[Intro]
00:00:35 Mary McCaughey
Hello and welcome to this edition of Eurofound Talks. Today, we’re going to focus on the issue of care. Care for our children, care for our older people, for those who are frail or those with disabilities. We’re going to talk about access to care, the quality of that care and the conditions of work for care workers. Care is an issue that affects us all in some way at some time in our lives. And yes, it’s always been on the policy agenda. But during the pandemic, it’s clear and fair to say that the spotlight was placed fairly firmly on care during this time. Who was providing it, for whom? And importantly, in what context was this care being delivered? There are several initiatives at the EU level at the moment, as we know, to address some of these issues. And most recently, the Commission launched the European Care Strategy. So, a lot on the agenda for us to talk about today. And I’m here today with Hans Dubois, who is one of our Senior Research Managers here at Eurofound and he is our resident expert in this area. So welcome, Hans.
00:01:45 Hans Dubois
Hello.
00:01:46 Mary McCaughey
So, Hans, we’ll just get straight into it. As we look at care and we look at it as a policy area, it’s always, I think good and helpful for people to understand what it is that we mean by care, what the definition of care is, and particularly for this topic because it’s so all-encompassing. So, Hans, maybe you can kick us off by talking to us about what we mean when we refer to care, who are the recipients of care for the most part and who generally are the caregivers?
00:02:19 Hans Dubois
So we are focusing here on child day care and long-term care, not on healthcare where the focus is really on cure. The recipients, these are children up to school-going age for childcare and for long-term care that’s older or disabled people with care needs. Now these are the recipients. There are many people with unmet needs who are not receiving the care they need.
With respect to the caregivers, you have the formal caregivers. So those who are in the care workforce, which has rapidly grown by one third in one decade for long-term care, a bit less for childcare. Then there are the informal carers who care for friends or relatives. And these are not to be confused with people who are employed by households, which is also an important part of caregiving. These are domestic carers and sometimes are engaged in undeclared care work. And that’s why it’s sometimes confused with informal carers.
00:03:23 Mary McCaughey
So, Hans, what I’m hearing from you is that there really are two parallel care sectors: the formal care sector that’s provided to a large degree by the state authorities, governments, etc., and then you have what you refer there to as the informal care sector. And maybe you can explain a little bit in terms of the informal care sector. You talk about undeclared work there to some degree. Is it mostly women? Is it migrant workers? Have you got a picture of who is involved in this informal care sector in terms of caregiving?
00:03:59 Hans Dubois
Yes, it’s indeed mostly women. By the way, the informal care sector is much larger than the formal care sector. With informal care here, I refer to people caring for relatives or friends. You also have paid domestic workers. They are particularly important in some Member States. So in seven Member States, there’s a big role for these domestic care workers.
00:04:24 Mary McCaughey
And so is this informal care sector picking up the slack to a large degree for where the state is failing to provide?
00:04:31 Hans Dubois
To some degree, yes, but it’s impossible to think of a scenario where all care is formalised. So you will always have an informal care sector in the sense that people care for their relatives or friends.
00:04:46 Mary McCaughey
When you first referenced who we were talking about in terms of the care recipients; there you mentioned children. In the beginning of or during the pandemic, the EU adopted the European Child Guarantee that is there to ensure that every child in Europe at risk of poverty or social exclusion has access to basic rights like healthcare and education. Do you think that that goes some way to addressing those particular issues? But do you think that the pandemic really, if you like, exposed the underbelly of the inequalities that existed when it comes to provision of care for children?
00:05:23 Hans Dubois
Yes, definitely it goes some way. And I think here it’s important to mention for simplification, I say childcare but actually it’s more appropriate to speak about early childhood education and care. And that’s why it’s so important in particular for lower socioeconomic groups in society. Those whose children have missed out on childcare during the pandemic has also missed out on development of their children. Also, let’s not forget about the parents of these children. We are about to publish a working paper on online education and we see that the overall experience during the pandemic was particularly bad for parents of young children.
00:06:06 Mary McCaughey
And is it the same situation replicated across the European Union? Would you see similar types of issues emerging with respect to childcare and early education in every one of the Member States, or is it particularly problematic in some as distinct from others?
00:06:27 Hans Dubois
There’s a huge disparity in the proportion of young children who are attending childcare among the Member States. So there are very big differences. So in some countries where children would not have gone to childcare, the closure of childcare during the pandemic has obviously had less of an impact. But it was not good beforehand either because all these children missed this development aspect of childcare.
00:06:57 Mary McCaughey
In terms of what we are looking at now with respect to the unpaid care, we talked there a little bit about the informal care sector. But during the pandemic, we knew that there was an increase in pressure being brought to bear for families and specifically for women who continued to be the main providers when it came to care, both of younger people, older people and as you referred to people with disabilities. What do you think are the labour market implications of this?
00:07:30 Hans Dubois
First, on the pandemic, I think it’s important to look not only at the proportions of people who provided care during the pandemic, but also at the intensity for those who already provided care, the intensity went up dramatically. If you look at changes, you will see that actually older men, there was a particularly large increase in care provision. However, I think it’s really important what you mentioned that indeed women are still the main care providers regardless of that increase.
It’s also important to mention, I think that many of these care providers, informal care providers are beyond working age. So if you look at policies to support them, yes, it’s important look at policies related to employment, but also support carers who may be retired; they also need support to be able to provide a sustainable form of care, which doesn’t affect their mental or physical health. In Italy, people who provided childcare during the pandemic received a monetary benefit and suddenly it became clear that many older women, mainly, were providing grandchild care, for instance. So from one day to the other, they suddenly got paid for that in huge numbers.
So looking beyond the pandemic, there are about one third of inactive woman in the age range of 25-49 are economically inactive, so one third because of care activities. There’s also men, 8%, so important not to ignore them totally. But also it’s not only economic inactivity, also many people work part time because of care activity, so one fifth of people work part time do so because of care activities.
Then I think with regard to gender, there’s actually a threefold gender dimension. Informal carers are mostly female. Formal workers are also largely female formal care workers, and that’s even more the case for childcare than for long-term care, and less so in healthcare, and that has been remarkably stable because the workforce expanded a lot. But the proportion of women among that care force has been the same as compared to one decade ago. The third gender dimension is that most recipients – and that’s for long-term care – most recipients of care are women because women tend to live longer. So whatever you do with care to improve the situation, it’s good for women because of this threefold gender dimension. However, to really obtain gender equality, broader measures are needed to fight gender stereotypes, for instance, to ensure that men are more employed in care provisions.
00:10:30 Mary McCaughey
So in terms of gender equality, clearly, it is a multi-pronged approach that is required there to deal with the issues around gender equality and what they conjure up in terms of the care sector. But you yourself have talked about the need to improve access to formal care and you’ve highlighted that many people with care needs and their informal carers don’t use formal care. What sort of issues do you think are preventing people from accessing services and what could we do to improve that situation?
00:11:04 Hans Dubois
In many countries there’s really very little publicly funded care, so there’s no access for people who cannot afford private care options. Now access is about more than affordability because sometimes there are affordable options but they are seen to be of bad quality or they are too far away. There’s also sometimes lack of flexibility to match people’s specific needs and preferences. So for instance for long-term care facilitating combinations of formal and informal care. It’s also more than just legal entitlements because people may be entitled to care but they don’t find their way to actually use these entitlements. In the 2020 report on access to care services, we provide a broad framework of access to care services and goes from acknowledging that you actually have these needs, so for instance acknowledging the childcare can contribute to the development of the child, to actually satisfying these needs in a good way.
00:12:09 Mary McCaughey
So there you’re talking about non-take-up, if you like, of services that are available to people and is that a problem across the European Union?
00:12:17 Hans Dubois
Yes, it definitely is. We have mapped this problem in a previous report and we see this coming up. It’s also with COVID support, it’s emerging all the time as problematic and particularly among groups where arguably would most need these services.
00:12:35 Mary McCaughey
So in fact it’s having a double whammy effect that they are not receiving the services or not being able to access those services in a way that they should and could. But also it is affecting disproportionately the people who could benefit most from those services. So it requires a large-scale approach, including communication.
00:13:00 Hans Dubois
Definitely, yes. And it could really be seen as a social injustice. So also for public discontent, it’s an important point to address that.
00:13:10 Mary McCaughey
Yeah. And in fact, to come back to what you were talking about there, about the staff and the care sector itself. You referred to the fact that there are more women in the sector, but there’s general underemployment in the care sector, in the formal care sector. And to some degree, is that driven by the issues of staff themselves not being able to access those services; is it sort of an unvirtuous circle that we’re looking at here?
00:13:39 Hans Dubois
Yes, and foremost the issue of lack of staff, it’s driven by the bad working conditions in the sector. Pay in social services. Social services is for 70 % long-term care; 30 % mostly childcare; in all the Member States, it’s well below the national average pay. Overall it’s 21 % below the national average, but there’s only three Member States where it’s less than 10 % below average.
But there are also other issues. It’s not only about pay. For long-term care, we map that in a report on the long-term care workforce. You see for instance, that there’s little say on work schedules, there’s exposure to adverse behaviour at work, physical strains, or lifting/moving people. Now it’s also important to note that there’s competition for staff between countries, so there’s countries with bigger shortages than others, but also between sectors with healthcare generally being a more attractive employer for nurses, for instance, than long-term care. However, and that’s what I think you alluded to, there can be synergy. So if you improve access to long-term care and childcare, you facilitate care workers to work more hours or to work at all, because then many of them do not work full time or do not work because they are involved in care activities themselves.
00:15:12 Mary McCaughey
Of course, yeah. So in fact, that whole idea of liberating, if you like, part of the potential labour market by improving access to childcare services and elder care services and long-term care. So in fact we could approach the problem in a very different way by just improving the very essence of what is available and improving accessibility. However, it doesn’t address the issues of pay, physical exhaustion, strenuous work, lack of autonomy, which you referred to there, and they are serious issues for a sector. What’s being done to address that?
00:15:49 Hans Dubois
I think a nice example that comes from Sweden, there’s an initiative called Elderly Care Take-Off that kind of ticks most of the boxes towards a good solution. There’s many people working in long-term care with very low qualifications. They are very basic-level carers. This initiative provides them with the opportunity to work part time and use the rest of the time to get a degree, to become a recognised carer or an assistant nurse.
00:16:22 Mary McCaughey
A qualification.
00:16:23 Hans Dubois
Exactly, a qualification. So that raises the profile, raises the quality of care and raises pay.
00:16:31 Mary McCaughey
So we can do things to attract more people to work in the sector by those elements that you outline there, but we still need to address the core elements of the sector and the working conditions in that sector once they are in it to retain them in that area. And when you look at that with respect to the current situation, I mean now we’re seeing demographic change in an ageing continent in the European Union, but not only of course, it’s saying that by 2050 there will be fewer than two people of working age for every person aged 65 or more; that’s fairly dramatic in terms of who’s going to look after us when we’re old. And in terms of improving care provision there must be other actions that can be taken to ease the pressure on the care sector in the years ahead.
00:17:25 Hans Dubois
True, but then I always like to add a word of caution when these numbers are cited, so the proportion of people over 65 as compared to people of working age. Many people who are currently of working age are unemployed or economically inactive so they could be integrated in the labour market. Also the people aged 65 and over are not the same as two decades ago, many of them more and more so are healthier than before, they are working. And including in the care sector, many people over 65 are continuing working and that’s needed because it’s a rapidly ageing workforce with many about to retire. Still of course there’s increasing demand also because the care sector is expanding, should expand in many countries where it’s not yet to standards, so how can that pressure be decreased? One solution which may not receive the attention it should receive is to prevent and postpone care needs and it can be done by improving living and working conditions. So improving living conditions, just to give an example, which is kind of unexpectedly in line with another key development, the green transition. So you improve people’s health by certain measures you can take in their living environment, which would be in line with the EU Green Deal and that will be to stimulate active forms of transport, to improve the quality of the air people breathe, healthier foods, but also insulating homes, for instance. So there’s a lot of, among older people, a lot of health conditions are related to cold or heat. Good quality homes can play a part in preventing care needs.
00:19:22 Mary McCaughey
That’s interesting, Hans. So in fact what you’re saying is that this is such a multi-dimensional area of work because what you’re saying is by improving living and working conditions across the board, and here, specifically, you just referred to kind of a just transition and what is involved there, that that can actually defer or postpone the need for care in the long-term care sector. But going back to what you initially referenced there, I’m fascinated at the idea of sustainable work, how that dovetails in with this also and the idea that an approach to sustainable work over the life course could actually have benefits in the care sector. Who would have thought?
00:20:07 Hans Dubois
It’s certainly true and it has an impact in general. So reducing care needs by improving health, but in particular also within the care sector. Because if you provide sustainable work conditions within the care sector, which is an increasingly large proportion of the workforce, you’ll allow the people employed there to continue working for longer. And one aspect which currently may not receive enough attention is the mental health risks which are larger for that sector than for other sectors because of exposure to adverse behaviour at work, emotional strain and, because there are so many women employed in this sector, women are more affected. So it’s also important from a gender equality point of view.
00:20:56 Mary McCaughey
So in fact, a lot of the early education elements that you were talking about earlier are relevant to the future because in terms of education, good lifestyle choices, healthy eating, exercise, mental health awareness and treatment, these are all things that can actually help us as we go through the life course coming through to the long-term care aspect of our existence. So it’s a life course approach to this particular area. And that’s why, and understandably so, the European Commission launched the European Care Strategy in September this year. And in terms of the issues that we’ve already discussed, in what way do you think that the strategy does reach out to address or resolve some of these issues? And has there been good reaction? Has it been well received so far?
00:21:50 Hans Dubois
Yes, so I think first of all it should be appreciated greatly that there is a care strategy. There has been very little interest in care at the EU level, maybe nationally as well. And in particular for long-term care, healthcare and to a lesser extent childcare have received more attention. Childcare with the Barcelona Targets, for instance, setting some specific percentages for the children which needed to be in childcare in the different Member States. But the care strategy has changed this and this was really needed. The reactions have been broadly positive and I think mostly because so far long-term care sometimes emerged in the discussions on the sustainability of public finances. So with ageing societies, yes pensions become more expensive but also there’s a greater demand for long-term care. So it was all about affordability. But this document clearly goes beyond this and it sees long-term care and childcare as a social investment with returns for the individual, for society and also for the economy.
00:23:00 Mary McCaughey
And in terms of, generally speaking, the implementation of that will roll out over the next period of time, are there any particular milestones that we should be aware of when it comes to the care strategy over the next a year or so?
00:23:14 Hans Dubois
There are specific targets attached for childcare. It doesn’t look only anymore at the proportions of children in care, but also looks at the intensity of care. So children should get enough childcare. I would say more generally, in terms of milestones, it’s really important to look at the Member States now. This care strategy is a great document. There are many, many aspects where there’s broad consensus on the direction in which care should go. However, it needs to be implemented by the Member States.
00:23:50 Mary McCaughey
Thank you very much, Hans. I mean, today has been a fascinating discussion and really has highlighted the multidimensional, very multifaceted aspects related to the care sector, the working conditions, the gender dimension, the informal, the formal care provision, access, affordability. And looking at this, certainly the fact that the European Care Strategy is in place seems to be a very good foundation for the next steps in terms of addressing some at least of the issues that we’ve talked about today. But at the end of each of these Eurofound Talks, we tend to say if you, as the expert, had a policymaker in front of you or in an elevator, had three points that you think were still relevant to this debate that could help progress these issues into the future, what would you say if you were to talk to me in three?
00:24:50 Hans Dubois
One thing to highlight in the current context is related to domestic care workers. Domestic care workers are employed by the household and they are often in the worst situation with regard to working conditions and also the quality of care they provide is not really controlled or anything. So they are often doing undeclared work and there is a risk at the moment. There’s a large number of Ukrainian refugees in the European Union at the moment and there is a risk they will end up working in the domestic care sector in countries where currently the number of people in this sector is still low but is growing fastly, for instance Poland, Hungary. These countries, and maybe the EU as a whole, should look towards countries where such work has been regularised effectively. For instance in Austria or in Italy during the pandemic where support was contingent on regularising domestic carers, or in Malta or Cyprus, which have a very clear migration path where people enter in a legal way to do such work. However, one could also look to the Nordic Member States, for instance, where such domestic care is basically absent, in particular live-in care is absent, so where domestic carers live in with the care receiver. And that’s because there’s really good access to flexible regular home care provided only by acknowledged providers. So that’s one.
Secondly, of course, with this care strategy and with when you speak about care, you tend to seek solutions within the care sector. I think many solutions are actually to be sought outside the care sector, such as some of those which I mentioned earlier in terms of preventing and postponing care needs. This could also be by providing good quality housing, so to prevent falls for instance, but also by safe and welcoming local areas where people can move around easily with their walkers or wheelchair which can reduce support because they can move around by themselves effectively.
And then lastly, I wanted to reiterate that the care strategy is really a document which provides many insights into providing good quality, sustainable care but the Member States need to implement it.
00:27:22 Mary McCaughey
Thank you, Hans. So to highlight the issue of domestic care workers particularly and the particular position of undeclared work. And also interestingly, the environmental issues and facilities that we could put in place outside the care sector, which could be of benefit to addressing some of those issues. And of course, the fundamental and critical role of the Member States in rolling out the provisions of the care strategy. So thank you, Hans for today’s discussion. It’s been really very interesting at a very timely moment for us. In terms of the policy debate, I would ask you all who have joined us today to follow us on our website where you can find the care topic on our pages on Eurofound’s website. Plus, of course, you can follow us on social media. And indeed, you can check into all the other podcasts which might be relevant today on sustainable work, gender equality, young people etc. So until next time when Eurofound talks to you.
[Outro]
