Capitalising on Care? The Political Economy of Long-Term Care in Ireland

While existing literature has studied several fundamental aspects of LTC dynamics in Europe, my PhD thesis identifies three significant knowledge gaps. First, few studies systematically analyse how LTC markets evolve once initiated. Second, there is a striking lack of research that focuses on the role of private for-profit actors in the dynamics of LTC markets. Third, little existing research studies the interests and policy preferences of private for-profit actors in LTC. My PhD’s contribution is to address those significant knowledge gaps and advance existing literature beyond the current state-of-the-art. As such, the project is motivated by three research objectives that align with each knowledge gap. First, to analyse the explanatory factors that have shaped the evolution of LTC market dynamics, with a focus on the role of private for- profit actors (including financial investment funds such as private equity and real-estate investment trusts). Second, to examine the factors that drive private for-profit actors’ interest in LTC. Third, to outline and explain the policy preferences of private for-profit actors in LTC. To operationalise those objectives, the project implements a case study of Ireland’s nursing home market to answer three corresponding research questions: 1. What are the key mechanisms of change that explain the transformation of Ireland’s nursing home market? 2. What factors drive private for-profit actors’ interests in Ireland’s nursing home market and why? 3. What are the policy preferences of private for-profit actors in Ireland’s nursing home market and why? My PhD thesis is located at the intersection of social policy and political economy — and engages directly with the LTC marketisation literature. The overarching theoretical contribution of my PhD is to advance existing literature beyond the current state-of-the-art by bringing a political economy approach to the study of LTC market dynamics. Existing research is dominated by institutional and ideational theoretical approaches, which have deepened our understanding of the role of policies and pro-market ideas in shaping processes of change (Burau et al., 2017; Ranci and Pavolini, 2015). This project applies a novel political economy framework that adds to existing institutional and ideational approaches. Overall, my study is situated alongside emerging political economy approaches to LTC dynamics (Farris et al., 2024; Ledoux et al., 2021a; Mercille, 2024; Hoppania et al., 2022) that build on the work of seminal scholars in the field (Meagher and Szebehely, 2013; Estes, 1988; Phillipson, 1982; Gingrich, 2011). Methodologically, the thesis implements a case study design using a qualitative approach. In terms of data collection, in-depth interviews with senior managers at key stakeholders (e.g., private for-profit nursing home group CEO, private equity managing partner, real-estate fund chief investment officer, senior official at Department of Health), documents, government spending data, and nursing home beds data were used. The data were analysed using process tracing and abductive analysis methods.