Navigating the dark and bright sides of co-production in Long-Term Care

Background: Demographic aging in Italy necessitates innovative and sustainable long-term care (LTC) models, particularly given limited resources and increasing care needs. This study explores the dynamics of co-production in LTC, focusing on both home and residential care across four Italian regions. Approach: This study employs a mixed-methods approach, including a literature review, database analysis, and normative comparison. Public spending on social and health services for LTC and the degree of economic co-participation required from citizens are compared across four regions: Emilia-Romagna, Tuscany, Abruzzo, and Molise. The research considers both personal and public involvement by examining the roles of families and caregivers in co-producing care, with a focus on the influence of sociocultural factors such as family structures and social capital. A radar chart analysis is used to represent key elements of LTC management, highlighting the balance between home-based and residential care and associating this information with the prevalence of self-sufficient and non-self-sufficient residents in those settings. Data from ISTAT and regional sources are analyzed to assess the impact of co-production on service access, utilization, and sustainability. The study also examines the role of policy decisions, such as co-payments for home-based and residential care, on families' care choices. Results: The analysis reveals variability in public spending and co-payments for LTC services across the four regions. Emilia-Romagna and Tuscany show higher public spending and greater investment in home services than Abruzzo and Molise. In contrast, Abruzzo and Molise show a greater investment in residential care despite a significant proportion of self-sufficient residents in these facilities. While co-payments influence family care choices, this relationship is complex and likely affected by factors such as the availability of residential beds, home care services, and waiting lists. The study also identifies a link between family structures, social capital, and the capacity for co-production; regions with stronger social networks and more diverse family structures, can tend to demonstrate greater effectiveness in co-producing LTC services. Implications: This study emphasizes the need for a balanced approach to LTC models, recognizing both the benefits and challenges of co-production with families. While co-production can enhance care personalization, family satisfaction, and resource efficiency, it also requires significant engagement from families and caregivers, potentially leading to burdens and “co-destruction of value” if not managed effectively. Policy decisions must consider regional disparities in social capital, family structures, and co-payment schemes to promote equitable access to LTC services and ensure the sustainability of co-production models. Future research should investigate the complex interplay between policy decisions, family dynamics, and co-production outcomes and develop strategies to support families and caregivers involved in co-production. References: 1.Pavolini E. Long-term care social protection models in the EU. European Social Policy Network, Report. 2022. 2.Gori C, Luppi M. Cost-containment long-term care policies for older people across the OECD: A scoping review. Ageing & Soc. 2022;pp.1-24. 3.Cepiku D, Marsilio M, Sicilia M, Vainieri M. A comprehensive framework for the activation, management, and evaluation of co-production in the public sector. J Clean Prod. 2022;135056.