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Author: Henk Nies

The assessment of need and the vested interests of powerful actors constitute two major problems in the local planning of services for elderly people. In this article the contribution of applied research to these planning processes is explored by means of a case study into care delivery to long term elderly patients.

The case study design appears to be well suited for this type of research. Triangulation, a focus on person-environment dynamics and a close interaction between the researchers and significant actors in the policy process, enhance the applicability of the research. In the current study these strategies failed to resolve completely the central policy question, but they certainly brought more rational elements into the policy process. The latter is a valuable contribution in itself.

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Collaboration has become an imperative of many new healthcare policies; however, little attention has been paid to how system-level narratives in both policy documents and the media create boundaries that shape implementation processes. By using boundary work as a theoretical lens, this article critically analyses the discourse found in both policy documents and the media surrounding the 2015 Dutch LTC reform. This discourse analysis contributes, first, by revealing two separate narratives – one epic, one tragic – which we argue represent different rhetorical styles used to (de-)legitimise symbolic boundaries. Second, we contribute by unravelling boundary work in both the social and symbolic dimensions to show how the design of the 2015 reform led to a tension-ridden position for local actors: symbolic boundaries demanded integration, while social boundaries imposed differentiation. These findings have implications for literature on boundary work as well as for policy design and its local implementation.

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