Navigating access to long-term care for older adults in Italy: a comparison of lived experiences and local practices

As populations age and autonomy declines, access to long-term care (LTC) becomes crucial to quality of life, yet it remains deeply unequal. This thesis examines how these inequalities are experienced by care-seekers and how they are potentially reproduced and mitigated through the local implementation of LTC policies. The study draws on qualitative research conducted in two towns in Northern Italy, where strong reliance on family care and policy fragmentation create significant barriers to access. By integrating the perspectives of care-seekers and professionals, the research explores how individuals approach, navigate, and obtain public LTC over time. The first empirical chapter identifies factors and mechanisms in initial LTC policy approaches, providing actionable insights and a conceptual framework for understanding their interactions. The second chapter explores how public LTC intersects with care utilisation over time, revealing that, while protecting the vulnerable, LTC policy also reinforces inequalities and undermines the sustainability of informal care. The third examines administrative burdens in a fragmented LTC system, showing how local practices offer band-aid solutions, while joint access procedures offer more effective, equitable solutions that guide care-seekers over time. Overall, the thesis advances understanding of how LTC policies are experienced over time and implemented, and of the mechanisms by which inequalities in accessing public care can be alleviated or exacerbated.