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Setting the Scene: Long term care challenges and the role of ICT and
migrantsLong term care challenges in an ageing society: the role
of ICT and migrants Brussels, 19th of January 2010
Ricardo Rodrigues
Setting the scene for the discussion
• Challenges facing long-term care in Europe
• Could migrants be part of the answer?
• The role of ICT
• Drawing on:• “Who cares” discussion paper
• Publication “Facts and Figures on Long-term Care”
• Other relevant literature
Long-term care (LTC):a latecomer in social policy
• A “new” social risk: only recently integrated in social protection;
• At the boundaries between health and social care;
• No other area of social policy in which countries differ more (Who cares).
Health Care Systemdifferentiated, professionalised,
hierarchical, funded, rights-based Social Care Systemlocal, less professionalised, badly funded, discretional
Hospital General Practitio
ner
Nursing
Home Care
Short term Care
Home Help
OtherServices,Housing,
etc.
Residential CareDay
Care
A changing world will bring changing LTC needs
• Health situation of older people – crucial for care needs
• Alzheimer and other dementia:
1. Uncertainty about future health trends;
2. Special training in recognising and dealing with dementia;
3. Shifting care needs: less sophisticated care, need of 24h presence, care at home.
Source: Own calculations based on Alzheimer Europe (2006)
Prevalence of Dementia in Europe (2005)
Home is where you’re cared for
Institutional care confined to a
minority
Source: ECFIN (2009), European Centre 2009
Home care is key for more people accessing care
Beneficiaries of institutional and home care in EU Member States (latest available year)
A changing world will bring changing availability of care
• Demography may impact care needs (depends on health)… but will surely impact availability of care
1. Labour shortages (formal care)
• Competition with health sector (higher paid, better social status)
• Low salaries;
• Increasingly demanding jobs;
• Constraints on wages: Baumol “cost disease”;
• Reorganisation of skills and tasks;
2. Availability of informal care
Source: Eurostat
“Support ratio”: number of women aged 45-64 for each 80 year-old
Informal care:The “workhorse” of LTC
Current portrait of informal carers in Europe:
• Women
• Late 40s till early 60s
• Not employed (country diversity)
• Family members:
• Daughters;
• Spouses
Public support for informal care
• Cash for care benefits: care allowances and attendance allowances;
• Linked with a consumerist (choice) rhetoric.
Targeted by EU Employment Policies
Decreasing fertility rates:Less siblings sharing the “burden of care”Changing living arrangements
Migrant carers:a solution to gaps and shortages?
• Labour shortages in the care sector, pressure on informal care;
• Demand for care: e.g. 24h care;
• Budgetary constraints: state and household level;
• Favourable policy settings: unregulated cash benefits.
Targeting immigration of skilled labour for health and LTC
sector:
“Legal” carers” (e.g. nurses employed by health sector)
Migrant carers
Allowing /incentivising “grey markets of care”, particularly in
home care:
Undocumented carers hired by private households
Migrant carersVienna and Bratislava: tale of 2 cities
Austrian LTC context
• Unregulated LTC allowance;
• Limits on subsidised care;
• Financial constraints: real decrease of benefit value;
• Lack of social services, especially 24h assistants.
Supply-side:• Cultural and geographic proximity;
• Wage differentials: average wage of €596 (OECD) against Austrian LTC allowance between €148.30 and €1562.10;
• Labour market situation: higher unemployment rates in SK.
Demand
Supply
Grey market of care based on migrant carers
Dilemmas surroundingmigrant carers
• Financially convenient: key to the sustainability of systems (policy-makers); source of income (migrants); value for money (patients);
• Tailored to needs, hard to get in the care market (e.g. 24h care);
• “Ageing in place” as an alternative to institutional care;
But on the other hand…
• Ethical issues: exploitation, lack of social protection; two-tier labour market through imperfect formalisation (Austrian Home Assistance Act);
• Beggar-thy-neighbour policies? Care gaps in sending countries and “brain drain” (qualified migration);
• Integration with formal care;
• Quality of care both for carer and person in need of care;
• Integration of migrants in receiving societies.
The (potential) role of ICT in LTC
• The ICT in real world economy:
• Efficiency/productivity gains;
• Wide use found on service sector.
• The (potential for) ICT in LTC:
• Improved coordination between health and social care (e.g. information sharing through electronic health records);
• Patient focus;
• Enhance independent living;
• Improve quality of care: embedded in care practices, quality management, increased transparency;
• Training and empowerment of carers (e.g. improving the social integration of migrant carers).
Why has ICT use in LTCfallen short of its potential?
• The real use of ICT in LTC:
• Information for carers and patients…
• Limited services (e.g. telecare, alarm services)…
• Pilot programmes or initiatives (e.g. transparency in quality)…
• Overall limited role.
• Organisational constraints – are innovations spreading in the care sector?
• ICT literacy of users, both carers and those in need of care;
• Cost barriers and lack of evidence-based results;
• Ethical concerns.
Why?
Some conclusionsfor further debate
On migrant carers:
1. Migrant carers are key to the fiscal sustainability of many LTC systems, even if based on unsustainable arrangements.
2. Undocumented carers follow opportunities, but are also a conscious if not always recognised policy option.
3. Not a “silver bullet”, but it’s unwise to ignore their potential or otherwise take half-hearted measures to integrate them.
On ICT use in long-term care:
1. ICT use and impact falls short of its potential in LTC systems.
2. Little evidence-based knowledge of its impact is available.
3. Which strategies are best suited to enhance ICT use in LTC?