The call for a paradigm shift towards a care system that is based in the community, as part of the conclusions adopted by EU Social Affairs Council on 28 November is a great step forward in the EU’s social care policy. In the adopted conclusions, social ministers from the 27 EU national governments recognise the inadequacies of institutional care for people and encourage national governments to promote reforms to ensure people’s right to high-quality, person-centred community-based care, recommending how to prevent institutionalisation of people with disabilities and dependency needs and promote access to free high-quality early childhood education and care. While these conclusions represent progress in recognising EU member states, the conclusions do not explicitly mention children in care. They should also explicitly underline the importance of prioritising community and family care for children who are in state care.
Building community-based care systems
In their conclusions, ministers request EU national governments to ensure access to long-term care, which enables those who require it, and who so wish, to conserve their autonomy and live independently in the community. Instead of living in an institution, they should be able to freely exercise control over where, with whom and how they want to live.
With this statement, ministers follow ESN’s long term advocacy for change towards a community-based care model. ESN first called for this in its 2011 developing community care report, recently reiterating this plea during our 2023 seminar on social services leading care in the community, held in cooperation with the Spanish EU Council Presidency, and ESN members, the Spanish Ministry of Social Rights and the Department of Social Rights of the Regional Government of Catalonia.
At the seminar, ESN members presented practices on how to make community care a reality. Promising practices presented were among others: Barcelona's neighbourhood community care teams; Innsbruck’s community nursing programme; and community-based day centres for people with Alzheimer's in Masovia, Poland.
Transforming long-term care with local services
In their conclusions, ministers call on national governments to undertake the necessary transformation so that care services, “including those offered by care institutions,” are provided on the basis of person-centred, community-based care and support. ESN wants to reiterate that care in institutions too often takes away people’s dignity, creates a strong hierarchy and forces residents to follow a set routine whether or not it suits them and their needs. Therefore, we should aim at closing institutions, and create a set of services that allow people to receive care at home or in a home-like environment.
Local social services are the key partners in making this transition happen. For example, the City of Stockholm has put in place regulations, that require residential care to be provided in group accommodation or housing of a maximum 5 or 6 people, living in connected, but separate flats, situated in ordinary residential areas and with specialised care staff available 24 hours. Other cities, such as Innsbruck or Barcelona have invested in home care services to allow people to receive long-term care, while living in their homes and communities.
For local authorities to lead this transformation, financing is key. “The transition of taxing from national to local level was crucial for the success of our deinstitutionalisation reforms”, said Frederik Jurdell, Stockholm's then Director of Social Services, at our 2021 European Social Services Conference, making it clear that “every new legislation should be followed by a clear financing system.” Helping local authorities to lead the change towards community care is crucial for a successful transformation. ESN is currently involved in the Spanish nationally funded reform programme Come a Casa, which helps Spanish regional governments to apply a community-based model in residential care. As a follow up to the Council Conclusions, national governments should make resources available to make similar reforms in collaboration with local social services.
Addressing institutional care for children – the missing part
In their call for a transition towards person-centred and community-based care throughout a person’s life, EU social ministers address not only long-term care but also the need to ensure children’s access to early childhood education and care. While ministers mention the need for access to early education and childcare, they remained however silent on deinstitutionalisation for childcare and child protection services. In a life course approach to community-based care, child protection must be taken into account. In a recent article, we have spelled out why addressing institutional care for children is key for their development, health and wellbeing. Access to early prevention services, as well as kinship and foster care should be crucial components of truly community-based care throughout life, and ESN will continue to call for this as EU social policies continue to evolve.