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The Commission’s approach to support health process in Europe is based on the concept “to provide caring needs”: it is centered a) around enabling more people to live as independently as possible for as long as possible, and b) the concept is managed through numerous assistance, e.g. with a help from friends, family, state officials and/or wider community.

The EU’s idea is to provide “more care” in many different ways in order to overcome the challenges linked to Europe's ageing population, i.e. to support older people (so that they can continue to take an active part in the economy and in the wider society) and to turn “care needs for growing older” into employment opportunities for younger people.

Social platform

In a speech at the Social Platform's Annual Conference on Care, on behalf of the European Commission, László Andor, Commissioner for Employment, Social Affairs and Inclusion paid tribute to the work undertaken by the Social Platform and its members. At times of major budgetary constraints this platform plays a key role in raising awareness of the need to protect the rights of elderly people, as well as those who need care, whether formal or informal.

The Commissioner underlined that Social Platform recommendations on care were vital for social solidarity and social cohesion; they could be a major source of job creation and ultimately help to support sustainable economic growth. However, more thoughts are needed to the fundamental rights’ aspect of care. These Recommendations make an important contribution to this and the wider debate on care.

“The Commission is fully aware of the importance of ensuring access to adequate care, including long-term care, to all citizens who need it. My message is that Europe does care and will increasingly devote more attention to caring issues”, said László Andor, Commissioner for Employment, Social Affairs and Inclusion.

 Reference:  Speech/11/870 at the Social Platform's Annual Conference on Care (Brussels, 9 December 2011).

Facilitating best practice through Long-Term Care issues

At present, member states are at very different stages in their efforts to address the need for help and care. The EU can and must provide valuable support by facilitating exchanges of best practice, knowledge and experience – in particular on the subject of long-term care.

The Social Open Method of Coordination (OMC) is the natural platform for this kind of exchange. Member States have already used it to agree on common objectives in health and long term care that aim to:

·        Secure access for all to adequate care;

·        Promote quality in care; and finally,

·        Ensure that adequate and quality care is delivered in financially sustainable systems.

These principles have formed the background of all Commission’s work implemented in this field since 2006 and will continue to guide the EU actions during this year. Recent EU Presidencies have given increasing attention to access and quality sides of Long-Term Care issues.

Commission’s plans

The Commission intends to publish a Staff Working Paper to map the issues surrounding care and the extent of current provisions across EU-27; it will also identify how the EU can best support the member states’ activities. Important to remember that these activities – according to the Lisbon Treaty- are solely in the hands of the member states and that the EU institutions can only support and coordinate these activities.  

Already in 2013, the Commission plans to launch a Communication that would take a holistic approach to Long-Term Care issues. The Communication will look at all relevant policies and it will take into account the Social Platform's Recommendations.

Quality of care

Dignity in care is, obviously, dealing very much with its quality; that is an important side of the Commission’s agenda. Together with the member states, the Commission is working through the Social Protection Committee (SPC) to develop a Voluntary European Quality Framework for Social Services of Common Interest, in which Long-Term Care plays a prominent part.

This Quality Framework aims to develop a common language and understanding of quality in social services. It also seeks to establish a common methodology for setting and assessing quality standards and it looks at a wide range of areas which have a direct impact on “quality of care”.

These services’ standards include such issues as:

- service provision itself, which needs to be accessible, affordable, person-centered and outcome-oriented;

- relationships between service providers and users; in particular, respect for user's rights and strong levels of participation;

- relationships between service providers, public authorities, social partners and other stakeholders, i.e. partnership and governance;

- adequate physical infrastructure; and

- human and physical capital.

Fostering quality services also means paying closer attention to working conditions in the sector, as well as investment in the training of workers. Services should be provided by skilled and competent workers under decent and stable working conditions. It is important that the member states look at the rights of both care recipients and “careers”.

Preventing elder abuse

Ensuring quality for both care recipients and careers is also an important part of activities aimed at preventing and tackling elder abuse. Since 2007, the Commission has supported a number of projects under the DAPHNE programme, i.e. the health action programme and a pilot project on elder abuse. These projects have led to some concrete and very useful results, e.g. a European Charter for older people in need of long-term care and assistance was adopted, as well as a checklist of measures needed for preventing elder abuse.

At the end of November 2011, the Commission organized a representative conference on dignity in ageing, which examined effective strategies for ensuring high quality in long-term care and for preventing elder abuse. The conference showed that social partners and authorities have to look at many different aspects of care to prevent, identify and treat elder abuse, and to ensure that people can age in dignity. Such as providing support to family careers, improving working conditions of professional careers and ensuring quality standards.

It is becoming evident that only through a comprehensive national strategy which involves all the different levels of governance the EU can offer effective protection for vulnerable elderly people.

This challenge cannot be solved by the EU alone; it requires commitment and action at all levels. The Commission stands ready to support the member States in their efforts and it will continue to pay close attention to improving the quality of long-term care and protecting the dignity of older people.

Innovative solutions

Europe's demography is changing: over the coming years its population will age, birth rates will decline and the number of working-age individuals will shrink.

The Commission suggested the following measures to overcome challenging issues:

First, to promote independent living; this means fostering healthy and active ageing to prevent, postpone, and mitigate the need for care – to allow people to live as independently as possible for as long as possible. Innovative solutions to existing and emerging problems must be found as new technologies, for example, can make a big difference by enabling age-friendly adaptations of homes and the external environment.

An increasing number of relatively cheap, accessible and user-friendly technologies that help elderly people to remain independent for as long as possible have appeared in the member states. Hence, there is a need to focus on better and far larger scale deployment.

The EU and the member states also need to fully exploit existing systems in terms of prevention, early detection and efficiency gains, in order to ensure the long-term sustainability of Long-Term Care systems.

Second, to promote stronger partnerships to develop and implement better solutions through the EU new European Innovation Partnership on Active and Healthy Ageing. The Partnership is an integral part of the wider EU-2020 strategy which has a strong focus on innovation-friendly policy.

This initiative brings together the public and private sectors to translate innovative ideas into concrete innovative solutions specifically designed to help older people lead more active and independent lives.

Third, to transfer the Long-Term Care program into an opportunity for the EU economy: initially, as an important source of employment and then as a potential market in its own right. Some examples, the health and social sector created 4,2 million jobs in the EU during 2000-09, which was more than a quarter of total jobs created during that period. Today, the "white jobs" sector, i.e. employment in health and social services accounts for almost 10 per cent of the EU employment, in general.

This challenge is reflected in the Commission's Annual Growth Survey 2012, which recognises the health and social sector as one of the three sectors with the highest employment potential in the EU (together with green jobs and ICT). Member States need to capitalize on this by prioritizing initiatives that further develop these sectors.

Agenda for skills & jobs

However, an opposite trend must be recognised: over the next decade large number of health workers will be leaving the labour market. The member states have to see that this does not lead to a mismatch between labour demand-supply curves, or to the decrease in the quality of health care.

In order to address the potential of labour shortages in the health and social sector, the Commission recommends the following initiatives affecting employees:

- reduce barriers which limit intra-EU mobility, for example those linked to social security and in particular pensions;

- to see positive elements in issues concerning doctors and nurses immigration from third countries; and

- optimizing working conditions.

As is already announced in the EU-2020 initiative program "Agenda for new skills and jobs", the Commission will be working together with the member states to develop an action plan by the end of 2012 to address the gap in the supply of health workers. The plan will also provide an opportunity for all EU institutions to address other issues related to health workforce such as ethical recruitment and retention and recruitment strategies.

People in caring duties

Research has shown that over the coming years there will be an increase in the care needs of people with a disability, as well as older dependent persons.

Home care services are one way of providing care and support for older people and for those with disabilities in a financially sustainable manner. These kind of services are already prevalent across the EU, e.g. according to Eurostat, personal services in 2010 in the EU represented 5,4 mln jobs, a number that will increase in the future to respond to the growing demand.

Nonetheless, there is also a strong tradition of informal care across the EU. A recent Eurofound report shows that about 80% of time spent caring for people with a disability or older dependent persons is provided by informal careers, whether family, friends or neighbors. This is a highly commendable expression of social solidarity with the most vulnerable.

But it also brings with it its own difficulties. Undeclared supply of personal services represents roughly 17,5 mln workers in the EU, which has potentially significant implications on social security contributions, such as pensions.

It also gives rise to the question of training and whether people involved in caring duties have access to adequate levels of training; as well as, the wider issue of working conditions.

Gender dimension

Moreover, there is a strong gender dimension to Long-Term Care, notably:

- three-quarters of people in need of some form of long-term care are women;

- and 4 out of 5 careers in the EU are women.

The Commission recommends giving more attention to the rights of informal careers including in relation to pensions; this issue is brought up in the Commission’s Green Paper on Pensions.

The Commission and the member states need to open the debate about the cost and the advantage of a public intervention in care. In many EU member states, systems have been put in place with a view to reducing the risk of these services being taken over by informal economy and undeclared work. This means effectively waiving direct or indirect social contributions and taxes associated with these jobs, the main example being vouchers ("chèque service").

The Commission regards the European Year of aging as a great opportunity not just to raise awareness, but serve as a catalyst for action that could bring about real changes aimed at supporting older citizens in Europe.