Social services for older people in the Czech Republic: Towards deinstitutionalization or marketization?

The concept of deinstitutionalization has become part of Czech policy since 2006, making it interesting to evaluate the response of local government in implementing it, in the context of changes that were part of the movement... [ view full abstract ]

The concept of deinstitutionalization has become part of Czech policy since 2006, making it interesting to evaluate the response of local government in implementing it, in the context of changes that were part of the movement away from old pre-1989 Eastern European models.

The authors focus their investigation on a case study of elder care services, and especially domiciliary care services provision in a municipality within the South Moravian region. Main emphasis is put on the implementation of the mutually supportive policies of deinstitutionalization and marketization, investigating the manners and mechanisms through which these were implemented.

A mixed-method design was used combining several data sources (administrative data, statistics, qualitative case study data and policy documents).

In spite of an aging population and of a policy purporting to want to transfer care from institutions to support at home, state provision for both institutional and home-based care are declining. Moreover, domiciliary care service agencies persistently concentrate on the provision of practical help, while there is little or no provision of 24/7 care services or case management support. The dearth of places in registered nursing homes has occasioned the large growth of unregistered facilities that tend to take the most vulnerable older people, the latter being the ones that bring with them the highest care allowances. Thus, the care for these people takes place increasingly in settings where the standards of care and care workers’ qualifications are not checked, resulting in low levels of quality of provided care as well as poor working conditions for care workers.