Who cares for the carers?

The long-awaited European Care Strategy is a step in the right direction but care workers need more.

The population of the European Union is ageing: the number of people aged 80 and over is expected to increase by 88 per cent over the next 30 years. Principle 18 of the European Pillar of Social Rights, the right to long-term care (LTC), will be ever more important.

Yet the response to the booming demand for LTC has been decentralised, fragmented and in many countries market-driven, resulting in geographical and socio-economic disparities in access. Staff shortages, exacerbated by low pay and poor working conditions, have made the situation more challenging. As did the onset of the pandemic: a report from the European Federation of Public Service Unions (EPSU) found 421,000 fewer LTC workers in the EU in 2020 than a year previously.

To deliver on principle 18, there needs to be a fundamental shift in the way care is valued and organised. In this context, yesterday’s publication by the European Commission of the new European Care Strategy is very timely. It includes a communication, setting out a vision, and two proposed recommendations from the Council of the EU, on LTC and early-childhood education and care (ECEC).

Workforce resilience

The strategy rightly recognises that a resilient care workforce is the backbone of a resilient care sector. It also recognises that to recruit and retain such a workforce, higher pay and better working conditions must be on offer.

Despite the physically, mentally and emotionally strenuous nature of care work, and its fundamental value to society, many carers are found in the bottom third of the wage distribution and have precarious employment contracts. Care workers and public-service unions who have long fought for the revaluing of the sector will welcome the focus on better recognition for care professions, skills and training and opportunities for continuous professional development.

Importantly, the strategy highlights the specific needs of live-in care workers and domestic LTC workers, who are often particularly vulnerable, especially if engaged in undeclared work. In the past, the commission has created confusion by grouping together—as one personal household-services sector—home care for persons in need of care with domestic work (such as cleaning) for those without care needs.

The strategy addresses this confusion by identifying ‘domestic long-term care workers’, thereby emphasising the primary care function of certain domestic workers and their inclusion in the formal care workforce. It calls for tighter monitoring to ensure that live-in care workers and domestic LTC workers benefit equally in terms of fair wages, good conditions and protection from exploitation.

This follows a recent victory for the German union ver.di, which won a court case against the exploitation of a 24-hour care worker. The court ruled that the statutory minimum wage also applied to round-the-clock care.

Social dialogue

The importance of social dialogue and collective bargaining to improve the attractiveness of the sector cannot be overemphasised. Social partners should be involved in all discussions on working conditions, to ensure that workers’ interests are protected.

For example, the recommendations in the strategy for digital solutions to improve working conditions must be developed in close co-operation with unions. But as the strategy points out, in many countries the coverage of collective bargaining in LTC is low. Member states need to undertake dramatic measures to change this.

The council recommendation on LTC proposes the appointment of national-level co-ordinators who can also monitor implementation of the strategy. These co-ordinators could play a leading role in ensuring carers and union representatives are actively involved in policy-making.

The strategy also highlights that EU-level social dialogue can help address workforce challenges in care. To this end, the commission is reviewing a request from the EPSU and the Social Employers to establish an EU Social Dialogue Committee for Social Services.

Poverty in old age

Tackling the workforce shortage will be essential to ensure everyone has access to quality care as well choice about provision, whether residential or home and community-based. The strategy makes several references to the unevenness of accessibility, affordability and quality. Territorial disparities, lack of social protection and differences in the role played by national and regional administrations exacerbate inequalities and increase the risk of poverty in old age.

The strategy finds that where social protection is available, this is still often inadequate—that, even after receiving support, ‘nearly half of older people with long-term care needs are estimated to be below the poverty threshold after meeting the out-of-pocket costs of home care’. This results in over-reliance on informal carers—family members, friends and neighbours—most of whom are women. This is neither a suitable nor a sustainable solution.

EU member states must invest more in public services, which are the foundation of universal access to high-quality care. Recognising LTC as a public good, as the strategy does, is one thing, but ensuring that social-protection systems are developed and public services available is another. Care should be integrated into public health services and national social-protection systems, which are best placed to deliver on an equitable basis.

Yet in 2019, public expenditure on LTC amounted to only 1.7 per cent of EU gross domestic product. For comparison, the value of the hours provided by informal carers (were they monetised) is estimated at 2.5 per cent of EU GDP. This chronic underfunding and undervaluing of care services has left space for the commodification and marketisation of care—with disastrous consequences.

Embroiled in scandal

Over the last year, a number of multinational care providers have become embroiled in scandal, following revelations of worker and resident abuse, misuse of public funds and tax evasion. Most notably, the care company Orpea came under fire following the publication of a book, Les Fossoyeurs (The Gravediggers).

The author, Victor Castanet, detailed how profitability had been prioritised over the wellbeing of the elderly, to the extent of rationing food and hygiene products. In addition to appalling working conditions, union and worker representatives had faced bullying and harassment, with the company going as far as threatening to hire private investigators to intimidate members.

The European Care Strategy misses the point by seeking to promote private investment as long as it is regulated and quality mechanisms are respected. The commission does not indicate where this private investment will come from or how it will ensure that profit-making is limited.

Better that profits are not made on the backs of care workers and those for whom they care. Contracts to provide care services are after all funded with public money, as with the European funds which are and will be used to support care services.

Ensuring long-term care is a public good and a human right—with affordable, accessible quality services for all—must mean a stand against commercialisation of the care of the elderly and others we care about.