Formal and informal Formal and informal resources in meeting old age-resources in meeting old age-

related care needs: A related care needs: A European comparisonEuropean comparison

Anneli AnttonenAnneli AnttonenProfessorProfessor

University of TampereUniversity of TampereDept. of Social Policy and Social WorkDept. of Social Policy and Social Work

Presentation atPresentation atRECWOWE DOCTORAL WORKSHOPRECWOWE DOCTORAL WORKSHOP

Work, care and well-being: public and Work, care and well-being: public and private arrangementsprivate arrangements

Helsinki, Stakes, September 16-17, Helsinki, Stakes, September 16-17, 20082008

Elder care and social policyElder care and social policy

Elder care coming more important.Elder care coming more important.Societies are greying, old people are living alone Societies are greying, old people are living alone more often than before, and working age more often than before, and working age population is expected to retire later than now. population is expected to retire later than now. Consequently, care needs are increasing at the Consequently, care needs are increasing at the same time when informal care resources are same time when informal care resources are diminishing. diminishing. In addition, the public service provision have met In addition, the public service provision have met its limits of growth at least in countries, which its limits of growth at least in countries, which have been so called have been so called social services statessocial services states or or caring statescaring states (Anttonen 2005; Szebehely 2004). (Anttonen 2005; Szebehely 2004).

Elder care: less modern part of Elder care: less modern part of the welfare statethe welfare state

In many countries, elder care service In many countries, elder care service provision is even today organised locally provision is even today organised locally (and sometimes) without national (and sometimes) without national legislation and regulation.legislation and regulation.

It might carry some features of poor law It might carry some features of poor law tradition, for instance, in the form of tradition, for instance, in the form of extensive means-testing. extensive means-testing.

Yet, it is becoming more modern.Yet, it is becoming more modern.

Elder care as a social Elder care as a social investmentinvestment

Until these days, elder care has lacked Until these days, elder care has lacked the high social valuation typical to health the high social valuation typical to health care, education or childcare. Elder care care, education or childcare. Elder care is not seen as a social investment is not seen as a social investment needed for the economic success of the needed for the economic success of the society. Yet, social policy commentators society. Yet, social policy commentators within the EU (Feasibility…2003) and within the EU (Feasibility…2003) and OECD (2005) are increasingly paying OECD (2005) are increasingly paying attention to elder care. attention to elder care.

Welfare state change – welfare Welfare state change – welfare state redesignstate redesign

• To what direction? What is the To what direction? What is the dynamic of change? Degree of dynamic of change? Degree of change? Object of change? Outcome change? Object of change? Outcome of change? Impact of change?of change? Impact of change?

• What should be studied? Paradigms? What should be studied? Paradigms? Discourses? Institutions? Policies? Discourses? Institutions? Policies? Outcomes?Outcomes?

JJøørgen Goul Andersen (2007)rgen Goul Andersen (2007)

Elder or adult care policies in Elder or adult care policies in transition: old and new transition: old and new directionsdirections

• Comparision of 12 European countries (Anttonen & Sointu Comparision of 12 European countries (Anttonen & Sointu 2006)2006)

• Increase in public responsibility in some countries or in Increase in public responsibility in some countries or in some policy fields (payments of care schemes).some policy fields (payments of care schemes).

• Formal/semi-formal/informal care arrangements (Geissler & Formal/semi-formal/informal care arrangements (Geissler & Pfau-Effinger).Pfau-Effinger).

• From services to money (care insurance, personal care From services to money (care insurance, personal care budget, cash for care schemes).budget, cash for care schemes).

• New hybrid forms of ‘work’ and ‘care’ emerging (Ungerson New hybrid forms of ‘work’ and ‘care’ emerging (Ungerson 2004).2004).

• Commercialisation/economisation of care: private solutions.Commercialisation/economisation of care: private solutions.• Social responsibility of firms (mainly childcare).Social responsibility of firms (mainly childcare).

Nordic care policies in Nordic care policies in transitiontransition

• Finland and Sweden have met the limits Finland and Sweden have met the limits of public service provision (e.g. home of public service provision (e.g. home care services for adults; institutional care services for adults; institutional care).care).

• From universalism toward targeting: de-From universalism toward targeting: de-universalisation (Gilbert 2001)universalisation (Gilbert 2001)

• Informalisation of care (Szebehely 2004).Informalisation of care (Szebehely 2004).• Marketisation and commercialisation of Marketisation and commercialisation of

care.care.

Privatisation of public care Privatisation of public care provisionprovision

• Privatisation of financing: increased Privatisation of financing: increased fees for service users;fees for service users;

• Privatisation of service provision: Privatisation of service provision: increased presence of private increased presence of private providers (contracting out, vouchers);providers (contracting out, vouchers);

• Privatisation of the work organisation: Privatisation of the work organisation: NPM, new wage systems.NPM, new wage systems.(Szebehely 2004).(Szebehely 2004).

From old to new politics of From old to new politics of elder careelder care

The old politics of the elder care bases on strong The old politics of the elder care bases on strong centralised institutions, universal treatment of centralised institutions, universal treatment of ‘clients’ or ‘patients’ and professional needs-‘clients’ or ‘patients’ and professional needs-interpretation. In the new politics of the elder interpretation. In the new politics of the elder care the figure of client/patient becomes replaced care the figure of client/patient becomes replaced by the figure of ‘consumer’ (Clarke 2006; Kremer by the figure of ‘consumer’ (Clarke 2006; Kremer 2006) making ‘free choices’ on the emerging 2006) making ‘free choices’ on the emerging social care market.social care market. Since the early 1990s, the transition from the Since the early 1990s, the transition from the ‘old’ to the new market-related politics of the ‘old’ to the new market-related politics of the welfare state has taken place in a number of welfare state has taken place in a number of countries.countries.

How to solve the care How to solve the care puzzlepuzzle• Care puzzle (Marta Szebehely): Care puzzle (Marta Szebehely):

increasing care needs and decreasing increasing care needs and decreasing informal care resources.informal care resources.

• Is the development of formal care Is the development of formal care resources following the change in needs resources following the change in needs (for instance the ageing of population)? (for instance the ageing of population)?

• Increase in formal care resources and Increase in formal care resources and decrease of informal care resources.decrease of informal care resources.

Table 1: Female employment rates, years 1980, 1991 and 2003; maternal employment

rates around 2005; and total fertility rate in 2005

Share of women aged 15-64 in

employment1

Maternal employment rates,

women aged 15-642

Total fertility

rate 2005

Year 1980 1991 1998 2003 children

0-16

children

<3

children

3-5

Children per

woman

Austria -- -- 58,5 61,5 64,7 60,5 62,4 1,41

Belgium -- 43,0 47,5 51,4 59,9 63,8 63,3 1,72

Czech Rep. -- -- 58,7 56,3 52,8 19,9 50,9 1,28

Denmark -- 70,1 70,3 70,5 76,5 71,4 77,8 1,80

Finland 66,1 68,4 61,3 65,7 76,0 52,1 80,7 1,80

France 50,0 50,8 52,4 56,4 59,9 53,7 63,8 1,94

Germany 49,6 56,3 56,3 58,7 54,9 36,1 54,8 1,34

Greece -- 34,9 40,3 44,5 50,9 49,6 53,6 1,28

Hungary -- -- 47,3 50,9 45,7 13,9 49,9 1,32

Ireland -- 36,3 48,2 55,4 57,5 55,0 1,88

Italy 33,4 36,5 37,3 42,7 48,1 47,3 50,6 1,34

Luxembourg -- 43,6 45,6 52,0 55,4 58,3 58,7 1,70

the NL 34,2 49,3 59,4 64,2 69,2 69,4 68,3 1,73

Norway 60,8 67,0 73,6 72,7 -- -- -- 1,84

Poland -- -- 52,5 46,2 -- -- -- 1,24

Portugal 45,8 57,6 58,3 60,6 67,8 69,1 71,8 1,40

Slovak Rep. -- -- 53,5 52,5 48,4 23,1 46,6 1,25

Spain 28,5 32,5 36,5 46,8 52,0 52,6 54,2 1,34

Sweden 73,3 79,3 69,4 72,8 82,5 71,9 81,3 1,77

Switzerland -- 66,5 68,8 70,7 69,7 58,3 61,7 1,42

the UK -- 62,2 64,2 66,4 61,7 52,6 58,3 1,80

1 OECD Factbook 2007: Economic, Environmental and Social Statistics. 2 OECD 2007: Babies and Bosses: Reconciling Work and Family Life (Vol 5): A Synthesis

of Findings for OECD countries, Table 3.2. (www/oecd.org/els/social/family).

Table 2. Female population aged 55-64 active in the labour market, years 1992, 1998 and

2004

Female population aged 55-64, active in the labour market

change change1992 1998 2004 2004/1992 2004/1998

eu27 33,7eu25 28,0 34,0eu15 25,6 29,0 35,5 1,39 1,22Belgium 11,8 14,8 22,1 1,87 1,49Bulgaria 26,8Cz. Republic 23,9 31,3 1,31Denmark 48,5 45,3 56,5 1,16 1,25Germany 26,3 34,1 37,8 1,44 1,11Estonia 43,1 51,9 1,20Ireland 17,9 24,2 34,4 1,92 1,42Greece 22,6 24,4 25,2 1,12 1,03Spain 19,0 21,4 27,2 1,43 1,27France 26,5 26,7 35,9 1,35 1,34Italy 15,7 20,4 1,30Cyprus 31,6Latvia 29,2 46,1 1,58Lithuania 30,4 44,2 1,45Luxembourg 15,1 15,8 22,6 1,50 1,43Hungary 10,2 25,8 2,53Malta 11,9Netherlands 17,1 20,9 34,4 2,01 1,65Austria 17,7 19,9 1,12Poland 25,6 21,4 0,84Portugal 35,5 39,1 44,8 1,26 1,15Romania 44,5 31,9 0,72Slovenia 16,4 18,1 1,10Slovakia 10,3 14,8 1,44Finland 38,9 38,9 54,3 1,40 1,40Sw eden 64,0 62,6 69,7 1,09 1,11UK 39,0 40,4 47,9 1,23 1,19Norw ay 61,2Sw itzerland 52,4 56 1,07

mean, all 29,1 35,4 1,22mean, 14 29,4 31,4 39,4 1,34 1,26mean, 8 26,0 31,7 1,22

Source: © Eurostat / table: lfsi_act_a: Population, activity and inactivity – Annual averages

Who will be future informal Who will be future informal carers?carers?• The overall share of women aged 15-64 in paid The overall share of women aged 15-64 in paid

employment has risen between 1980/1991 and employment has risen between 1980/1991 and 2003, except in Eastern Europe.2003, except in Eastern Europe.

• Maternal employment has rapidly increased, rapid Maternal employment has rapidly increased, rapid change in some countries (e.g. Ireland and Spain).change in some countries (e.g. Ireland and Spain).

• The employment rate among women in the age The employment rate among women in the age group of 55-64 years increased from 29 to 39 group of 55-64 years increased from 29 to 39 percent (by 24 percent) in the group of 14 West percent (by 24 percent) in the group of 14 West European countries (no data from Austria, Italy European countries (no data from Austria, Italy and Switzerland). Most of the increase occurred and Switzerland). Most of the increase occurred between 1998 and 2004. between 1998 and 2004.

• Feminisation of labour market › decrease in Feminisation of labour market › decrease in informal care resources.informal care resources.

Table 3. Percentage of population, age 65 and over in 1991, 1998, and 2004 Percentage of population, age 65 and over

change change1991 1998 2004 2004/1991 2004/1998

eu27 13,9 15,3 16,4 1,18 1,07

Belgium 15,0 16,5 17,1 1,14 1,04Bulgaria 13,4 15,6 17,1 1,28 1,10Cz. Republic 12,6 13,6 13,9 1,10 1,02Denmark 15,6 14,9 14,9 0,96 1,00Germany 14,9 15,8 18,0 1,21 1,14Estonia 11,7 14,5 16,2 1,38 1,12Ireland 11,4 11,4 11,1 0,97 0,97Greece 13,8 15,9 17,8 1,29 1,12Spain 13,8 16,2 16,9 1,22 1,04France 14,0 15,5 16,1 1,15 1,04Italy 15,1 17,5 19,2 1,27 1,10Cyprus 10,9 11,1 11,9 1,09 1,07Latvia 11,8 14,4 16,2 1,37 1,13Lithuania 11,0 13,2 15,0 1,36 1,14Luxembourg 13,4 14,3 14,1 1,05 0,99Hungary 13,5 14,7 15,5 1,15 1,05Malta 10,5 11,8 13,0 1,24 1,10Netherlands 12,9 13,5 13,8 1,07 1,02Austria 15,0 15,4 15,5 1,03 1,01Poland 10,2 11,7 13,0 1,27 1,11Portugal 13,6 15,6 16,8 1,24 1,08Romania 10,6 12,9 14,4 1,36 1,12Slovenia 10,8 13,2 15,0 1,39 1,14Slovakia 10,4 11,2 11,5 1,11 1,03Finland 13,5 14,6 15,6 1,16 1,07Sweden 17,8 17,4 17,2 0,97 0,99UK 15,8 15,9 16,0 1,01 1,01Norway 16,3 15,7 14,7 0,90 0,94Sw itzerland 14,6 15,0 15,7 1,08 1,05

mean, all 13,2 14,4 15,3 1,15 1,06mean, 17 14,5 15,4 15,9 1,10 1,04mean, 6 11,2 12,9 14,1 1,26 1,09

Source: © Eurostat / table: demo_pjanind: Population structure on 1st January

Table 4. Percentage of population, 80 years and over, years 1991, 1998 and 2004

Percentage of population, 80 years and overchange change

1991 1998 2004 2004/1991 2004/1998eu27 3,2 3,4 3,9 1,22 1,15

Belgium 3,5 3,6 4,1 1,17 1,14Bulgaria 2,2 2,1 2,9 1,32 1,38Cz. Republic 2,5 2,4 2,9 1,16 1,21Denmark 3,7 3,9 4,0 1,08 1,03Germany 3,8 3,7 4,2 1,11 1,14Estonia 2,6 2,7 3,0 1,15 1,11Ireland 2,2 2,5 2,6 1,18 1,04Greece 3,1 3,1 3,3 1,06 1,06Spain 3,0 3,6 4,2 1,40 1,17France 3,7 3,7 4,3 1,16 1,16Italy 3,3 4,1 4,8 1,45 1,17Cyprus 2,4 2,6 2,6 1,08 1,00Latvia 2,8 2,6 2,9 1,04 1,12Lithuania 2,7 2,4 2,8 1,04 1,17Luxembourg 3,1 3,2 3,1 1,00 0,97Hungary 2,6 2,6 3,2 1,23 1,23Malta 2,0 2,2 2,7 1,35 1,23Netherlands 2,9 3,2 3,4 1,17 1,06Austria 3,6 3,5 4,1 1,14 1,17Poland 2,0 2,0 2,4 1,20 1,20Portugal 2,6 3,2 3,7 1,42 1,16Romania 1,8 1,9 2,2 1,22 1,16Slovenia 2,3 2,3 2,9 1,26 1,26Slovakia 2,1 1,9 2,3 1,10 1,21Finland 2,9 3,3 3,7 1,28 1,12Sweden 4,3 4,8 5,3 1,23 1,10UK 3,7 3,9 4,3 1,16 1,10Norway 3,8 4,2 4,6 1,21 1,10Switzerland 3,7 4,0 4,3 1,16 1,08

mean, all 2,9 3,1 3,5 1,19 1,13mean, 17 3,3 3,6 4,0 1,20 1,11mean, 6 2,4 2,3 2,8 1,15 1,20

Source: © Eurostat / table: demo_pjanind: Population structure on 1st January

Ageing of societiesAgeing of societies

• In 2004, the highest proportion of In 2004, the highest proportion of elderly population was found in Italy elderly population was found in Italy (19.2 percent), and lowest in Ireland (19.2 percent), and lowest in Ireland (11.1 %).(11.1 %).

• We simply can assume that at age of We simply can assume that at age of 80 the need for help starts to increase.80 the need for help starts to increase.

• There is an increase also of population There is an increase also of population over 80.over 80.

Table 5. Cash benefits, old age function, as a percentage of GDP, years 1991, 1998 and 2004

Cash benefits, old age function, as a percentage of GDPchange change

1991 1998 2004 2004/1991 2004/1998eu25 10,4eu15 9,6 10,4 10,5 1,09 1,01Belgium 7,9 8,5 9,4 1,19 1,11Cz. Republic 7,2 7,2 1,00Denmark 8,0 9,3 9,2 1,15 0,99Germany 9,8 11,1 11,8 1,20 1,06Estonia 5,6Ireland 3,9 2,6 2,6 0,67 1,00Greece 10,2 11,7 11,8 1,16 1,01Spain 7,4 8,1 7,6 1,03 0,94France 9,5 10,6 10,6 1,12 1,00Italy 11,2 12,5 12,8 1,14 1,02Cyprus 8,1Latvia 8,2 5,7 0,70Lithuania 6,4 5,7 0,89Luxembourg 8,9 7,9 5,8 0,65 0,73Hungary 6,9Malta 7,7 8,6 1,12Netherlands 9,0 8,6 8,8 0,98 1,02Austria 11,5 12,4 12,8 1,11 1,03Poland 10,8Portugal 5,0 6,5 8,9 1,78 1,37Slovenia 10,5 10,2 0,97Slovakia 6,4 6,3 0,98Finland 7,3 7,2 7,6 1,04 1,06Sw eden 9,3 9,2 9,3 1,00 1,01UK 9,4 10,1 10,1 1,07 1,00Norw ay 5,8 5,8 5,5 0,95 0,95Sw itzerland 8,4 11,1 11,9 1,42 1,07

mean, all 8,4 8,7 8,6 1,02 0,99mean, 17 8,4 9,0 9,2 1,10 1,02mean, 6 7,7 7,3 0,94

Source: © Eurostat / table: spr_exp_fol: Tables by benefits and currency – old age function

Meeting care needs of older Meeting care needs of older people: cash benefits (share of people: cash benefits (share of GDP)GDP)• Cash related benefits: over the period of 1991-Cash related benefits: over the period of 1991-

2004 EU-15 + Norway and Switzerland: share of 2004 EU-15 + Norway and Switzerland: share of cash benefits of GDP increased by 10 % when cash benefits of GDP increased by 10 % when counted as a difference of 17 countries’ means. counted as a difference of 17 countries’ means.

• Growth was fastest in Portugal (78 %), some Growth was fastest in Portugal (78 %), some reduction in Luxembourgh and Ireland, smaller in reduction in Luxembourgh and Ireland, smaller in the NL and Norway.the NL and Norway.

• In the new member states (1998-2004) the In the new member states (1998-2004) the expenditure of old age related cash benefits fell expenditure of old age related cash benefits fell to some extent.to some extent.

• All in all, related to ageing of popultation there All in all, related to ageing of popultation there seems to be a minor decrease in these expenses.seems to be a minor decrease in these expenses.

• Cash benefits: a resource to be used for care.Cash benefits: a resource to be used for care.

Table 6. Change of old age benefits in kind, euros PPP, 1991, 1998 and 2004

Change of old age Standardised w ith benefits in kind, euros PPP the change of GDPper inhabitant and of population 80+

1991 1998 2004 2004/1991 2004/1998eu27

Belgium 2,3 18,9 40,7 8,23 1,67BulgariaCz. Republic 54,1 58,1Denmark 376,7 407,8 512,3 0,75 1,05Germany 51,1 39,5 48,6 0,55 1,02Estonia 14,4Ireland 50,7 55,5 107 0,61 1,30Greece 6,5 15,6 20,6 1,65 0,91Spain 22,2 24,8 79,5 1,05 2,39France 30,6 38,3 78,5 1,32 1,65Italy 20 19,2 29,6 0,51 1,35Cyprus 14,4Latvia 9,6 13,7 0,87Lithuania 13,7 18,9 0,85Luxembourg 57,6 71,8 0 0,00 0,00Hungary 76,6Malta 75,6 96,9 1,07Netherlands 89,3 156,1 247,2 1,23 1,23Austria 30,1 72 139,5 2,36 1,57Poland 3Portugal 14,3 29,6 64,4 1,44 1,75RomaniaSlovenia 7,1 8,3 0,84Slovakia 34,2 30,5 0,65Finland 134 157,7 249,4 0,73 1,23Sw eden 408,9 542,1 711,4 0,76 1,03UK 55,2 109,7 155,8 1,21 1,06Norw ay 327,4 506,1 672 0,69 0,88Sw itzerland 58,9 63,4 76,5 0,73 1,04

mean, all 102,1 109,7 132,1 0,91mean, 17 102,1 136,9 190,2 0,94 1,06mean, 5 32,4 37,7 0,84 Source: © Eurostat

Table 7: The proportion of 65+ population in long-term institutional care (%), and the

proportion of those receiving public support at home (%) in the beginning of 1990s and

around 2000

Countries Long-term care (proportion of

over 65 population, %) Public support at home (proportion of over 65 population, %)

around 2000 early 1990s around 2000 early 1990s Netherlands 2,4 8,8 12,3 12,0 Spain 2,8 2,0 Ireland 4,6 5,0 5,0 3,5 Italy 3,9 3,0 the UK 5,1 5,1 20,3 5,5 Austria 3,6 4,9 14,8 11,7 Luxembourg 3,8 - 4,2 Norway 61 6,6 182 17,0 France 6,5 6,1 Sweden 7,93 8,7 9,14 11,2 Germany 3,6 6,8 6,5 9,6 Finland 6,9 5,3-7,6 10,6 14,0 Denmark 9,1 7,0 24,6 20,3 Hungary - 4,5 5,1 OECD-countries 4,8 9,1

1According to NOSOSCO statistics the corresponding figure for Norway is 11,9 %. 2 NOSOSCO 15,2 %. 3 NOSOSCO 8,1 %. 4 NOSOSCO 8,2 %.

Source: OECD 1999, 120: Table 6.4 (early 1990s); OECD 2005b, 79: Table HE5.1;

NOSOSCO 2004, 138: Table 7.11 (Scandinavian countries 2002, foot notes).

Social care servicesSocial care services

• Social expenditure on old age benefits in Social expenditure on old age benefits in kind presented as Euros (PPP) per kind presented as Euros (PPP) per inhabitant.inhabitant.

• Large country variation.Large country variation.

• Although the expenditure in kind has on Although the expenditure in kind has on average increased, there has happened average increased, there has happened some relative decrease in the expenses some relative decrease in the expenses related to persons over 80 and the growth related to persons over 80 and the growth of GDP.of GDP.

ResultsResults

• There was a slight decrease (related to GDP) in money There was a slight decrease (related to GDP) in money spent to cash benefits per person over 65+.spent to cash benefits per person over 65+.

• There was no real increase in the public expenditure spent There was no real increase in the public expenditure spent to servcies per person 65+.to servcies per person 65+.

• The expenditure of the benefits in kind accounted only 4 The expenditure of the benefits in kind accounted only 4 percent of total expenditure on old age; all the rest was percent of total expenditure on old age; all the rest was expenditure on various cash benefits.expenditure on various cash benefits.

• Moreover, the number of long-term care hospital beds has Moreover, the number of long-term care hospital beds has fallen dramatically.fallen dramatically.

• However, the lack of reliable data makes it difficult to However, the lack of reliable data makes it difficult to evaluate public policy for older people in any detail.evaluate public policy for older people in any detail.

• Previous research findings give us evidence that there Previous research findings give us evidence that there really is a great variation in service provision for older really is a great variation in service provision for older people in Europe (Bettio & Plantenga 2004, Rostgaard people in Europe (Bettio & Plantenga 2004, Rostgaard 2002).2002).

Support for informal carersSupport for informal carers

• Anttonen & Sointu (2006): public policy Anttonen & Sointu (2006): public policy of care in 12 European countries.of care in 12 European countries.

• Support for informal care at homeSupport for informal care at home– Cash benefit to care giverCash benefit to care giver– Cash benefit to care receiverCash benefit to care receiver– Care leave to care giverCare leave to care giver– Services supporting informal care at homeServices supporting informal care at home

Table 10. Benefits to caregivers in 12 European countries in the beginning of 2000s

1In some restricted cases. 1 Very seldom. 2 Entitlement to a modest leave. Payment at employer’s discretion. 3 A student carer is not supported. Local government supports carer’s holidays with vouchers. 4 Needs-tested, depends on resources. 5 Some local benefits may exist. 6 No support to a relative carer in the age of 65 or over 7 An employee may appeal for part-time work, but the employer need not agree. A possible payment negotiated between the employee and employer. 8 No proper care leave but the rotation leave can be used for caring. 9 Local government may employ a relative for six months if the patient is seriously ill. A particular compensation to the carer of a moribund patient exists. 10 An insignificant benefit, not paid to a housewife or a pensioner. Sources: Eurofamcare (Mestheneos & Triantafillou 2005, annex 6 and Eurofamcare country reports 2004); Lundsgaard 2005: OECD 2005.

Country Leave to care adult person

Paid leave Other support to the carer?

Can a relative or spouse receive support

Netherlands yes yes no - Spain no1 no yes, local1 yes Italy yes yes yes, local yes UK yes2 sometimes yes restraints3 Norway yes yes yes4 yes Poland yes sometimes no5 - France no no no - Sweden yes yes yes yes6 Germany yes7 sometimes yes yes Finland no8 no yes yes Denmark yes yes yes9 yes Hungary no no yes restraints10

Table 11. Monetary benefits paid to an elderly care receiver in 12 European countries in the beginning of 2000s Country Tax deduction Benefit to the

care receiver Benefit receiver May a relative be paid?

Netherlands yes yes anybody in need1 restricted2 Spain yes no3 - - Italy yes yes anybody in need4 yes UK no yes anybody in need5 yes Norway yes yes anybody in need yes Poland yes no6 - - France yes yes anybody in need7 restricted8 Sweden no yes a person with heavy need9 yes Germany yes yes anybody in need yes Finland no yes anybody in need yes Denmark no n o - - Hungary no no - -

1 The benefit may be used to cover costs or to employ a personal assistant. 2 The relative must not live in the same household. 3 Some local benefits exist. 4 Strict criteria. 5 A small benefit covering extra costs in practice. A new direct payment introduced, which can be used to employ a relative who does not live in the same household. 6 All people 75 and over receive a small monetary benefit. 7 The benefit may be used as wanted. 8 A relative may be paid if unemployed; not paid to a spouse or a pensioner. 9 Local governments make the decisions, usually the benefit is only granted if a person needs help at least for 17 hours a week. Sources: Eurofamcare country reports 2004; Lundsgaard 2002a, 107-8; Lundsgaard 2002b, 36-7; Mestheneos & Triantafillou 2005; MISSOC 2004, table Long-term care; OECD 2005; Rostgaard & Fridberg 1998, 593-4.

Payments for informal care: Payments for informal care: some conclusionssome conclusions• 12 countries have slighlty different policy alternatives to 12 countries have slighlty different policy alternatives to

support informal caresupport informal care• 8 countries paid cash payments for care receivers (+ 2 tax 8 countries paid cash payments for care receivers (+ 2 tax

redcutions)redcutions)• 8 countries offered care leaves often accompanied by 8 countries offered care leaves often accompanied by

financial remunerationfinancial remuneration• 6 countries paid cash payments for care givers6 countries paid cash payments for care givers• 3 of studied countries offered a wide range of support (the 3 of studied countries offered a wide range of support (the

NL, Norway and Sweden) following by Germany, Italy and NL, Norway and Sweden) following by Germany, Italy and the UKthe UK

• France: nearly all support to care receiversFrance: nearly all support to care receivers• Denmark: nearly all support to care giversDenmark: nearly all support to care givers• Large country variationsLarge country variations

Summary: formal and informal Summary: formal and informal resourcesresources• Social spending on pensions and other cash benefits Social spending on pensions and other cash benefits

(a remarkable share of GDP) meaning that changes (a remarkable share of GDP) meaning that changes in this spending have a great impact on resources in this spending have a great impact on resources older people have in use.older people have in use.

• Social spending on services in kind is still marginal, Social spending on services in kind is still marginal, more difficult to estimate outcomes and impact on more difficult to estimate outcomes and impact on resources in situation of changes.resources in situation of changes.

• More public money spent on supporting informal More public money spent on supporting informal care at home: motivating informal carers to do their care at home: motivating informal carers to do their work or strengthenin autonomy of older people.work or strengthenin autonomy of older people.

• There is no European social care strategy or policy.There is no European social care strategy or policy.

Whose choice? Money instead Whose choice? Money instead of servicesof services

• In Austria and Italy (same in Germany): money In Austria and Italy (same in Germany): money received is not used to good quality care or received is not used to good quality care or medical aid by low income households.medical aid by low income households.

• Empowerment of users by choice: exit of low Empowerment of users by choice: exit of low income families and difficult/vulnerable users income families and difficult/vulnerable users (family takes over care; immigrant workers are (family takes over care; immigrant workers are used). used).

• Marianne Egger de Campo: Exit and Voice. An Marianne Egger de Campo: Exit and Voice. An Investigation of Care Service Users in Austria, Investigation of Care Service Users in Austria, Belgium, Italy and Northern Ireland (2007)Belgium, Italy and Northern Ireland (2007)

Is choice the answer for good Is choice the answer for good care? care? • Personal budget: empowerment of consumers Personal budget: empowerment of consumers

(through money).(through money).• Managing own money leads to independence of Managing own money leads to independence of

those need in care. Voice and choice. Yes.those need in care. Voice and choice. Yes.• Disempowerment of professionals.Disempowerment of professionals.• From monopoly of professionals to monopoly of From monopoly of professionals to monopoly of

clients.clients.• Family members in first instance. Stronger sense Family members in first instance. Stronger sense

of responsibility.of responsibility.• Intimate relations are changing.Intimate relations are changing.

• Monique Kremer (2006)Monique Kremer (2006)

Care inequalitiesCare inequalities

• Access to formal care (services): Access to formal care (services): differences between differences between individuals/households;individuals/households;

• Informal care resources: huge Informal care resources: huge variation depending on life situation;variation depending on life situation;

• Care rich and care poor individuals Care rich and care poor individuals households;households;

• Right to receive good care? Right to Right to receive good care? Right to give care/not to give care?give care/not to give care?

What is the future of care What is the future of care work?work?

• Who are informal carers in the future Who are informal carers in the future societies, and in what terms?societies, and in what terms?

• How to compensate losses in informal How to compensate losses in informal care resources?care resources?

• Nor the family, state or market alone Nor the family, state or market alone cannot meet all care needs.cannot meet all care needs.

• Exit, voice and choice – but on what Exit, voice and choice – but on what terms and to whom?terms and to whom?

Thank you!Thank you!