Reform of private geriatric nursing system, Austria

About

Country: 
Austria
Sectors: 
Health and social work
Target Groups: 
workers/suppliersemployers/purchasers

For cost-saving reasons, many older people in Austria engage illegal foreign workers to provide private nursing care at home. In order to legalise this work and to make care services more affordable, the Austrian parliament passed new legislation in 2007. Thus, illegally operating care workers may now be employed under the terms of the Private Household Workers Act or be entitled to join the ranks of self-employed nurses. Due to a lack of accompanying evaluation to date, the effects of this initiative have largely remained unclear.

Background

In Austria, thousands of older people and those in need of care have privately engaged the services of illegal workers from abroad, mostly from the central and eastern European new Member States, for geriatric nursing services in the home. This is because many people cannot afford to pay licensed professionals providing such services. Older people, given that they are formally recognised as being in need of care, are entitled to claim a statutory nursing allowance of up to €1,563 a month, which is subject to the extent of their care needs. This allowance, however, is often totally insufficient to meet the costs of care duties performed by licensed nursing personnel; for example, some people may require 24-hour stand-by care, which would prove very costly. Due to the consistent shortage of licensed and affordable mobile nursing staff, as well as stationary nursing places for elderly people, an informal nursing system has been in operation for some time. This system comprised about 40,000 illegally operating care workers, as of mid 2006, who have been working as geriatric nurses but often lack the relevant qualifications for this work. These workers usually have to perform many specialised activities, such as medicinal provision and physical care, as well as housekeeping duties and providing a simple physical presence and company for the person in care. Many of these workers live in the same household as the person under their care, receiving some form of ‘allowance’ rather than regular pay.

This initiative was launched by the coalition government comprising the Social Democratic Party (Sozialdemokratische Partei Österreichs, SPÖ) and the conservative Austrian People’s Party (Österreichische Volkspartei, ÖVP), after a consultation process involving the social partners.

Objectives

The aim of the coalition government by launching the initiative was to legalise most of these illicit employment relationships, without threatening the widespread and necessary provision of private care services as such.

Specific measures

In a first step, in order to remove the threat of immediate prosecution of the parties involved and thereby secure the existing care relationships, in the autumn of 2006, the then opposition SPÖ and ÖVP agreed to temporarily legalise most of these illicit employment relationships. This interim amnesty was considered as a step towards the objective of completely reorganising the labour market in the field of private care services.

During the spring and summer of 2007, the newly formed SPÖ-ÖVP government agreed on a substantial reform of the private geriatric nursing system. As a consequence, the Act on Home Care (Hausbetreuungsgesetz, HbeG) was endorsed by parliament on 4 July 2007. The new legislation provides for two distinct employment alternatives for those working as geriatric nurses. First, the person requiring care may employ one or two geriatric nurses under the terms of the pre-existing Private Household Workers Act (in German, 152Kb PDF) (Hausgehilfen- und Hausangestelltengesetz). Accordingly, the nurses shall work 14-day periods on a ‘permanent’ basis, allowing for a maximum of 64 ‘normal’ working hours a week and additional stand-by duties of up to 34 hours a week. If a person requires permanent care, two nurses a month offering their services alternately have to be employed.

Secondly, nurses have the option of becoming self-employed under the new legislation. This means that the individual has to apply for a general trading licence and register with the Social Insurance Association for Entrepreneurs and Self-Employed Workers (Sozialversicherungsanstalt der gewerblichen Wirtschaft, SVA).

Both schemes are subsidised by the federal state. The first scheme based on regular employment provides for subsidies of up to €400 maximum per nurse each month, while the self-employment option provides for a maximum subsidy of €112.50 per self-employed nurse each month. The size of the subsidies depends on the extent of a person’s care needs. However, only persons requiring 24-hour stand-by care, and who do not possess assets – except their home – worth more than €5,000, can legally claim such subsidies.

The new legislation came into effect retrospectively on 1 July 2007 and has been binding since 1 January 2008, when the interim amnesty regulation expired.

Evaluation and outcome

Achievement of objectives

No accompanying evaluations of these measures are available to date. According to the Federal Ministry of Economy, Family and Youth (Bundesministerium für Wirtschaft, Familie und Jugend, BMWFI), about 15,000 people have entered the self-employment scheme and applied for a general trade licence under the HBeG. No figures are available for geriatric nurses who have been regularly employed by the person requiring care. Presumably, only some of the illegally operating foreign workers have entered one of the two schemes under the HBeG, mainly for cost reasons (see below).

Obstacles and problems

According to estimates from the Federal Ministry of Social Affairs and Consumer Protection (Bundesministerium für Arbeit, Soziales und Konsumentenschutz, BMSK), effective monthly costs of the new 24-hour care schemes are expected to amount to €1,500–€2,000 in the case of self-employment and to €2,600–€2,850 for regular employment. For many older people, these costs are still not affordable, and they feel therefore forced to continue to engage illegally operating foreign workers without a trade licence and thus often without social security cover to provide private nursing care at home.

Lessons learnt

Critics of the new legislation claim that the new schemes are not sufficiently funded by the state, such that a large proportion of the population still cannot afford them. Therefore, as many experts agree, most care services will continue to be provided outside of the official labour market by illegally operating foreign nationals. However, the responsible ministries have thus far rejected such criticism, without, however, having substantiated the alleged success of the measures concerned.

Impact indicators

Apart from the data provided earlier, no further information is available to date.

Transferability

As far as the general issue of transforming illegal employment into legal employment relationships is concerned, the initiative can be considered as transferable to other national settings. However, to render such an initiative attractive in terms of affordability and thus success, substantial public funding seems inevitable.

Contacts

BMSK, Website: www.bmsk.gv.at/

BMWFI, Website: www.bmwfj.gv.at/BMWA/default.htm

Bibliography

European Industrial Relations Observatory (EIRO), ‘New law sanctions private care services by foreign nationals’, 2007, available online at: http://www.eurofound.europa.eu/eiro/2007/09/articles/at0709019i.htm.

EIRO, ‘Temporary work permits issued to illegal foreign care workers’, 2007, available online at: /ef/observatories/eurwork/articles/temporary-work-permits-issued-to-illegal-foreign-care-workers.

BMSK, Legalisierung der 24-Stunden-Betreuung – Was ist zu tun?, Vienna, 2008, available online at: http://www.pflegedaheim.at/cms/pflege/attachments/8/4/6/CH0848/CMS1224591541106/090113_pflege24_210x297_legalisierung_infoblatt_web.pdf.

BMWFI, 24-Stunden-Betreuung zu Hause, Vienna, 2008, available online at: http://www.pflegedaheim.at/cms/pflege/attachments/8/4/6/CH0848/CMS1224591541106/09_bmsk_24stdbetr_auflage_4_web%5B1%5D.pdf.

Georg Adam, Department of Industrial Sociology, University of Vienna

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