This report provides an overview of current trends in LTC as it applies to the aging population and based on the perspectives and experiences of care recipients relying on the services of Caritas care staff. Caritas Europa, with its network of 49 Caritas organisations in 46 countries, has been at the forefront of providing LTC services for an ageing population throughout Europe.
The Caritas staff involved in the data collection process shed light on some of their own experiences and practices. Not surprisingly, Caritas’ experiences mirror the general key trends and demographic changes pertaining to LTC seen across Europe. Essentially, these trends relate to the affordability, availability, accessibility and quality of LTC, and they reflect, among others, the:
- increased number of older people and, thus, dependency on LTC services and support;
- increased demand for LTC services by people aged 65 and over;
- persistent major barriers to LTC in terms of affordability, accessibility and coverage;
- increased vulnerability of many older, poorer people;
- insufficient public expenditure on LTC at national level and lack of public investment in LTC;
- challenges in recruitment and retention of LTC staff;
- continued reliance on informal care in many countries;
- very limited statistical data on the diversity of LTC workers, particularly live-in care workers and those working irregularly in non-standard employment;
- very little control or protections for live-in care workers due to their placements in private households;
- low remuneration for LTC workers and low valorisation of this sector, with the majority being migrant women;
- concern about undeclared LTC workers in the EU and their likelihood of facing poor working conditions and exploitation;
- concern regarding the emigration of care workers from central and eastern European countries, both EU and non-EU, to other western European countries and particularly to EU Member States, for better pay and conditions, and the impact this has on the families and communities left behind;
- concern about the lack of qualified care personnel, especially in countries from where care workers are emigrating; and
the feminisation of poverty.
Our findings also refer to the lack of integration between social and health care, an increasing overemphasis on bureaucracy rather than on social impact, a misplaced marketisation and commercialisation of social care services, and a lack of investment in not-for profit service provision, including social economy initiatives, and home and community-based solutions, including investments in adequate and comprehensive live-in care services, which could fill this gap. Combined together this creates a social care sector that needs targeted attention and support. Overall, the experience of Caritas organisations demonstrates that the present LTC infrastructure, services and support across Europe are inadequate to meet the needs of the present population, evident by the above list of trends. This situation is further aggravated given the unequal access, the high costs, and the growing waiting lists for professional social care services.
Our findings refer to different levels of spending and investment, from one country to the next – with a generally unsustainable underfunding in the care sector overall – which has contributed to the current crisis in the social care sector in Europe and its over-reliance on “cheap labour”, often provided by mobile and migrant women care workers, informal carers, as well as those active in the undeclared sector. This also alludes to the phenomena of “care drain” and emigration and the repercussions of insufficient upward social convergence between EU Member States.
This imbalance is a major contributing factor to the phenomenon of the feminisation of poverty across Europe. Such emigration can impact negatively not only on the children and elderly parents left behind, but also on the entire community without adequate care services or personnel remaining. This, in turn, highlights the need to improve the valorisation of this sector and the working conditions and pay of the LTC workers. Not surprisingly, our findings highlight the significance of migration, and the important contributions migrants are making to the provision of LTC across Europe, and thus the need to expand regular labour migration pathways for purposes of work.
For Caritas, it is vital that governments do not resort to merely facilitating migration as the solution for addressing the labour market shortages in the LTC sector, as this just puts a “band-aid” on the problem rather than addressing the root causes, namely that there is too little valorisation of this essential job sector, often extremely low salaries for LTC workers, not enough career development opportunities, and major inequalities within and between EU Member States and between EU and non-EU countries. It is thus vital to address social asymmetries across the EU in order for Europe to achieve greater upward social convergence and strong social welfare systems across the continent. A long-term vision for reforming the current LTC systems is necessary, to ensure quality, affordable and accessible care that is available everywhere, including in rural settings. To achieve this, governments must reform their LTC systems and increase public investment in LTC, so that quality services and support are offered, obtainable, and affordable for all, particularly for those who are in situations of vulnerability and in most need.
Based on these and other findings, recommendations for policymakers have been formulated to support the Council of Europe, EU and national governments in reforming the LTC systems, which are currently underperforming in the context of demographic change. Considering the recent adoption of the Council Recommendation on access to affordable, high-quality LTC, agreed by Ministers in the EU Council, Caritas’ recommendations should not only be relevant for national governments in the design of their LTC action plans and strategies but should likewise be important for the EU institutions and non-EU governments in Europe to consider in modernising their LTC systems. This is relevant considering the certainty of the increasingly ageing population and the understanding that the need for LTC is not only a national issue but one that crosses borders and deserves a European solution, if not a global approach.
