A long-term care model is a combination of elements such as:
- • a care model (content and characteristics of the services and benefits that people receive),
- • a prescription model (who decides that someone receives care),
- • a management model (who hires the professionals) and
- • a financing model (who pays).
We have identified four ideal types that our long-term care future might look like:
1. In the corporate scenario, the interests of the main organized groups that participate in long-term care and, fundamentally, those of large and medium-sized provider companies (for-profit or non-profit) and those of less qualified and more numerous and organized workers, would weigh more heavily. Reactive services of low added value (technological, economic and social) are offered for relatively captive and disempowered audiences. Social services could be seen here as a complementary business to others (such as real estate).
2. In the consumerist scenario, the public powers and administrations would get rid of the provision (direct or indirect) of services and would be configured as insurers that give money (direct payments, service checks or personal budgets) to each person, based on some (more or less) objective requirements and then individuals and families would go to the markets and buy the different services or supports. It is a historical vindication of some movements of people with physical disabilities or other sectors.
3. The community scenario is the one that defends the community of practice and knowledge. It would be based on a model of preventive and population approach, as well as on technological, social and political innovation. It would be based on the technical and organizational strengthening of primary social care (which generates capacity and legitimacy for technical prescription) within a framework of integrated care.
4. The chaotic scenario would be that of an increase in the informal care economy and inequity in social care and welfare services in general. It would difficult people’s decisions about their future and the intergenerational contract.