Towards a new care model in Europe

The strategy encourages an integrated and person-centred approach, which implies improving the transition from institutional care to home care and community-based services. But deinstitutionalisation can only succeed with the professionalisation of care, including personal and domestic services.

The social impact of the pandemic on the residential sector for older people has opened a debate on what model of care needs to be developed to both prevent and care for situations of dependency. The structural causes of the impact of the pandemic on the elderly population are unsolved and accumulated problems, such as the ageing of the residential population, the high population concentration in large residential homes, the precariousness of employment in the social and health care sector and limited control of the quality of services. The debate has extended not only to all types of residential care homes, for example for people with disabilities, but has also placed a traditionally postponed but increasingly urgent task on the European Union’s political agenda: the development of a comprehensive care model that guarantees quality long-term care that is affordable and sustainable for people in long-term care, their carers and their families.

On 7 September, the European Commission presented its proposal for a European care strategy. In this Communication to the Council and Parliament, the Commission makes a correct diagnosis of the condition, but fails to prescribe appropriate treatment, which would have required an ambitious directive and not just a package of recommendations.

However, this package of indications and good advice will not necessarily fail. The Commission is timidly opening the door to a new model of care, the design of which it leaves in the hands of the member states, which will have to gradually forge a new path. It is a fundamental first step in the application of principle 18 of the European Pillar of Social Rights and predicts a paradigm shift in the way care for dependent persons is assessed and organised. The proposal, which has been developed in response to the concerns of the Future of Europe Conference on demography, places particular emphasis on community-based services, gender equality, work-life balance, technological investment, digital empowerment and early childhood.

The strategy encourages an integrated, person-centred approach, which means improving the transition from institutional care to home care and community-based services. But de-institutionalisation can only succeed with the professionalisation of care, including personal and domestic services, by implementing measures to improve working conditions in all settings and by tackling informal work.

The strategy recognises that a resilient workforce is the backbone of the care sector, but resilience requires decent wages, safe staffing levels, review of working conditions, good infrastructure, state aid, support and training for carers and other specific measures that do not seem to fall within the competence of the Commission and are left to the states to design.

At the same time, informal care needs to be protected and supported. Almost 80% of long-term care in Europe is provided by informal carers, mostly women. In 2019 before the pandemic, around a third (32.6%) of women aged 25-49 who were not in the labour force indicated that caring responsibilities were the main reason for not seeking employment, compared to 7.6% of inactive men. While the strategy emphasises the importance of gender equality and work-life balance, it leaves out the situation of irregular migrants working in the care sector. It also leaves out the issue of intersectionality.

It is well known that the digital transition offers multiple opportunities also for care, and the Commission is quick to point this out, but technology cannot and should not replace the human being, who is at the heart of care work. Assistive technology, telecare, telehealth, artificial intelligence and robotics can improve access to affordable high quality care and independent living services and support, especially in rural areas, but these investments must be accompanied by investment in the training of carers, not only digitally but also (and above all) in emotional management and psychological training to avoid situations such as abuse and ill treatment of dependent persons.

In this regard, although mental health seems to be a source of concern for the European Commission in its care strategy, there is a lack of ambition in the concrete proposals. In the report recently adopted by the European Parliament on mental health in the digital working environment, Socialists point out the need for the care strategy to be complemented by a strategy on mental health at European level. It is time to take this seriously.

Alongside this care strategy, the Commission presents a Council Recommendation on the revision of the Barcelona targets, which invites Member States to meet the revised targets for participation in early childhood education and care by 2030: at least 50% of children under the age of three and at least 96% of children aged 3 up to compulsory primary school age should participate in early childhood education and care. States should make good use of the European Child Guarantee to ensure that this care is provided to the most deprived children in order to prevent and combat poverty and social exclusion. But the Commission does not talk about the need to universalise free pre-school education for children aged 0-3 years at European level, to offer flexibility to parents and to provide subsidies and childcare vouchers for those enrolled in private institutions.

In short, the Strategy presented by the Commission recommends guidelines for action that states should work on by designing care investment packages, in order to shape a new care economy that recognises care as a right and values it as the backbone of our society. The challenge is enormous, requiring a rethinking of the health and social care model and a major financial injection to prevent the welfare state from collapsing.

We must consider care as a public good, which is why it is necessary to increase investment in care and to do so as a matter of urgency. Let us not forget, going back to the beginning of this article, that the precarious working conditions of formal carers and the very poor quality of the social and healthcare services offered during the pandemic, due to their privatisation and commercialisation, account for a large part of the deaths from Covid in nursing homes.

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