European Care Strategy: The ball is now in the court of Member States

Europe's care sector will be barely capable of responding to the growing care demands of its ageing population. It is in dire need of major investments and a shift in policy-making, which should ensure that care workers are properly paid, have regulated working hours and receive adequate support. To achieve this, EU action will not be enough, and political will at national level will be crucial, an EESC hearing said.

The European Economic and Social Committee (EESC) held a hearing on the new European Care Strategy to discuss its major challenges and the prospects for healthy and active ageing in the EU.

The hearing, which brought together representatives from EU institutions and civil society, took place a day before the Council of the EU adopted recommendations on early childhood and long-term care, putting the ball in the court of Member States, which now have to implement the recommendations made by the European Commission earlier this year.

The Commission's European Care Strategy, presented in September, was accompanied by two proposals for Council recommendations: one on early childhood education and care and another one on affordable high-quality long-term care. The strategy has an ambitious agenda of improving the situation for both carers and care receivers.

The care sector has been suffering for many years from a structural crisis. On one hand, it experiences chronic under-investment, and a shortage of workers, skills and structures. On the other hand, we see an increased demand in care, with the number of people in long-term care predicted to rise due to demographic change and an ageing population in the EU, said EESC president Christa Schweng, who opened the hearing.

In her keynote speech, Katarina Ivanković-Knežević, Director for Social Rights and Inclusion at the European Commission, said the EU was trying to help and reform national care systems by boosting a number of elements in them.

Care is the competence of Member States. The next step is to see how Member States will implement recommendations and different aspects of the care strategy, Ms Ivanković Knežević said, adding that the strategy is also aimed at revising the Barcelona targets from 2002. This includes  raising the percentage of children that needed to be included in early childhood education and care (ECEC), which should improve work-life balance for families, and especially of women who bear the brunt of care duties for young children.

The current figures point to the urgent need to invest in care and to prioritise it in policymaking.

By 2050 in Europe, seven million more people than today will need long-term care. Half of the people older than 60 currently have unmet care needs. Some 7.7 million women are not in employment due to caring responsibilities, and the projections say that more than 1.6 million care workers will have to be employed to assure long-term care for all in the foreseeable future.

The EESC, which has produced a number of opinions on various aspects of care, has thrown its support behind the Commission's proposal on the care strategy.

Rapporteurs of the EESC opinion, SOC/720 -  Health Workforce and Care Strategy for the future of Europe, Zoe Tzotze-Lanara and Danko Relić, stressed the importance of making access to affordable and quality care a right for all people throughout their life cycle, without leaving anybody behind. They also put the spotlight on a different set of challenges tackled in the strategy, which concern inadequate pay level and the working conditions of healthcare and care workers.

Pietro Barbieri, rapporteur of the EESC opinion SOC/730 - The role of family members caring for people with disabilities and older persons: the explosion of the phenomenon during the pandemic, spoke about the role of family carers being almost entirely filled by women, which negatively affects not only their work and social life, but also their financial status and health.

We need to prevent the isolation and marginalisation of carers. We have to ensure that psychological support services are provided to family carers. We also need to have monetary transfers to support these people, Mr Barbieri said.

With many care workers crossing borders for work, there are few issues that have such Europe-wide implications like care, said MEP Dennis Radtke. In addition, non-formal elderly care, which accounts for 80% of care in this sector, is a European question.

In order to move things out of the dark and away from the black market, we need to focus on data and sharing of best practices, and to tackle issues such as EU standards on training and qualifications of care workers, Mr Radtke said.

Improving working conditions is a prerequisite for filling workforce gaps and guaranteeing quality. Otherwise, we will limit the potential of policies such as increasing working hours for part-time care workers or facilitating work after the pension age, said Eurofound's Hans Dubois.

Care is a public good, and resilient workers are the backbone of a resilient sector. We need to value care; we need to allocate more time and resources, and more societal capacities on care. Commercialisation of care is not the way to go, said Jan Willem Goudriaan, General Secretary, European Public Service Union (EPSU), emphasising the crucial role of collective bargaining for the sector.

Enrico Tormen, Advocacy Advisor at the Save the Children Alliance, criticised the Council's watering down of the Commission's recommendation that Member States should ensure that by 2030, at least 50% of children below the age of three can participate in ECEC. The Council lowered the threshold to 45% and set up a series of different targets for different groups of countries.

This shows the lack of understanding of what the ECEC really means. 17 countries will remain under the recommendation's 45% threshold and only one country will reach it, Mr Tormen maintained.

Marta Branca, Secretary General at the European Hospital and Healthcare Employers' Association (HOSPEEM), emphasised the role of social partners in defining and providing care throughout Europe.

Staying fit and healthy in the old age

The hearing's second panel dealt with the potential for healthy ageing and prevention. EESC member Miguel Ángel Cabra de Luna, Rapporteur for the opinion SOC/687 - Towards a New Care Model for the Elderly: learning from the Covid-19 pandemic, said the EU should play a leading role in the area, which becomes more important every year, given that by 2050, one in three people in the EU will be considered old, compared to one in five today.

Demographic challenge also represents an opportunity, and we have to make most of it. This situation, at the same time, requires us to think more about ageing and longevity, active and healthy life, and we have to seek new solutions as the human race advances, Mr Cabra de Luna said, adding that there should be a broad and ambitious strategy for older people, which would need involvement on all levels.

Philippe Seidel, Policy Manager, AGE Platform Europe, pointed to the need for more home care and community-based care, which would end the segregation of older people and those in need of long-term care. But to achieve this, there has to be political will at national level, he said.

It is never too late to promote health, even in very old age. We have to take into consideration that we need to be looking at new models of long-term care, said Caroline Costongs, Director at EuroHealthNet. One example is care services engaging with other sectors for health promotion and prevention by addressing the social needs and mental health of older people. In this way, GPs can do "social prescribing", that is refer patients to community activities, which can greatly benefit their health and well-being.

Aude Boisseuil and Aurélie Decker, from the European Federation for Family Employment & Home Care (EFFE) and European Federation for Services to Individuals (EFSI), presented the recommendations for workers employed in the Private and Household Services sector (PHS). PHS workers are key players in the care economy, representing 5% of EU-27 total employment. Moreover, 91% of PHS workers are women, accounting for 7.5% of total female employment,  yet their rights and status are often unrecognised.

The hearing was concluded by Zuzana Freitas Lopesová, Deputy Minister of Labour and Social Affairs of the Czech Republic, and Laurenţiu Plosceanu, President of the EESC's Section for Employment, Social Affairs and Citizenship (SOC).

Ms Lopesová said the Czech EU presidency had worked on the possibilities of improving the resilience of long-term care systems. A recurring concept in care is quality. The key premise is to focus on individuality of the person in need of care and to preserve their dignity. There must be quality standards for the long-term care sector that are binding for all providers, regardless of their legal status.

At the same time, it is necessary to develop tools and forms of support for care workers, including suitable remuneration for their work, support for their professional development, and training. Quality of services reflects the quality of the staff, Ms Lopesová maintained.

The EESC is currently preparing an opinion on the European Care Strategy, due for adoption in January.