2021 EU Long-term care report : A highly useful analysis to inform care policymaking

The EU long-term care report publised by the European Commission last June provides a good overview of the trends, challenges and opportunities of an ageing Europe.
Yet, we have identified room for improvement, namely in terms of narrative and policy ambitions. We also point out some recommendations for action as a next step to this report.

EU-LTC-Report-2021-cover On 14 June, the European Commission and the Social Protection Committee launched a new Long-term care report. This document is composed of two volumes:

  • A 1st volume that delivers an overview of the situation in care in Europe.
  • A 2nd volume with a collection of country reports.

This report is a much welcome update of the 2014 report, which was a game changer in terms of developing strong data for care policymaking in Europe.

The report is available here

Together with other civil society organisations, we contributed to the reaction of the Social Platform. This reaction is available in European Commission’s website, here.

A great basis for further work at EU level

We welcome the effort made by the European Commission and the Social Protection Committee (SPC) to address virtually all the key aspects of the ongoing debates on long-term care in the EU. The wide scope of the report and the data it provides are excellent basis for further work on long-term care and support at EU level.

The report recognises explicitly that long-term care is a matter of shared interest across the EU, in line with the principle 18 of the European Pillar of Social Rights. This narrative confirms the central role of the Pillar in orienting EU action and EU’s level of ambition in the field of care and support.

The report reflects on the key issues, including on access – with a much welcome reference to social inequalities – and on quality – with references to the human rights framework and the importance of capturing all the dimensions of the lives of older people with care and support needs.

Data and analyses in the report include some key points that policymakers need to address:

  • Insufficient access: only 1 in 3 older people with severe difficulties in activities of everyday life had access to homecare services in 2014. In 2019, 47.2 % of people over 65 with severe difficulties in personal care or household activities had an unmet need for care.

  • Affordability issues: In 11 EU countries, 60% of older people would be at risk of poverty for care-related expenses, even after public support.

  • Quality issues: there is a lack of shared European understanding of what quality in care means, and diverse and sometimes inadequate systems of quality monitoring.

  • Difficult working conditions and over-reliance on informal carers: the work of informal carers has an economic value of between 2.4 and 2.7% of EU’s GDP, which is higher  than the expenditure on professional care in many EU countries.

But stop seeing long-term care and ageing as a problem!

The report frames long-term care as a “challenge”, linked to the “negative impacts of ageing”, with the European Commission “focusing its work on mitigating the social and economic consequences of demographic change and population ageing”. The catastrophic framing of ageing and care is a missed opportunity to put forward a new narrative in which care is seen as a social right. Care needs are a human reality and the problem is not related to ageing or the need of care but rather to the failure of our policies to address them in an adequate manner. In this sense, the report could have sought to raise the levels of appetite and political imagination among policymakers and challenge more openly the budgetary anxiety that is pervasive in political discourses.

Such framing has concrete consequences on the analyses and solutions that the report proposes. The life-course approach, for instance, is largely absent from the report, or only referred to on some rare occasions. By framing care as a problem, the report fails to explore more in depth the need to ensure healthy ageing throughout individuals’ lives. Such approach can help prevent care needs in the future and improve the social value of care and support as elements inherent to people’s lives, from early childhood to older age. We will not realise the full potential of healthy ageing if we limit its scope to older people.

We need a “long-term” vision of long-term care

The report balances policy options and points to different ways forward. Whereas this is technical work without the ambition to prescribe how laws and policies will evolve in the future, more audacious policy pointers would have been welcomed. In particular, the report says little about the overarching goals of long-term care services, with shy references to wellbeing, participation and autonomy.

At AGE, we will continue our work to influence policymakers’ approaches to long-term care and make sure they are fully anchored on human rights.

Some recommendations

Despite some shortfalls, the report is a very useful tool for policymaking and advocacy. The next step should be about taking action. In line with our contribution to the Action Plan of the European Pillar of Social Rights, AGE would like to recommend the following measures for further EU work on long-term care (LTC):

  • Adopt the two new indicators on LTC proposed in the action plan of the EU Pillar of Social Rights (spending and coverage of needs).

  • Introduce an EU target on LTC, enabling the measurement of progress towards improving access to quality services, as demanded by AGE and recently also by the Spanish and Belgian governments.

  • Improve the coherence and systematic linkage of EU’s work on disability rights, including the 2021-2030 Disability Rights’ Strategy, and the work on LTC. LTC should not be a category with a lower level of ambition but needs to develop in line with the high standards set both by the Strategy and principle 17 of the Pillar.

  • Adoption an Age Equality Strategy at EU level to ensure that the intersection between ageing and disability is better addressed. Such a strategy would contribute to addressing the negative narratives that prevent policymakers from adopting care policies that guarantee access, quality and sustainability at once.

  • Use the Disability Rights Strategy and a potential new Age Equality Strategy as the basis for an EU-endorsed Quality Framework for long-term care and support services. Such framework would contribute to consolidating a shared understanding across the EU on how to approach quality, based on the key principles of equality and non-discrimination. The 2012 European Quality Framework led by AGE could be a starting point.

For more information, you may contact Borja Arrue-Astrain, AGE’s policy officer responsible for long-term care, borja.arrue@age-platform.eu

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