Challenges and prospects in the EU: Quality of life and public services Chapter 3
31 Introduction The 2017 European Pillar of Social Rights calls for universal access to affordable long-term care services of good quality, in particular home care and community-based services. The European Commission and European Council’s Joint employment report for 2019 notes that, as the EU population ages, demand for long-term care is growing and needs are changing (European Commission, 2018a). It sets as a guiding principle for Member States to have good access to quality long-term care and that its effectiveness should be improved. Digitalisation plays an increasing role (see Chapter 8). The European Commission’s 2018 ‘Ageing’ report identifies a ‘clear need for a broadening of formalised coverage of the European population with long-term care services’ (European Commission, 2018b, p. 155). It also emphasises the need to take into account financial sustainability, identifying long-term care as a key contributor to age-related public expenditure, after healthcare and pensions. The Annual Growth Survey (AGS) 2019 stresses the importance of good access to quality long-term care services for social inclusion (European Commission, 2018c). It further emphasises the need for the sustainability of these services in the context of an ageing population. The 2018 CSRs included comments and recommendations relating to long-term care for several Member States. Some of the CSRs note that the availability of long-term care services is low (e.g. Cyprus and Czechia) or argue that formal long-term care costs may be unsustainable (containing costs – Austria, Belgium; or simply underline the fact that long-term care costs are high – Luxembourg, Malta and the Netherlands). Some CSRs highlight that levels of informal care and lack of formal (affordable) care contribute to low female employment rates (Croatia, Czechia, Italy and Poland). However, progress in implementation of CSRs around long-term care has been slow (European Commission, 2019). Despite the diversity of systems that are in place for long-term care, the focus here is on messages that apply across the Member States. As in the previous chapter, this chapter discusses access, quality, prevention, sustainability and survey data for policymakers. It examines how these can be improved, building upon existing Eurofound findings, complemented with new analysis and discussion. Access Improving access to formal long-term care There are several important dimensions of access to long-term care, including basic availability and affordability, which varies immensely between Member States (SPC and European Commission, 2014; Eurofound, 2017, 2019). Here, the focus is on the extent to which integration and clarity of the system facilitates prompt access to the most appropriate services. But first, the use of long-term care services is discussed broadly, drawing on data from EQLS 2016. Figure 11 shows the proportion of people reporting that they or someone close to them had used various types of formal long-term care services in 2016. 8 It also indicates the proportion of people who at least three days per week provide informal care for disabled or infirm family members, neighbours or friends (hereafter ‘frequent carers’). In all Member States there is heavy reliance on informal care, but some countries stand out in terms of the proportion of frequent carers (Belgium, France, Latvia and Romania – all 15% or over). In other countries, a relatively high proportion of residential or nursing home care is provided (Finland, the Netherlands and Sweden – all 11% or over). Home help or personal care are also particularly prevalent in some of these countries (Belgium, Finland, France, the Netherlands and Sweden) as well as in Denmark. 3 Long-term care services: Access and quality 8 In this chapter, the focus is often on both users and people close to users. This aims to address the following limitations of the EQLS sample: people in institutions are not included; some user groups may be underrepresented (even after weighting) due to interviews not being designed to include them (this applies, for instance, to people with certain disabilities); and for some groups, low sample numbers do not allow for valid analysis.