Forthcoming European Care Strategy must look towards the future
The European Pillar of Social Rights states that 'everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services'. Taking a step to make this principle a reality, the European Commission is currently preparing a European Care Strategy, expected in September 2022. Good access to care is crucial for the quality of life of people with care needs as well as the well-being of informal carers who care for family or friends. An ageing population translates into intensifying demand for long-term care (LTC). Meeting this demand calls for a future-oriented strategy, one that should identify current trends and seek to improve them. Here we present four policy options that such a strategy should include.
1. Facilitate early access to flexible home and community care services
Access needs to be improved along the length of the care path, starting from people’s awareness of their care needs up until having these needs met.
People with care needs and their informal carers do not use formal care if it does not fit their needs and preferences. Home and community care options need to be flexible and responsive to changing circumstances, and people need to be able to combine formal and informal care. Providing some level of formal LTC for people in the early stages of care could allow for early intervention to prevent further needs from developing. It would also stimulate interaction between formal and informal carers, helping to build trust in and awareness of further formal care options when needed.
With the 2019 Work–Life Balance Directive, the EU has supported informal carers of working age by entitling them to carer’s leave. However, it is important not to overlook the many informal carers who are retired; for this group, support is key for their social integration and mental health. Such support can include respite care to provide occasional or regular care relief for informal carers, and this too must be flexible.
- Publication: Access to care services: early childhood, education and care, healthcare and long-term care
2. Acknowledge links between care sectors
The strategy needs to recognise the interlinkages between care sectors, meaning that interventions in one care sector often come with implications for the other.
This is apparent, for instance, in regard to staff shortages. There are large staff shortages in the care sector, especially for nurses, and healthcare tends to be a more attractive employer than LTC. Working conditions need to be improved in all care sectors to address this situation, but solutions could also be sought in upskilling. An example is the ‘elderly care take-off’ scheme in Sweden, which enables care workers to work part-time while studying to become care assistants or assistant nurses, receiving a full salary (paid by government) and full-time job security after they finish their studies.
The formal care sector would also be aided if its own staff had better access to childcare and long-term care services so that they had the choice to work more hours. The sector has one of the largest part-time work rates of all sectors of employment: a whopping 42% work part-time (compared to 19% in all sectors), and 20% do so because they have care responsibilities of their own. 
Good access to primary care can contribute to early intervention and prevention and can play a role in facilitating longer lives in the community. The great potential e-care has in primary and mental healthcare was demonstrated during the COVID-19 pandemic, in particular for more minor care needs and follow-up consultations. A future-oriented Care Strategy should seek to encourage Member States to solidify this great leap made during the pandemic into well-thought-through systems, with appropriate incentives for healthcare providers to offer e-consultations and e-prescriptions where beneficial for patients and preferred by them.
3. Regularise or prevent domestic care work
Provision of LTC by domestic care workers employed by households needs to be addressed by the strategy, for several reasons. These domestic care workers – especially those who are living-in with the care receiver – face particularly challenging working conditions, and there are also concerns for the quality of care. Undeclared work in LTC is concentrated almost exclusively in this subsector, which is even more female-dominated than other parts of LTC. It tends to employ migrants or mobile citizens, whose situation can be more vulnerable to exploitation. Furthermore, platform work is playing an increasing role in this area.
Domestic care is common in a number of Member States and is on the rise, especially in those where household incomes are lower. With underdeveloped LTC systems, more households are likely to start employing domestic care workers when they can afford it. The Ukrainian refugee crisis increases the urgency of this concern. Ukrainians are already providing domestic care, for instance, in Hungary and Poland, usually undeclared. Many of the adult refugees may end up working in this precarious LTC subsector.
A future-oriented Care Strategy should encourage Member States to regularise the situation of domestic carers (as Austria has, for instance). Importantly, though, it could also contribute to limiting the reliance on this form of LTC by calling on Member States to improve access to home and community care.
4. Postpone or prevent care needs by improving working and living conditions
There is a risk that the European Care Strategy will focus too narrowly on care provision. A future-oriented strategy needs also to seek to prevent and minimise care needs. Improved living and working conditions over the life course are key in achieving this.
Good health delays the need for care, but many negative health trends have been aggravated by the pandemic situation, such as increased overweight (in particular among lower socioeconomic groups) and mental health problems.  Where possible, tackling the causes of these health problems should be a priority, along with treating them. In the case of mental health, this includes reducing financial insecurity and social exclusion. It also means paying more attention to mental health risks in working conditions, not least in the growing care sector, which employs a large number of people: 12.4 million in healthcare and 9.1 million in social services. Facilitating physical activity can be an effective policy option to address overweight.
There are synergies between measures to postpone or minimise care needs and the objectives of the European Green Deal, addressing climate change and environmental degradation. For instance, neighbourhoods that promote active modes of transport, including for people with walkers and wheelchairs, can stimulate health and social interaction and lessen the need for support, while reducing carbon emissions at the same time. Better insulated homes could reduce health problems.
Taking a broad perspective
The European Care Strategy has the power to be particularly effective if it takes a broad perspective. It must take account of the differences in people’s care needs and preferences and the multiple types of care available to meet them. But it must also look beyond those who seek care now to those who will need care in the decades to come, to minimise those care needs, or even to prevent them from arising in the first place.
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