and Ledoux 197
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