1 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, November, 2007

2 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

3 A. Historical diversity in common background Originally: Family Care for elderly and armshouses 19 e century formal family responsibility based in Civil Codes (Napoleontic and Austrian) 19 e 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

4 B. Common changes in diverse contexts Demographic changes Changes in the family Normative changes Developments in the Welfare States Welfare Regimes

5 EU-25 over 65 population in 2005 & 2050 Source: Eurostat 2006

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7 Old age dependency ratio 2000 and 2050 (population 60 and over to population years)

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

9 B. Common changes in diverse contexts Demographic changes Changes in the family Normative changes Developments in the Welfare States Welfare Regimes

10 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

11 C. Actual Family Care: continuity and diversity –The Survey of Health, Ageing and Retirement in Europe ( SHARE) study ( ) : Europeans EU countries, plus Switzerland 3 phases of life, pre- and post-retirement and old age

12 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

13 Proximity to nearest living child (SHARE, 2005)

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

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

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

17 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)

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

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

20 Proportions of respondents living alone who receive non- family help with personal care or practical tasks (SHARE, 2005),

21 Percentages of respondents who give help (SHARE, 2005)

22 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

23 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

24 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 Elder care country-clusters

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

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

27 Provision-mix in domestic care (in %)

28 Support services for family carers in EUROFAMCARE countries (6 core countries) Type of supportsAvailability/diffusion: Low/none Medium High Day care centresGr,It,Po Ge Sw,UK Inform/counselingGr Ge,It,Po Sw,UK Self-help,support gr Gr,Ge,It,Po,UK Sw Respite care servGr Gr,It,Po,UK Sw “Granny Sitting”It Ge,Po,Sw,UK,Gr Weekend breaksGr,It Ge,Po,Sw,UK Training Gr,It,Po,UK Ge,Sw Form. assesmentGr Ge,It,Po Sw,UK Monetary TransfersGr,Po Sw Ge,It,UK Integr.planning careGr Ge,It,Po,UK Sw

29 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

30 with foreign Total nationality % , , , , , , * * 86,0* *: estimates Home care workers in Italy by nationality

31 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: 16 Marocco: 15

32 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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