Recommendation 1: The EU should adopt a “golden rule” for social investment and social infrastructure for Member States as part of the fiscal framework. The adoption of a “golden rule” to allow Member States to invest in social infrastructure and social innovation would support them in implementing the Council Recommendation on LTC and in revamping and modernising their care systems.

Recommendation 2: The European Commission should introduce a Social Convergence Mechanism to the European Semester process, in order to ensure a balanced approach to social, economic and environmental policy at EU level and that macro-economic policy does not undermine or inhibit progress towards social or environmental goals. A Social Convergence Mechanism would provide a counter to the current focus on fiscal and economic policy at the expense of social goals and enable Member States to deliver real social progress in areas such as LTC, work-life balance, secure employment, and countering poverty and social exclusion. Such a mechanism would also foster an environment for productive social investments as it would help Member States to identify which areas of social investment should take priority for public expenditure.

Recommendation 3: All governments – the EU and its Member States, as well as non-EU countries – should prioritise a person-centred approach in the provision of LTC, ensuring quality care and dignified care work. As social services of general interest, LTC services must serve a clear social function, facilitating social inclusion and safeguarding the fundamental human rights of all people in need of care, as well as orient quality criteria and financial incentives towards this goal so as to guarantee the right to care for everyone regardless of their financial situation. Investments in not-for-profit service provision, such as through social enterprises, are known for this and should be encouraged.

Recommendation 4: The European Commission should propose an EU Care Guarantee. An EU Care Guarantee would support and complement the Council Recommendation on LTC, respecting the principles of participation and freedom of choice, and supporting the monitoring and implementation thereof. It would also create supportive conditions for social care services across Europe and help efforts in addressing social asymmetries across the EU relevant to Member States’ care strategies. This requires the establishment of a very comprehensive system of benefits, supports and services.

Recommendation 5: Linked to the Work-Life Balance Directive, Member States should adopt care schemes allowing workers, who wish to exit their current jobs temporarily in order to provide care for relatives, to receive poverty-proof wages. This should be in combination with adequate education and training opportunities for the informal carer.

Recommendation 6: The European Commission should develop a binding minimum income framework to ensure Europe’s poorest have access to a minimum form of income support, in combination with guaranteed access to services, including LTC. Older people on the lowest pensions are more likely to have unmet care needs simply because they cannot afford LTC services. Addressing income inadequacy and recognising the reality that the cost of care is well above the minimum income and low pensions will be core elements of delivering the Council Recommendation on LTC and balancing the regional inequalities/disparities that exist within the EU and between the EU and non-EU countries.

Recommendation 7: Member States must transpose the Directive on Adequate Minimum Wages into national law as quickly as possible, and to its fullest extent, covering all types of workers, including LTC workers, adhering to the international indicator of 60% gross median wage and 50% gross average wage, and ensure regular monitoring of the implementation thereof, particularly in the LTC sector. This would help address the issue of low pay and in-work poverty in the LTC sector, particularly in those EU Member States with very low statutory minimum wages and those where collective bargaining needs to be improved.

Recommendation 8: Member States should engage in social dialogue and collective bargaining in order to improve wages and working conditions in LTC. Such collective bargaining should also contribute to high-value care jobs, opportunities for career progression, access to training, upskilling and reskilling opportunities so as to improve qualifications, the recognition of educational and professional qualifications and work experience attained abroad, including soft skills, as well as respect for employees’ rights, all of which are preconditions to ensuring the quality of service, treatment and respect for the dignity of users of care services.

Recommendation 9: Member States should step up efforts to quickly transpose and fully implement the Work-Life Balance Directive, allowing workers to take care leave so as to care for family members, and including financial support to compensate for the related wage loss.

Recommendation 10: National governments should expand regular labour migration pathways for people with different skill sets (including low and medium skills) to work in the EU under fair and non-discriminatory workplace conditions, and prioritise secure and sustainable residence statuses with clear, efficient and accessible administrative procedures that enable access to the social security system in the host country and avoid the risk of precariousness and exploitation. Flexibility is needed to ensure that the rights and residence status of migrants are not tied to one employer or one sector, so as to avoid workers falling into irregularity when a job situation changes or in cases of exploitation.

Recommendation 11: Member States should de-escalate heated debates around regularisation and instead consider it as a real policy option, among a menu of options, that could contribute to addressing labour shortages in the LTC sector as well as protecting the working conditions of care workers. Seen in the broader context of expanding regular migration pathways and addressing informal economies and exploitation, governments should: strengthen the prevention and protection of migrant workers from exploitation; offer incentives to employers to hire workers on formal contracts; facilitate the issuance of stable residence permits through regularisation schemes; and collaborate more closely with the European Labour Authority (ELA), to increase political will and public investments in labour inspections and judicial institutions, enforce existing rules and regulations around informal work, and sanction employers who violate the law. The European Commission should ensure that the ELA is equipped with the necessary personnel and funding to ensure migrant labour mobility, social security coordination and the fight against labour exploitation, whilst also encouraging Member States to enforce sanctions on employers who engage in exploitative practices and permit undeclared work.

Recommendation 12: National governments should recognise that the development of mobility partnerships with non-EU countries to fill labour shortages in the LTC sector is only a temporary solution to a larger issue, namely the lack of recognition and inadequate remuneration for essential LTC workers, the majority of whom are migrant women. Considering that Member States already rely on mobility partnerships outside of the EU, it is vital to remind them that they must ensure decent working conditions and fair and dignified wages in accordance with local standards, training and professional LTC and nursing-services support as well as respect for labour rights.

Recommendation 13: European institutions and EU Member States must prevent and reverse further growth in the east-west divide in relation to LTC. Action must be undertaken to promote upward social convergence and address the challenges that care drain presents to countries inside and outside of the EU, such as the impact of this divide in terms of LTC infrastructure and investment and on the movement of mobile LTC workers from poorer European countries to more affluent Member States. Member States must ensure that labour migration policies do not contribute to care drain by, for instance, ensuring safeguards, ethical recruitment, facilitating circular labour migration, promoting family unity and the reunification of migrant workers, including low and middle skilled workers, so as to ensure that the right to family life is respected. Member States must also guarantee that the jobs carried out in the field of care, whether carried out by national or foreign workers, have the same guarantees, salaries, labour protection and benefits as other workers.

Recommendation 14: The European Commission should continue supporting Member States to apply strategic national upskilling actions in order to build career pathways and professionalisation in the LTC sector and to foster related skills development, thus living up to 2023 as the European Year of Skills, and making use of the European Skills Agenda to respond to the upskilling and reskilling needs across Europe. Considering the number of mobile and migrant care workers across Europe, implementing some form of non-bureaucratic skills testing – that recognises and confirms the skill level, competencies, and certificates of the LTC workers throughout Europe – would be important, as this would ensure minimum standards are maintained for delivering quality care. This could likewise contribute to greater recognition of higher/highly skilled LTC professionals and so prevent/lower the risks of them working beneath their qualifications and pay grades in different Member States.

Recommendation 15: The European Commission, the Council of Europe and national governments should ensure the mainstreaming and harmonisation of efforts that support equality between women and men across all policy areas, particularly as it relates to the LTC sector, the labour market and poverty concerns.