The ageing of our societies is a common challenge impacting communities across Europe. Social services at national, regional, and local levels are at the forefront of responding to the growing long-term care (LTC) needs of our ageing populations. In this process, social services are confronted with four key challenges: changing the care model, building and developing the workforce, ensuring quality, and sustaining finances. The European Social Network (ESN) has gathered researchers, policymakers, and service practitioners in a live-streamed workshop in Warsaw (Poland) to discuss solutions for each of those challenges. 

Changing the care model

The European Pillar of Social Rights (EPSR) promotes people’s right to be cared for in the community by stating that: “everyone has the right to (…) long-term care services, particularly home care and community-based services”. Most people wish to stay in their own homes and communities, despite increasing frailty and care needs related to ageing, so public authorities must consider this when planning their LTC services. 

How to do this effectively has recently been demonstrated in Spain, where a National Strategy promotes a new model of care in the community. Meanwhile, Poland is preparing similar reforms. Pawel Rabiej from Korczak University in Warsaw highlighted that with stronger community services in place, many people could stay in their homes for much longer, quoting a recent World Bank study that found that with more community care support, 20-30% of current care home inhabitants could live in their own homes. 

Building and developing the workforce

Across Europe, social services experience staff shortages and high turnover, as found by, among others, the Council of Europe’s recent Ageing Communities report. Workshop discussion revealed that this is partially due to the high workload, non-competitive salaries, a perceived negative image of the sector, and the absence of career development. To develop their workforce, Vienna’s public care home provider ‘Häuser zum Leben’ has introduced the career programme ‘Move’, which builds capacity for future managers inside the organisation. The provider also invests in training employees to foster their specialisation and provide supervision and coaching. Heinz Stieb, working at the organisation’s management level, explained: “Career development is a key element of our retention strategy.” He claimed that to address the workforce challenge on a larger scale, the EU and Member State governments should develop a joint framework to address better recruitment, working conditions and training in the sector. 

Ensuring quality 

“Ensuring good quality in long-term care is directly linked to workforce challenges”, explained Kai Leichsenring, Executive Director at the European Centre for Social Welfare Policy and Research, before adding, “Only if we manage to ensure sufficient availability and training of staff can we keep a high standard of quality”.  According to him, quality assurance can sometimes be perceived as a burden for staff if not recognised by funders as a central element of the service. To recognise the value of quality assurance, funders should earmark budgets for quality assurance in their agreements with providers.

Sustaining financing

As revealed by a recent OECD study presented at the workshop, responsibility for providing funding to LTC is scattered across national, regional, and local levels. Depending on a country’s individual system, long-term care costs are funded by health care budgets, social care budgets, or a mix of both, which adds to the complexity of LTC funding. 

Against this backdrop, OECD expert Pietrangelo De Biase recommended reducing spending overlaps and equipping local authorities with the necessary financial means to honour their responsibilities in often-decentralised LTC systems. He explained that investment in prevention services is another key action towards saving costs. In this vein, Lex Staal, Director of Social Work Netherlands, referred to recent reforms in the Netherlands, where social care interventions can be reimbursed by public health insurance due to their proven preventative effects for LTC needs. 

Calling for EU action

Building on the workshop’s findings, this month ESN CEO Alfonso Lara Montero presented to the EU’s Social Protection Committee ESN’s central recommendations on EU actions needed in long-term care. Among others, we need an EU social services workforce strategy, a review of the EU Voluntary Framework for Quality in Social Services, the Promotion of Community Care, including telecare, to facilitate people's staying in their homes for as long as possible, and encouragement of adequate funding of long-term care services. Read ESN’s key proposals for the EU level here.