Europe’s demographic changes are bringing challenges to our society. The increasing ratio of inactive to active population puts stress on public finance and welfare systems need rethinking. Faced with these challenges, new models for long-term care are being developed in order to improve access to and the quality of the sector’s services. These were the topics discussed at our seventh Policies & Practices breakfast debate on 19 March 2014.
Daniel Molinuevo Research Officer in the Living Conditions and Quality of Life unit of Eurofound
John Halloran Director of the European Social Network (ESN)
Claudia Menne Confederal Secretary of the European Trade Union Confederation (ETUC)
Keynote speakers at the event were Daniel Molinuevo, Research Officer in the Living Conditions and Quality of Life unit of Eurofound and John Halloran, Director of the European Social Network (ESN).
Long term care sector: specificities and stocktaking of the sector
Introducing the audience to a study on the topic, Daniel Molinuevo explained the specificities of the sector, he mentioned the difficulty to determine the size of the workforce in community-based care for the elderly and disabled in the EU. “Data are available only for a handful of Member States,” he lamented. Nonetheless, it seems the home care workforce is on the rise.
Improving working conditions in home care services, he explained, is crucial as recruitment and retention of staff in care is extremely difficult. Therefore, professionalising the sector, through trainings for instance, and providing more career opportunities are essential. In France and Spain there are certification schemes for the professional accreditation of experience. The evaluation of the case studies included in the research project show that training and accreditation schemes need to have a strong, practical component. For example, “people who took up a training course in management in Germany," he pursued, “experienced lower stress levels once that they took up management duties”.
The study also emphasised the importance of the use of new technologies in the sector. IT allows for new ways of organising care, although this means that workers have to be trained to be proficient in new technologies.
Some of the main success factors and barriers identified in the study are the following:
- training and accreditation should include a practical component and accommodate the needs of practitioners;
- to improve the efficiency and attractiveness of work, greater responsibility and autonomy should be given to the professionals;
- IT can be perceived as a challenge by professionals as well as users and training the staff to technological tools can overcome this;
- the sustainability of funding is key.
On the last issue, Mr Molinuevo insisted “it was important to raise awareness about the value of social care in order to ensure that its financial sustainability is high in the political agenda
Following up on the presentation, John Halloran, Director of European Social Network, rephrased the concern. He asked: “how do we promote sustainable, cohesive, inclusive societies? Young and old, disable, all living together? How people grow and how they spend their final years?” The solution, he believes, lies “in a skilled, valued workforce.”
New needs, new approach
Also, because the needs between and within Member States are so different, “we need to bring a flexible response.” There is room for a wider debate about the role of social welfare. Mr Halloran suggested “we define the care around the needs of social users as well as involving service users.” In his view, this will help define the type of workforce we need in the future.
The institutional approach to long term care has, by definition, a limited range of options. “The framework is quite inflexible,” said Mr Halloran, “when people have all kinds of needs”. The answer to these challenges must be both responsive and individual. It also needs to be formal and informal, as it should allow for support from families and friends.
Person-centred care is community based rather than institution based. It consists of placing the service user in an inclusive community, where they remain visible and close to their family. It seeks to put them in an environment where they develop a normal life for as long as possible, because people want to spend their time at home, not in an institution. “Today the words are inclusive, participative – it is all about hearing people’s voices, the right to choose where you live” said Mr Halloran.
These are the challenges long-term care services are faced with. “We are talking re-enablement, preventive services,” he added.
Impact on costs
Prompted to comment on the cost impact, Mr Halloran said there was a lot of debate on the return on investment in social care. “Good community care doesn’t come cheap” he admitted, “but there are different ways of getting value out of this system.” Mr Halloran mentioned co-payment, co-responsibility, sharing the risk, and involvement as alternatives to consider. “There is a need for greater understanding of the cost/benefit approach,” he noted, before adding: “a more tailored approach to care could mean that people stay active longer.”
The term “squaring the circle” was mentioned regarding costs and needs. Because the latter are on the rise and public spendings cannot follow the trend, a mix of solutions needs to be brought in. “Otherwise you end up rationing expensive services and that doesn’t suit anybody,” said Mr Halloran before adding that technology can offer cost-cut opportunities. E-health could enable remote diagnosis and care and therefore more flexible services.
Another way to help square the circle is to bring in all the undeclared workers towards the formal economy.
Asked whether Eurofound was going to evaluate the implementation of the social investment package on the national level, Mr Molinuevo replied that it was looking to support with evidence and research the messages of the package. The Agency, for instance is investigating the correlation between investment in working conditions and the improvement of living conditions in other areas of care such as childcare,. “There is a lot of scepticism as to whether increasing wages does reflect in better services,” he continued “while actually it leads to less turnover and this has a huge impact on the services.”. Eurofound research shows that a lot of social workers work part time, there need to be incentives for social carers to work full time.
The convention for domestic workers – where are we now?
Claudia Menne, from the Confederal Secretary of the European Trade Union Confederation (ETUC), was a speaker at the previous session. Here, she gave the audience her feedback and insight on the convention for domestic workers, adopted in 2011. The convention seeks, among other issues, to provide the rights for workers to be unionised, the right to collective bargaining or to be protected in the workplace and regulates working time.
Once it was adopted, ETUC had to persuade Member States to adopt the convention. This took place through the “12 by 12” campaign led by the International Trade Union Confederation, trying to obtain 12 certifications by the end of 2012. Since she last spoke at the P&P session, Ms Menne said that only Italy had ratified it. Now Germany has joined in and “there are further discussions with Belgium, the Netherlands and Norway,” she said. She noticed that it helped a lot to have support from the European institutions, with the Council giving guidance and the Parliament trying hard to have the convention adopted.
Ms Menne acknowledged the transition from institutional care to more person-centred care. “We can share this vision”, she added, “and most of us can follow these lines. But there are also a lot of obstacles.” One of them lies in the disparities of the care regimes of the Member States.
Ms Menne also raised the issue of privatisation which, in ETUC’s view, can distort the quality of service as the sector would focus more on profits.
How can we combine the notion of building a European labour market with the idea of family-based care? Illustrating her point, Ms Menne mentioned the example in Germany, where “there was discussion around legislating in order to give grandparents the status of parental care, as there are more and more families that rely on the elderlies to look after the grandchildren. “But,” she asked, “how could this match with the extension of working life?”
Concluding the session, the three speakers agreed that the very different models of ‘family’ across Europe could prove challenging to find a one-size-fits-all solution. One single legal, financial and policy framework is rarely optimal. “There are structural problems that are being addressed. What models of integration can we push forward?” finally asked Mr Halloran.
 More and Better Jobs in Home Care Services, Eurofound, available at www.eurofound.europa.eu/publications/htmlfiles/ef1353.htm