15 October 2019

The provision of care services is a key component of social protection, improving quality of life and access to education and employment for EU citizens. It includes childcare, healthcare and long-term care

As people are living longer, the number of adults needing access to healthcare and long-term care is increasing. While formal care services play a key role, much care is also being provided by family members or relatives. At the same time, families with dependent children have been seeking to reach a better balance between work and caring responsibilities.

Due to the ageing workforce, more people of working age will have to combine employment with the provision of care, especially to elderly and disabled relatives. However, combining work and care is also an issue for the younger workforce, in terms of access to quality and affordable childcare services. This has become more of a challenge as more women are in paid employment and many continue to shoulder most responsibility in caring for family members and carrying out household duties.

EU context

The European Commission’s goal to increase employment rates will create new challenges for care provision and work–life balance. Therefore, higher employment rates among women and older workers will need to be supported by measures in the form of childcare and elderly care to make it possible for people to work.

The European Pillar of Social Rights puts a strong focus on care, firstly regarding the right to equal opportunities and access to the labour market. This focuses on the right of parents and those with caring responsibilities to a better work–life balance, which includes the right to suitable leave and flexible working arrangements, as well as access to care services. In the area of social protection and inclusion, it highlights the right of children to affordable early childhood education and good-quality care provision. It stresses the right to timely access to affordable and quality healthcare. It also underlines the right of all to affordable long-term and good-quality care services, particularly home-care and community-based services. 

In May 2019, the European Parliament and Council of the EU adopted the Council Recommendation on high-quality early childhood education and care systems, which aims to support Member States in their efforts to improve access to and quality of their early childhood education and care systems. Eurofound participates in a thematic Working Group as part of this initiative. In June 2019, the Council adopted a new Directive on work–life balance for parents and carers, which aims to increase women’s participation in the labour market and the take-up of family-related leave and flexible working arrangements.


Eurofound research focuses on a range of care-related topics. These include working and caring, initiatives to support informal carers involved in paid work as well as those who are not, the increased need for long-term care, childcare provisions and access to public services.

Survey data on care

Eurofound’s regular European Quality of Life Surveys (EQLS) and European Working Conditions Surveys (EWCS) cover various aspects related to these topics.

The six editions of the EWCS to date provide valuable information about working time and flexible working arrangements, paid and unpaid work, work organisation and work–life balance. Research has covered topics such as the working conditions of women and men, the working conditions of an ageing workforce, as well as health and well-being at work.

The four editions of the EQLS to date offer extensive data on care, including the high amount of informal care performed by people who are not in paid employment. The EQLS 2016 provides a range of information about quality of and access to healthcare, long-term care and childcare services in particular.

A 2019 study based on EQLS 2016 data examines access to and quality of key public services in the EU. It reveals citizens’ perceptions of quality in healthcare, long-term care and childcare and compares them between countries, groups in society and the receivers of care and indirect service users.

Care and quality of life

Using data from the EQLS 2012, Eurofound explored how Europeans perceive the quality of their societies and of their public services such as childcare, healthcare and education. It also looked at how the crisis has affected families with children, the situation of children at risk of poverty, and the struggles of households to combine work and care commitments and to cover childcare costs.

Combining care and work: towards sustainable work

In order to be available for employment, work demands must be reconciled with those of one’s private life – in particular, the needs of children or dependent adult relatives. And these needs shift over the course of a working life. To ensure that men and women can participate in working life until a later age, and still fulfil their domestic obligations, there is a need to rethink how time is allocated to both work and care throughout the career. Eurofound discusses these issues in its EWCS research on working time and work–life balance in a life course perspective, and more recently on working time patterns for sustainable work.

Workers with care responsibilities

Addressing the childcare needs of working parents has become central to the discussion around resolving the work–life balance conflict. Also in the spotlight is the care of older or disabled relatives and dependants which can lead to more frequent work–life balance problems. People aged 50+ in employment are more likely to care for elderly or disabled relatives than those not in employment.

However, providing informal home care places a substantial demand on sections of the working population and affects whether and to what extent these individuals can reconcile their work and care duties. For this reason, the support of working carers should play a prominent role in the debate around extending working life and the sustainability of work. Eurofound’s study on reconciling working and caring responsibilities shows the challenges involved in combining work and care in times of demographic change, and what measures are available to working carers to allow them to balance these demands. Another study on work preferences after 50 highlights the demands on older workers as care providers. 

Eurofound has investigated cases in companies across Europe that have adopted measures to support employees who have care responsibilities either for children or adults. Key initiatives include: leave arrangements, reduced working hours, counselling and practical support. A review of company initiatives for workers with care responsibilities for disabled children or adults concludes that addressing the work–family balance needs of working carers can be a ‘win–win’ outcome for employers and employees.

Access to healthcare

Public spending cuts and reduced access to healthcare, in the aftermath of the economic crisis, highlights the policy need to look at the impact this will have on the health of a workforce from which more work is expected in the coming years. Eurofound’s study on access to healthcare in times of crisis looked at examples of measures by service providers and governments to maintain access amid sometimes increased demand for services and reduced budgets. It also identified groups at risk of reduced access. The findings suggest that short-term measures introduced to reduce costs may now need to be re-evaluated since the crisis has eased. The report emphasises that timely access to good‑quality healthcare can help to make work sustainable over the life course.


Childcare is an increasingly important element both for people personally and in the European policy agenda. Eurofound has looked at the extent to which it meets the needs of parents, children and society at large. In the EQLS, it has also analysed the barriers to formal childcare services, such as cost, availability, access and quality.

Enjoyment of early childhood education and care provides a host of benefits for children. These range from enhanced academic performance at school and later stages of education, reduction of poverty and a better work­–life balance for parents. Eurofound has reviewed evidence from across the Member States to identify which elements of training and the work environment matter most in order to increase the quality of early childhood education and care services

Long-term care

As the number and needs of dependent older people increase, the care sector has had to develop in parallel. While most care is still provided by spouses and adult children, the role of formal paid care workers has become more important.

With population ageing, care budgets shrinking and the incidence of chronic disability and ill-health on the rise, the need for long-term care services has risen. Member States need to provide an adequate supply of skilled, motivated people working in home and community care. Eurofound’s study on more and better jobs in home-care services examined recruitment and retention measures in home- and community-based care. It also looked at support services for adults with physical and intellectual disabilities and chronic health problems – both physical and mental.

Other research looks at the differences in the accessibility, quality and efficiency of services provided in public and private care homes for older people across Member States. Meanwhile, the EQLS 2016 offers new findings on long-term care services, as well as data on the social and economic situation of carers.

Data and resources


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