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2018 Conference Presentation

Care integration GermanySwitzerland

10 September 2018

Intermediary structures for frail older people: Switzerland and Germany in comparison

Konstantin Kehl, Zurich University of Applied Sciences, Switzerland

Rahel Strohmeier, Zurich University of Applied Sciences, Switzerland


Long-term care for frail older people has become more diverse and pluralistic including a range of services “in-between” residential and home care such as temporary day and night care, amongst others. In both Switzerland and Germany, the role of such intermediary structures has been debated and affected by recent policy reforms. They have been interpreted as a “social innovation”, albeit within different institutional frameworks.

We show the differences regarding two countries with a “conservative” welfare tradition, in which families play a crucial role in the provision of LTC. By comparing the two countries in the context of their welfare architecture and institutions, the aim is to discuss three research questions:

• How do intermediary structures have to be located within the current LTC models; i.e. which functions within the specific institutional frameworks and care arrangements do they serve?

• Can we identify differences regarding access and use?

• Does the introduction of new forms of LTC services go along with the welfare tradition and conventional care arrangements, i.e. in what sense their introduction has to be seen as path-dependent or can be interpreted as a “social innovation”?

We analyse the different concepts and definitions of intermediary structures, compare findings regarding access and use in the Swiss and German case, and draw conclusions with regard to their fine-tuning potential in the (care-related) welfare mix.

Despite starting from similar welfare regimes, we are able to show that intermediary structures have been set up in a different way and tend to have a different impact on care regimes: In Switzerland, intermediary structures are to be seen as a part of the public services, while in Germany they are more often located within local communities and civil society organisations with less public funding. We offer fruitful explanations accessing institutional, socio-economic and cultural factors offering a somewhat different story in two countries commonly associated to the “conservative” regime.

In a short outlook, we seek to broaden the perspective beyond the two countries by introducing some comparative insights from a European perspective. We would like to invite the panel participants to share the experiences of their home countries in order to lay the foundations for an international research agenda regarding intermediary structures in LTC.

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