New joint report by the Social Protection Committee and the European Commission

Over the next five decades, the number of Europeans aged 80+ requiring long-term care is expected to triple. This factor, together with a declining working population, changing family structures and raising expectations in care services, are the main challenges outlined in the Social Protection Committee’s new report ‘Adequate social protection for long-term care needs in an ageing society’. The report was endorsed by the Employment and Social Affairs Council on 19 June.

The Social Protection Committee (SPC) is a group of Member States representatives that deals with social protection issues, monitors social conditions and promotes policy coordination within Europe. The Commission works together with EU countries through the SPC using the Open Method of Coordination in the areas of social inclusion, health care, long-term care and pensions. While EU countries are responsible for long-term care provision, they have also agreed, in the context of the Open Method of Coordination, on the provision of accessible, high-quality and sustainable health care and long-term care.

Aim of the report

The report outlines the need for Member States to implement a ‘proactive’ policy approach in order to address upcoming challenges in long-term care (LTC) provision. Moreover, it reiterates the case for social protection against the risk of LTC needs and it identifies existing practices in the EU that could be considered in other countries too. It also suggests policy action to increase EU support to Member States’ efforts to address future challenges.

The current situation

There are substantial differences between LTC systems in different countries, in terms of defining long-term care (and its constituent parts of health and social care and the relation between them), resources allocation and workforce situation. According to the European Commission’s 2012 Ageing Report, for instance, Member States’ public spending on long-term care in 2010 ranged from 4.5% of GDP in Denmark* to 0.2% in Cyprus; the average for the EU27 was 1.8% of GDP. The report also highlights further differences between paid and unpaid care, health and social care responsibilities, home and residential care, and availability of services.

Challenges

It is projected that in the EU27, there will be only two people aged 15 to 64 for every person aged 65 or more in 2060, compared with four in 2010. With the growing population of older people dependent on care services and the shrinking workforce, there is an ever-widening gap between the need for and the supply of long-term care. Even in countries with a high spending on LTC, the number of informal carers is estimated to be at least twice as big as the professional care workforce, and the economic value of unpaid care is estimated around 50% to 90% of the overall cost of long-term care. The demographic change and the difficulties to recruit professional care workers will put more pressure on informal carers, while Member States will face more challenges to supply quality and financially sustainable care.

Closing the gap

In order to address the widening gap between the need for and the supply of long-term care, the report calls for a shift from primary reactive to proactive policy responses. The main elements of a proactive response are illustrated through practice examples from different countries:

• Preventive and rehabilitative measures to reduce the fast-rising number of older people needing long-term care or to enable dependent people to live more independently. The well-known Fredericia model from Denmark serves as an example; in the municipality, care needs have been reduced due to a home-based rehabilitation programme, a 72 hours intensive training over 31 days, with a focus on everyday tasks.
• Measures to improve the effectiveness of care delivery which could cover service cooperation, the use of technology and the creation of age-friendly environments. For example, the Swedish national plan to improve social and health care aims to enhance person-centred approaches and integrated care by pooling finances between sectors, through data-sharing and case-managers that provide personalised support.
• Measures to improve supply and retention of formal carers and to support informal carers, including by helping them to reconcile work with family and care responsibilities. At the Dutch Buurtzog home-care provider, professional carers actively changed the way they provide care: by spending more time with the persons in need for care and developing a personal relation with them; additionally, they were able to reduce costs with the help of ICT and less administrative tasks.

Future steps

The EU can help to highlight the social challenges caused by dependency on long-term care and the report proposes some actions in this sense:

• acquiring a better understanding of the different LTC systems in different countries and the impact on social and employment issues;
• developing a methodology for estimating costs of LTC and measuring cost-effectiveness of various ways of tackling LTC needs in order to assess innovative approaches (to be developed by a European Commission/OECD Joint Action);
• promoting age-friendly environments;
• encouraging a systematic and integrated approach to implementing strategies for the secondary and tertiary prevention of frailty;
• cooperating with the European Group of National Human Rights Institutions (NHRIs) to promote greater respect for the human rights of people in long-term care.

In September, the European Social Network (ESN) is launching a new working group on Ageing and Care for its members. The working group will analyse national, regional and local policies and practices in long-term care. Based on this analysis, the group will develop recommendations for sustainable, person-centred services at local level. The outcomes of the working group will also contribute to the implementation of suggested policy approaches in the new report ‘Adequate social protection for long-term care needs’.

Read the full report and the key messages

*estimate particularly uncertain because of lack of data