Abstract

The article deals with the difficulties of institutional change in a policy field, such as long term care policy in Italy, characterized by high social pressure for changes on the one hand, and strong, prolonged institutional inertia on the other. This analysis considers the implementation of an innovative national LTC scheme: «Home Care Premium» (HCP). Currently restricted only to public employees and their relatives, HCP offers two main provisions: a) a voucher system aimed to support families in paying a personal care assistant; b) in-kind home care services provided in accordance to an individual care plan. Despite its innovative content the implementation of HCP has been undermined by several critical issues that can be considered paradigmatic of the difficulties to implement institutional change, in the light of the role played by the different actors involved in the implementation process.