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Webinar report - Long-term Care & the European Pillar of Social Rights

elderly people illustration 300x300Photo credits

EU Events series of webinar reports on the European Pillar of Social Rights continues (See PREVIOUS ARTICLE)

See ITALIAN VERSION

This webinar by Eurodiaconia, the European network of churches and Christian NGOs providing social and healthcare services and advocating social justice, was organised with AGE Platform Europe, a network of non-profit organizations promoting and representing the interests of older people.

Alexander Elu from Eurodiaconia introduces long term care as a key area of work for the European Union, as aging and dependency represent a strategic challenge for Europe today and in the coming decades. Long term care has very important intersections with other dimensions of social protection, some of which are also part of the European pillar of social rights.

The European Pillar of Social Rights is the European commission’s initiative to strengthen the social rights of people legally residing in EU territory. It was proclaimed on November 17th, 2017 in Göteborg at the first EU summit about social issues in more than 20 years. Since there is a lack of legal basis in the EU treaties for adopting binding legislation in areas such as social protection and social dialogue, the pillar as such is not directly enforceable and requires dedicated measures and legislation to be taken at the appropriate level in order to be effectively implemented on the member states’ reality. The principles defined in the pillar should be interpreted as a baseline from which member states are invited to build on.

The rights that are enshrined in the pillar already exist in national and EU legislation, for instance in the Charter of Fundamental Rights of the EU or in the European Social Charter. The Pillar is however necessary as these rights may exist on paper but are not being made effective in all contexts and circumstances, especially because of inadequate funding or the changing nature of employment.

It contains 20 principles divided in 3 chapters:

  1. Equal opportunities and access to labor market: 1. Education, training and life-long learning; 2. Gender equality; 3. Equal opportunities; 4. Active support to employment;
  2. Fair working conditions: 6. Wages; 7. Information about employment conditions and protection in case of dismissals; 8. Social dialogue and involvement of workers; 9. Work-life balance; 10. Healthy, safe and well-adapted work environment and data protection;
  3. Social protection and inclusion: 11. Childcare and support to children; 12. Social protection; 13. Unemployment benefits; 14. Minimum income; 15. Old age income and pensions; 16.Health care; 17.Inclusion of people with disabilities; 18.Long-term care 19.Housing and assistance for the homeless; 20.Access to essential services.

The third chapter contains Principle 18: Long-Term Care, which is of interest for Eurodiaconia and AGE Platform Europe. ‘Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services’: the sentence contains a strong message on quality and affordability, but there are some missing aspects. Mr Elu appreciates the reference to community-based services, which would implicitly include the idea that services should go where users are. He however also expresses doubts about the lack of an explicit mention to integration between health and social services as a way forward for the delivery of long-term care. The goals enshrined in the pillar have to be reconciled with the sustainability of long-term care, which is crucial in light of the increasing share of older people in Europe. As there’s no prescription in the pillar document on that, Mr Elu predicts that when quality and affordability goals are pitted against sustainability considerations, it’s usually the latter that prevails.

The European Pillar of Social Rights - Approach of AGE Platform Europe

AGE Platform Europe is a European network of about 120 organizations of and for people aged 50+ that aims to voice and promote the interests of 40 million senior citizens in the European Union. Their goals are:

  • Bringing older people's point of view in the European policies' debates
  • Raising awareness on the users' needs and wishes to add value to the European research, to industrial production, to the service provision and policy-making.
  • Creating synergies and pooling with other NGOs and stakeholders

Philippe Seidel explains that the EPSR has been pursued between 2011 and 2015 through the European Semester, the annual cycle of macro-economic, budgetary and structural policy coordination aimed at monitoring progress towards the Europe2020 goals and ensuring the active involvement of EU countries.

If the Europe 2020 strategy contains some social goals, such as the reduction of poverty and the increase of the employment rate, they still don’t have enforcement mechanisms and remain soft goals. Then, the economic crisis came by and led to the introduction or the reinforcement of austerity and the search for ways to cut in public budgets. As Mr Elu mentioned, economic concerns always came before the social considerations. Mr Seidel highlights the economic senselessness of this: in terms of social investments, what is not spent today will be spent twice or three times in the future, especially in long-term care. Age Platform also always tries to highlight that there is a legal

basis for social policy in Article 9 of the Treaty on the Functioning of the EU: ‘In defining and implementing its policies and actions, the Union shall take into account requirements linked to the promotion of a high level of employment, the guarantee of adequate social protection, the fight against social exclusion, and a high level of education, training and protection of human health’.

The “EU Semester Alliance” group was formed (that also includes Eurodiaconia) and got additional funding in 2013-2014 to train national members to form national alliances for the semester to be more effective and more vocal about the social impact of austerity. 2014 saw one first attempt: the EU set up a “Social Scoreboard” mapping the indicators of the Europe2020 social targets. The Alliance also helped in making the language of rights in the EPSR more explicit from the first to the second draft. Some examples:

  • • Principle 3 – Equal opportunities: initially framed only on the idea of access to the labor market, they managed to have the text rewritten to expand the concept;
  • • Principle 4 – Active support to employment: they managed to have a reference to ageism in the labor market, meaning that older people are often denied active support to employment and are rather put on a track to early retirement.

However, the Council of the EU then added a preamble that specifies that these rights are only principles and only apply where they are explicitly referenced to in EU legislation. This is due to a precedent: the EU Charter of Fundamental Rights, which was also proclaimed inter-institutionally and was never part of the Treaties. The legal value of the Charter was not clear, but the European Court of Justice intended this text as a will of the legislator in the EU: the ECJ used the Charter to interpret with a more rights-based approach certain principles that were not so detailed in European directives.

Towards a right to long-term care

By Borja Arrue (AGE Platform) - project policy officer responsible for long-term care and elder abuse

Borja Arrue defines more in detail what long-term care should ideally be for AGE members. Their meaning goes beyond medical aspects and encompasses health and social care. It should include the notion of support to integration in the community aimed at remaining independent and autonomous as much as possible. All the services of long-term care should also be integrated and coordinated among themselves and be person-centered (the services adapt to the person, not the opposite). It should also be community-based: the connection with the person to the community should always be guaranteed. Its access should be universal and considered as a person’s right.

Arrue, however, explains how long-term care has only quite recently integrated social welfare and equality with other social rights. We come from a very paternalistic approach: traditionally, there has been a clear neglect of the preferences and wishes of those that were needing long term care, so that those accessing it have often seen their autonomy and their independence at stake. The paternalistic/ageist approach typically includes a denial of preferences and wishes for the elderly such as managing their own finances, decisions on eating habits, on people to meet etc… It also encompasses abusive practices, isolation and exclusion and a lack of integration of services to deliver care. Informal carers often end up overburdened with people in need and duties.

Since the ageist prejudice is prevalent in society, AGE has got involved in discussions about older people in international projects, including with the United Nations. Arrue focuses the United Nations open-ended Working Group on Ageing, a group of UN member countries that was set up in 2010 at the initiative of Argentina. Its mission is to assess what is the state of the enjoyment of human rights of old people across the world and whether a new international instrument can be useful in terms of affirming the dignity of old people and responding to ageism. An international instrument is needed not because a new convention can solve all problems, but because it sets an intellectual framework that boosts people’s sense of being full citizens that should be able to enjoy their rights as anyone else. This year this group discussed long-term and palliative care, autonomy and independence. They met in New York and they identified gaps in protection of human rights for old people in long-term care services. They explored how a new instrument could help in shifting away from paternalistic care.

The European Pillar of Social Rights can also contribute in this shift through principle 18, which says that “Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services”. The pillar can therefore address:

1) The challenge of access: today in Europe services are not enough for the demand and this will be an increasing challenge as populations are aging

2) The challenge of quality: respecting the dignity of those in service as well

3) The challenge of funding

The Pillar can contribute to a representation of users as rights-holders and could change the way society looks at people needing any of the services and entitlements and rights recognized in the pillar. It could also rebalance financial and social concerns: long-term care during the crisis has been one of the scapegoats and one of the variables of adjustment of public spending, leading to an increasing burden on relatives of the elderly. The Pillar could affirm long-term care as an irreversible entitlement, regardless of public spending needs, and affirm it as an integral element of welfare systems. Finally, it should push for upward convergence between member states, in terms of access and quality. Some countries or municipalities are performing well and the pillar will attract interest and exchange of good practices.

At the European level, new EU legislation in the social field is very unlikely. What seems to prevail is an approach according to which the EU should play a greater role in sharing good practices, in orientating services, in supporting states. The Pillar has the potential of a “soft” instrument to push states to adopt further action in terms of improving quality and access.

Arrue introduces ideas of a potential European union recommendation, a non-binding text that the EU can adopt to set up priorities, objectives and guidance for states to advance in a given domain. Such recommendations for example exist in the domain of early childhood education and care for children, which has had a great impact in the development of child care across Europe. Regions across Europe in some cases introduced the content of the EU recommendation into their own reforms of child care at the regional level. For long-term care, we don’t have a coherent and comprehensive tool, so one of the actions in the medium term for the implementation of the pillar could be the development of such an EU recommendation. Countries could therefore opt for formal care service and develop accordingly social protection for care needs. This would need to be linked to setting a new tone regarding care in financial terms, because it is currently perceived by the EU commission as a spending burden. For example, the aging report that the EU commission publishes every year is in clear contradiction with European pillar of social rights: aging is looked at as a cost to be contained, instead of a new challenge on the table that need to be addressed in terms of introducing social rights. The recommendation could also include shared access and quality targets, that could define quality principles for services in line with human rights principles. Moreover, it could provide guidance on the use of structural funds and the new InvestEU funds. It could announce further regulatory actions, if not in terms of legislation for social rights, at least in terms of regulating for example the for-profit sector in care that can sometimes deliver uncontrolled low quality services.

Another aspect that should be considered is the introduction of European targets. One example could be the Barcelona targets for childcare set up by the European Council in 2002, which suggested that 90% of children between 3 and 6 years should be in formal childcare and that has pushed the countries to work in that direction. For long-term care, according to AGE Platform, we should have something similar, but the kind of services that old people are accessing are different: health care, social care… This effort should also be met with the introduction of European wide quality indicators, although this adds the risk of new reporting burden for member states.

Riccardo Cucconi, Winner of the Master’s Degree Prize “Europe that will be” given by the Emilia-Romagna Regional Council

Europe Direct Emilia Romagna