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Family Care in Europe

Kees Knipscheer

Faculty of Social Sciences / AOWscope

VU University Amsterdam

(with acknowledgement to the SHARE and EUROFAMCARE studies: Börsch-Supon et al, Lamura et al)

Annual Meeting GSA, San Francisco, 16-20 November, 2007

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Overview

• Historical diversity and common background• Common changes in diverse contexts • Actual Family care: continuity and change • Support services for family carers• Sustainability of welfare services as a policy

issue

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A. Historical diversity in common background

• Originally: Family Care for elderly and armshouses

• 19e century formal family responsibility based in Civil Codes (Napoleontic and Austrian)

• 19e century: Public and private charitable associations for people without family or at odds

• After Second Worldwar: evolving Welfare States, increasing public responsibility, evolution of professionalisation of care according country specific approaches of social protection

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B. Common changes in diverse contexts

• Demographic changes• Changes in the family• Normative changes• Developments in the Welfare States• Welfare Regimes

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10

15

20

25

30

35

40

2005 2050

Spain

Italy

Germany

Greece

Portugal

Czech Republic

Slovenia

Austria

Poland

Slovakia

Belgium

Hungary

France

Lithuania

Finland

United Kingdom

Estonia

Ireland

Cyprus

Latvia

Malta

Denmark

Sweden

Netherlands

Luxembourg

EU-25 over 65 population in 2005 & 2050

Source: Eurostat 2006

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Old age dependency ratio 2000 and 2050 (population 60 and over to population 20 -59 years)

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Employment rates of workers aged 55-64, 2001, and the employment targets according EU summits for 2010

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B. Common changes in diverse contexts

• Demographic changes• Changes in the family• Normative changes• Developments in the Welfare States• Welfare Regimes

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Examples of Welfare State regimes

Esping-Anderson (1990), focussing on (de)commodification of labour, social protection

Alber & Köhler (2004), Lamura (2007b)

Health care regimes

Lamura (2007a)

Focussed on elderly care regimes

1. Social democratic

Sweden, Denmark

Scandinavian

Sweden

Public-Nordic

Denmark,Neth,Sweden

2. Conservative

Germany, Belgium

Subsidiarity

Germany

Standard Care Mix

Germany, UK, France,Italy, Austria

3. Liberal

UK

Liberal

UK

Family based

Spain,Ireland, Greece

4. Southern European (Ferrera, 1996)

Italy, Spain

Family based

Greece, Italy

Transition

Poland,Hungary

5. Central/Eastern Europe (Standing,1996)

Hungary, Poland

Transition

Poland

Baltic

Lituenia, Latvia

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C. Actual Family Care: continuity and diversity

– The Survey of Health, Ageing and Retirement in Europe (SHARE) study (2002-2005) :

• 22.000 Europeans• 50 +• 11 EU countries, plus Switzerland• 3 phases of life, pre- and post-retirement and old age

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SHARE study, 10 EU countries, first report 2005

– Proximity to nearest living child

– Frequency of contact to most contacted child

– Frequency of contact to most contacted parent

– Percentage of grandmothers who looked after their grandchildren at least weakly and percentage of mothers who are in paid employment (grandmothers aged < 65)

– Percentage of grandmothers who looked after their grandchildren at least weakly and percentage of mothers who are in paid employment, grandmothers aged < 65) Coresidence of older parents and adult children

– Proprotions of respondents living alone who receive non-family help with

– Network of people who help with personal care within the household

– Proportions of respondents living alone who receive non-family help with personal care or practical tasks

– Percentages of respondents who give help

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Proximity to nearest living child (SHARE, 2005)

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Frequency of contact to most contacted child (SHARE, 2005)

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Frequency of contact to most contacted parent (SHARE, 2005)

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Percentage of grandmothers who have looked after their grandchildren regularly or occasionally during last 12 months (SHARE 2005)

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Percentage of grandmothers who looked after their grandchildren at least weakly and percentage of mothers who are in paid employment

(SHARE 2005, grandmothers aged < 65)

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Proportions of respondents who receive help with personal care and who are severely limited (SHARE, 2005)

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Network of people who help with personal care within the household (SHARE, 2005)

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Proportions of respondents living alone who receive non-family help with personal care or practical tasks (SHARE,

2005),

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Percentages of respondents who give help (SHARE, 2005)

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D. Support Services for family carers

• The EUROFAMCARE study:– 25 countries: national inventories about family care,

legal obligations, policy in support of carers– 6 countries: survey among 1000 family carers per

country:• Greece• Italy• UK• Sweden• Poland• Germany

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Policy and differentiation public support care

• General policy:– Keeping older people as long as possible at home– Sharing responsibilities between formal and informal care– Combining working in the labour market and contributing informal care– Avoiding overburdening of family carers– Appreciating the contribution of family carers

• Actual picture– Elder care country clusters (EU map)– Over 65 year old people receiving home care (%)– Over 65 year old people in residential care (%)– Households with three or more adults (%)– Provision mix in domestic care

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1. Standard care-mix:

AU-BE-CZ-FI-DE-

FR-IT-UK

2. Public-Nordic: DK-NL-SE

3. Family based: ES-IE-GR-PT

4.4. TransitionTransition:: HU-PL-SI-SLHU-PL-SI-SL

5. Baltic: LT-LV

55

44

3333

33

22

22

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11

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Elder care country-clusters

250 5 10 15 20

Baltic

Transition

Family based

Public-nordic

Standard caremix

Over 65 year old people receiving home care (in %)

260 1 2 3 4 5

Baltic

Transition

Family based

Public-nordic

Standard caremix

Over 65 year old people in residential care (in %)

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0 10 20 30 40 50 60 70 80 90 100

Poland

Greece

Germany

UK

Italy

Sweden

formal only both family only

Provision-mix in domestic care (in %)

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Support services for family carers in EUROFAMCARE countries (6 core countries)

Type of supports Availability/diffusion:

Low/none Medium High

Day care centres Gr,It,Po Ge Sw,UK

Inform/counseling Gr Ge,It,Po Sw,UK

Self-help,support gr Gr,Ge,It,Po,UK Sw

Respite care serv Gr Gr,It,Po,UK Sw

“Granny Sitting” It Ge,Po,Sw,UK,Gr

Weekend breaks Gr,It Ge,Po,Sw,UK

Training Gr,It,Po,UK Ge,Sw

Form. assesment Gr Ge,It,Po Sw,UK

Monetary Transfers Gr,Po Sw Ge,It,UK

Integr.planning care Gr Ge,It,Po,UK Sw

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Institutional backgrounds of Welfare State outcomes in Services for the elderly: 4 dimensions

• Universal coverage versus Coverage of needy– Scandinavian UK (Beveridge)

• Tax funded versus Insurance funded– Scandinavian LTC Ins: Germ, Neth

• Public versus Private mix– State resp. Legal Fam. Resp.

comp. Fr. vs Neth

- State organ. Privately organ Fam complem. State complem

• Care provision in kind versus in care allowances e.g. Italy, foreigners

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with foreign Total nationality %

1991 181.096 35.74016,5

1995 192.942 67.69735,1

2000 256.803 136.61953,2

2001 261.390 142.19654,4

2002 224.243 147.32865,7

2003 588.701 490.67883,3

2005 700.000* 600.000* 86,0*

*: estimates

Home care workers in Italy by nationality

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Countries of origin of migrant home care workers in Italy

(thousands, 2003)

UKR: 104

RO: 81

Philippines: 47

PL: 34

Ecuador: 31

MOL: 28

Peru: 25

Alb: 18

Sri Lanka: 16Marocco: 15

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E. Sustainability of welfare services as a policy issue

The focus of EU policy on the future of the Welfare State, and more specifically on Elderly Care, is on two issues:

• promotion of participation in the labour force• developing a sustainable elderly care in a

cooperation between informal and formal services and the promotion of support systems for family carers.

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To get the paper:

• www.AOWscope.nl