Family Care in Europe

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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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EU-25 over 65 population in 2005 2050
Source Eurostat 2006
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(No Transcript)
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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 lt 65)
• Percentage of grandmothers who looked after their
  grandchildren at least weakly and percentage of
  mothers who are in paid employment, grandmothers
  aged lt 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 lt 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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Elder care country-clusters

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. Transition HU-PL-SI-SL
5. Baltic LT-LV

1
2
5
3
1
2
4
1
3
3
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Over 65 year old people receiving home care (in )
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Over 65 year old people in residential care (in
)
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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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Home care workers in Italy by nationality
with foreign Total
nationality 1991 181.096
35.740 16,5 1995 192.942
67.697 35,1 2000 256.803 136.619 53,2 2001
261.390 142.196 54,4 2002 224.243
147.328 65,7 2003 588.701
490.678 83,3 2005 700.000
600.000 86,0 estimates
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Countries of origin of migrant home care workers
in Italy (thousands, 2003)
Ecuador 31
Peru 25
PL 34
UKR 104
MOL 28
RO 81
Alb 18
Philippines 47
Sri Lanka 16
Marocco 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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• www.AOWscope.nl