Policy learning and innovation in local regimes of home-based care for the elderly: Germany, Scotland and Switzerland

The content of this research report focuses on the local scale dimension of the regulation of domiciliary long-term care for the aged. Long-term care has become a widely debated issue about which contradictory or at least very ambivalent discourses and even policy goals are formulated. The main aim of this research is to analyse how concrete actors networks deal at local level with these conflicting goals in spite of constraining national institutional settings. The central assumption of this project is that the policy actors present at local level are the closest to the implementation of the policy at stake or directly deal with the implementation of the policy. At this level and during this phase of implementation, concrete choices have to be made, ambivalences are to be resolved: some policy discourses turn into something real while others are put back on the shelves of offices. This research project addresses the question whether local actors can derogate from national institutions to address the most important shortcomings perceived/formulated at either national or local level. It is centred on two main dimensions of change. The first one focuses on the capacity of local actors to trigger institutional change. The second is focused on "real" change processes, i.e. dynamics that happen without formalised, institutionalised process. In doing so, this research provides a four-step analysis of change process as they concretely happen, in real existing local contexts. The first part of the report is dedicated to an analysis of the issues of change (governance, network and diversity, quality and participation) on which we decided to focus for this report. The second step consists in an analysis of the three national cases and of their most noticeable shortcomings concerning the issues at stake. The third part of the study deals with the local case studies precisely picked for their relevance regarding the main patterns of the national cases. Finally, the last part of the research is dedicated to a comparative analysis of the mechanisms of social learning for institutional innovation in our six local cases, in their national contexts.