Social Structures
Author: Matthew McKenna, PhD Researcher at Maynooth University’s Assisting Living and Learning Institute (ALL), Research Funded through the Science Foundation of Ireland (SFI) Centre for Research Training in Advanced Networks for Sustainable Societies (ADVANCE CRT)
The highly anticipated publication of the European Commission’s (EC) ‘European Care Strategy’ (ECS/strategy) on the 7th of September 2022 has been met with cautious optimism and circumspection. Certainly, there is a unanimous agreement that the arrival of this strategy is a welcome policy development. However, last week’s unveiling of the ECS also underlined how long overdue this development has been, and it represents an initial and elemental step in addressing the long-term systemic deficiencies in the European Union’s (EU) approach to the care of its citizens. If one is to view this radical collective change as a physical journey, then the ECS is arguably representative of a social and legal point of embarkation from a policy sense, and it is certainly not a final destination.
The strategy aims ‘to ensure quality, affordable and accessible care services across the European Union and improve the situation for both care receivers and the people caring for them, professionally or informally’. Moreover, the ECS addresses the impact of expensive and poorly accessible long-term care services for older adults and persons with disabilities and advocates measures to assist member states in efforts to improve access to ‘high-quality and affordable care services, while improving working conditions and work-life balance for carers’. It also intends to reaffirm ambitious but realistic targets for childcare and education by 2030 to ensure that at least ‘50% of children below the age of 3 are in early childhood education and care and 96% of children between the age of 3 and the starting age for compulsory primary education are in early childhood education and care, as already agreed in the European Education Area framework’. In addition, the strategy complements the goals of the ‘Digital Europe Programme’ (2021-2027) and supports ‘rolling-out accessible innovative technology and digital solutions in the provision of care services, including to support independent living’.
The ECS acknowledges the historic exploitative and bureaucratic adversities faced by caregivers and care recipients in EU countries. The strategy highlights some sobering figures on the shortcomings of caregiver support and the increasing strain on this crucial workforce as pan-European ageing demographic trends result in greater numbers of people requiring long-term care (LTC) and a subsequent demand for greatly expanded caregiver resources. The document predicts that there will be just under forty million people who require long-term care in the EU by 2050. Furthermore, it highlights the gender imbalance among caregivers, with women making up ninety percent of the care workforce, which itself equates to roughly fifty-two million Europeans.
In addition, the ECS argues that care responsibilities frequently yield an adverse impact on women’s pay and pensions, resulting in many older women being unable to afford the care that they themselves need. Furthermore, the strategy notes that caregivers often occupy the lowest pay brackets. Women comprise an overwhelming proportion of informal caregivers due to the pervasive gendered attitudinal stereotypes that are still commonplace in the care sector. Informal and poorly remunerated care roles can result in the preclusion of highly skilled workers from the labour market and can manifest in a pure economic loss for both the caregiver and the wider economy.
The strategy will support the realisation of Article 3 of the Treaty of the Functioning of the European Union (TFEU) which, among other objectives, include the promotion of the ‘well being of its peoples’. The Strategy also supports the realisation of the European Pillar of Social Rights.
However, the European Disability Forum (EDF) observes in an analysis of the strategy that, in its current form, the ECS does not provide for binding or legislative measures that can adequately prevent EU countries from ignoring it. The strategy also calls for improved pay and conditions for care sector employees, including live-in care workers, who are particularly vulnerable due to precarious employment contracts and conditions, coupled with wholly inadequate remuneration.
Social Europe makes note of the recent landmark legal victory for a round-the-clock Bulgarian care worker who suffered from exploitation and the withholding of pay by her employer. This type of exploitation of care-workers is unfortunately commonplace throughout the EU. However, this noteworthy legal precedent, along with the ECS’ measures, may help to reduce the exploitation of care-workers in the absence of a concrete EU legislative instrument. Social Europe says that this case represents a significant 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 applied to round-the-clock care’. It is hopeful that such positive developments will precipitate change and encourage far greater levels of legal compliance among public and private care providers across the EU. Particularly, since several multinational care providers have recently been exposed for instituting abusive and exploitative practices against caregivers and care recipients, along with the misuse of public funds and tax evasion, as emphasised by Social Europe.
Social Europe also criticises the strategy for seeking to ‘promote private investment as long as it is regulated and quality mechanisms are respected’. The European Public Service Union (EPSU) elaborates on this point by stating that the ‘strategy falls short of placing any limits on the commodification of care’. It goes on to say that ‘all profits in the care sector should stay in the sector for the benefit of care workers and people cared for – be they children, elderly, persons with disabilities’. Furthermore, EPSU expresses disappointment and echoes the similar frustrations of other third sector organisation such as Social Europe, by highlighting that ‘Recommendation 51’ of the Conference on the Future of Europe (CoFE), which calls ‘for not-for-profit health and care systems’, was not incorporated by the EC into the ECS. This comes on the heels of numerous scandals in for-profit care provider companies that operate in Europe, with Social Europe noting that Korian, ‘the largest care-home company in France and a major player across Europe’, allegedly ‘aimed to spend under €4.50 per resident per day on food’ in an effort to boost its profits in France.
The strategy recognises that contemporary long-term strategic challenges present a threat to the sustainability of care provision in Europe, and that the current model of reliance upon informal carers such as family members, particularly in the case of care for older adults, is unsustainable. Furthermore, the strategy finds that ‘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’. However, with respect to low levels of public expenditure on the facilitation of long-term care within the EU, Social Europe says, ‘[y]et 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’. Social Europe also recommends that ‘care should be integrated into public health services and national social-protection systems, which are best placed to deliver on an equitable basis’, but expresses concerns that the ‘consistent underfunding and undervaluing of care services has left space for the commodification and marketisation of care—with disastrous consequences’.
The ECS can arguably be considered as a ‘genesis strategic document’ for a more equitable, affordable, and accessible system of care service provision in the EU. It broadly outlines and acknowledges the systemic and chronic challenges faced by caregivers, both formal and informal, and care recipients. The issues of massively unequal gender representation among caregivers, coupled with long and very challenging working hours and conditions with low pay are illuminated in the document. The EC recognises that current undervalued and underfunded structures of care provision in the EU are unsustainable as a model for the future.
As the third sector organisations referenced in this critical synopsis point out, the ECS represents a positive acknowledgement, at an EU level, of major systemic challenges in care provision that require addressment going forward. The EDF argues that ‘the importance of choice is an underdeveloped aspect of the strategy’, and further expresses that ‘persons with disabilities must be able to choose the type of support in a way that facilitates the life they choose to live – where, with whom and how they choose to live it’. The EDF infers that this aspect of the strategy does not fully honour the provisions of Article 19 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), on ‘Living independently and being included in the community’, that was ratified by the EU. The strategy has also received criticism for omissions such as that of Recommendation 51 of the CoFE, however, it is hopeful that through the continued advocacy of third sector organisations, the EC may revisit the issue and include this recommendation in a future strategic document. It is uncertain whether legislative change will follow the ECS in the near-term.
Although, it is possible that the ECS, through its strategic policy agency at an EU level, alongside the exposure by whistleblowing advocacy groups of exploitative for-profit care practices and landmark caselaw developments such as that created by the victory of the Bulgarian ver.di trade union member in Germany, the strategy may precipitate, by means of ‘soft-power,’ a fairer and more equitable care sector environment for caregivers and care recipients. To this end, the ECS represents an official recognition of the large-scale challenges that require very extensive addressment. It is not a solution in itself, but it signifies a promising and clear-eyed conception of policies and potential legal moves that can conceivably ‘snowball’ in their effectiveness to promote positive and equitable change for the reform of care provision in the EU.