The difficult reform of long-term care policies. About contradictory norms in the promotion of autonomy for older adults

With 22.8% of the population aged 65 and over in 2021 and a 19.1% increase in this population since 2016, New Brunswick ranks second among the most aging provinces in Canada, after Newfoundland and Labrador. As in many post-industrial economies, the response to an aging population is an increase in social and health spending. In a context oftension between growing needs and budgetary constraints, the New Brunswick model has been the subject of much criticism, so much so that the ways of regulating long-term care have undergone several transformations over the last twenty years. While there is now broad consensus on the lack of solutions to meet the growing and evolving needs of the aging population, what structural and cultural difficulties related to the modes of regulation of long-term care do these reforms highlight?Based on a corpus of 50 interviews with actors involved in the design and implementation of public policies, this paper proposes to revisit two interrelated issues. On the one hand, the influence of private actors at the same time as their fragmentation in a context of increasing needs seems to weaken the legitimacy of the norms structuring the sector. On the other hand, the contradictions in the international norms and references on which the actors are led to rely are likely to weaken the legitimacy and coherence of the proposed changes.