Fragmentation and the limits of governance in old age care?

Societies are increasingly complex and fragmented. Old people and their significant others struggle to navigate in fragmented care, that is care that is often split up into numerous tiny pieces provided by different parts of an institution, different private and public institutions, various professionals and sometimes volunteers. The very old and their significant others often become frustrated and confused. Fragmentation is a neglected object of study within the governance literature. But it is also understudied and undertheorized to what extent various forms of governance paradigms themselves contribute to fragmentation. I argue that the three paradigms of classic public administration (CPA), profession- based rule and New Public Management (NPM) reinforce each other in a particular way increasing the amount of fragmentation through splitting up tasks within and between different organizations (private and public) and different expertise (professionals). This hybrid form of governance can best be understood through a new analytical concept briefly introduced in Dahl (2021), that of regulated fragmentation. Simultaneously, the scholarly literature on governance pays scant – if any attention - to the relationship between steering and its objects of governance i.e. it neglects a discussion of what is governed (characteristics) and how it can be governed properly. This paper attempts to initiate a dialogue between the governance literature and care research. The governance of old age care has currently the form of regulated fragmentation that shows us some of the limitations of governing old age care in the form of oversteering (quantitatively) and form of regulation (qualitatively). Theoretically, I will discuss how governance can’t come to terms with the complexity and unpredictability of care and care needs that care research and especially care ethics has documented. I will apply feminist philosophers stressing the androcentric character of our thinking, the concept of heterotopy (Mol, 2008) and care ethics understanding of care as a universal vulnerability, situated and responsive to care needs (Tronto, 1993; Gilligan, 1982; Noddings, 1984; Fineman, 2008). Based upon their insights, I argue that old age care is the radical Other to governance and illustrate its limits/limitations in various ways.