ABSTRACT
In Europe, long-term care policies (LTC) for older adults are progressively shifting back towards family care, exacerbating gender and socioeconomic inequalities in care utilization. Previous studies have provided valuable insights into the role of LTC policies and individual factors in shaping the interplay between formal and informal care; however, how and by what mechanisms public LTC intersect with the dynamics of care utilization remains underexplored. This qualitative case study addresses these gaps by focusing on LTC policies in Italy, one of Europe’s most familializing countries. The findings indicate that access to public social care tends to be delayed by professionals discouraging public care use and redirecting individuals to alternative care solutions when and until these are exploitable. Conversely, through local interventions, early access can be prioritized and streamlined for older people with limited informal support and low ability to afford private care. Care-seekers either reinforce or contrast these mechanisms depending on the availability of other care resources and their interpretations of who, when, and how should provide care. This research enhances understanding of how familistic LTC policies intersect with care trajectories and shows how, while safeguarding only the most vulnerable, they also reinforce inequalities in access to care and undermine the sustainability of informal care.