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Long-Term Care Services in 4 European Countries

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Long-Term Care Services in 4 European Countries LONG-TERM CARE SERVICES IN 4 EUROPEAN COUNTRIES Labour markets and other aspects Edited by Karsten Krüger & Erik de Gier LONG-TERM CARE SERVICES IN 4 EUROPEAN COUNTRIES. Labour markets and other aspects Karsten Krüger & Erik de Gier (Editors) Long-Term Care Services in 4 European Countries. Labour Markets and other aspects – Karsten Krüger & Erik de Gier (Editors) Barcelona/Nijmegen/Oldenburg. 2011. www.dia-e- logos.com; www.pcb.ub.edu/xreap; and www.ru.nl/resorg Cover Illustration: José Manuel Taboada Lopez (2011) ISBN: 978-3-943087-01-7 This work is licensed under Creative Commons Attribution-Non-Commercial-Share Alike 2.5 Spain You are free: ! To copy, distribute, display and perform the work ! To make derivate works Under the following conditions Attribution. You must give the original author credit Non-Commercial. You may not use this work for commercial purposes Share Alike. If you alter, transform, or build upon this work, you may distribute the resulting work only under a licence identical to this one. This book is based on the cooperation between the XREAP and the Radboud University Nijmegen The seminar “Long-term care” and this book has been supported by The Generalitat de Cataluña The Bosch i Gimpere Foundation ICPP Corporación Parc Taulí Instituto Bonanova CONTENT PRESENTATION........................................................................................................................................ 1 INTRODUCTION........................................................................................................................................ 4 CARE SERVICES LABOUR MARKETS ................................................................................................ 13 The Spanish Long-Term Care System – A Case Study......................................................................... 14 The New Care Service Act: Frustrated Labour Market Expectations ................................................... 29 The Intricate and Uncertain Future of the Labour Market in the Dutch Health Care Sector ................ 71 “New Work” in the health economy...................................................................................................... 86 Labour insertion after occupational training in the health and social care sector in Catalonia ........... 100 Precarious perspective? Professional return and and labour market reentry of women ...................... 119 ORGANISATION AND QUALITY OF HEALTH AND CARE SERVICE SECTOR......................... 136 Long-term care of the elderly aged 75 and over: A home care service ............................................... 137 Care Is Coming Home. Towards a New Architecture of Health Service in Europe ........................... 147 Local administration challenges caused by ageing population and the attractiveness of care work ... 165 AUTHORS ............................................................................................................................................... 189 PRESENTATION Presentation There is no doubt that one of the major challenges that most developed economies will face in the next decades is demographic ageing. Europe is not an exception and in the context of the current economic crisis, the risk of social exclusion of elderly people is probably higher than in the last 30 years, particularly in Southern Europe countries where fiscal consolidation is the main objective of most governments. At the beginning of 2010, Dr. Karsten Krueger proposed to the Scientific Committee of XREAP (a network of more than 150 researchers from 4 Catalan Public Universities founded in 2006) to organize a joint workshop with Radboud University in order to discuss the situation of the long care services sector in different European countries. The aim of the workshop was not only to bring together original research papers that could cast some light on long-term care services but also to exchange ideas between Spanish and Dutch undergraduate students in the field of Economics and to involve potentially interested stakeholders such as training institutes and public authorities. Although it was not the first international event organized by XREAP (for instance, during August 2011 we have co-organized the annual meeting of the European Regional Science Association with more than 1000 delegates), it was going to be our first event with a very active role for undergraduate students and, at the same time, with a clear focus on policy advice, so I had to say that we were all a bit worried about our capacity to achieve these two objectives. However, and thanks to the efforts of Dr. Karsten Krueger and Prof. Erik de Gier and to the collaboration of other institutions such as ICPP, IES Bonanova, Corporació Parc Taulí and, of course, the Dutch and Catalan Goverment, we are really happy with the obtained results. During two days, more than 40 people took a very active role during the workshop. We counted with the participation of seven keynote speakers, several student’s presentations, a round table with seven experts, and two technical visits, but, perhaps, the most visible proof of the success of the workshop is this electronic book. In a world where academics are only recognised if they manage to publish in top-ranked journals, on behalf of the XREAP network, I want to thank all participants in the book for the efforts dedicated to this project. One of the aims of our network is to advance in the dissemination of knowledge and, in particular, to promote the cooperation between different research groups from a multidisciplinary perspective (although we cannot forget most of us are economists) and I think that, as the workshop, the publication of this electronic book is a new opportunity for us to go beyond the usual dissemination 2 Presentation actions that, for sure, will be followed by others in the future. I am sure that the readers of the book would learn a lot and enjoy your contributions that have already helped me to improve my perspective on this relevant policy issue. So, thank you again for your contributions and congratulations for this excellent book! Dr. Raul Ramos XREAP’s Scientific Secretary AQR-IREA, University of Barcelona 3 INTRODUCTION By Karsten Krüger and Erik de Gier 4 Introduction One of the European Union’s major concerns is its ageing population, and the need to develop a social and economic strategy able to meet this demographic challenge. One of the key issues is “who should care for elderly and dependent people in the future” (EUROFOUND 2006a: V). This question goes to the core of the European Social Protection system, which has “the aim, among others, of ensuring the access for all, to high quality care” (European Commission 2008: 1). But it is difficult to define exactly what care and care services for dependent people means. Traditionally a distinction has been made between health care and social care “partly on account of their origins but also due to the fact that interest groups have sought to maintain these boundaries.” (EUROFOUND 2003: 3). For several reasons, these boundaries are blurred and a more integrated perspective comes up advocating the concept of long-term care, defined by the OECD as “the organisation and delivery of a broad range of services and assistance to people who are limited in their ability to function independently on a daily basis over an extended period of time” (OECD Health Division 2008: 1) Long-term care systems are characterised by the diversity of the providers, of the institutional and organisational settings, and of the sources of funding. With regard to social care, the EUROFOUND study of “Employment in social care in Europe” (2006a) made a rough distinction between waged carers and non-waged carers, establishing the following classifications: ! Traditional formal carers Waged Carers: ! Mixed economy carers ! Independent formal carers ! Personal assistant carers ! Voluntary Carers Non-waged carers ! Family informal carers ! Non-kin carers The classification does not include undeclared waged carers (often immigrants) who play a highly significant role in certain countries. 5 Introduction However, this brief and probably incomplete list of carer types indicates that long-term care systems have complex configurations, combining different types of formal care with a wide range of informal care. The long-term care systems of the EU-member states are under pressure from four quarters: a) The improvement in the health of European populations has increased life expectancy. The over 65-year and the over-85 age groups have grown considerably in recent decades and will continue to do so in the future. Inevitably, this raised and will raise the demand for care for older people. b) The family structure has changed all over Europe, towards a model characterised by smaller double breadwinner families. And as female members have traditionally taken responsibility for family care, the growing incorporation of women in the labour market increases the demand for formal carers. c) The EU population in working age is decreasing, thus raising competition for labour between different economic sectors. This can be mitigated, but not resolved, by immigration. “Low paid, low status, and high rates of turnover and burnout make it difficult to attract workers to the care sector and to keep them in their jobs“ (EUROFOUND 2006b: 1). d) The retrenchment of the welfare state since the 1990s and the increasing public budget restrictions in EU-member states have made the funding of high quality national care systems
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