Policy Brief - Precarious versus protected care work in the European Union: finding the right balance

Drawing on research conducted during the project, this policy brief addresses care work for elderly people in European Union countries in the context ofthe right to free movement of labour. Despite a range of guidelines and directives in the past decades, the European Union still faces the intersectional problem of an ageing population, gender inequality, and lack of rights for
caregivers, the latter being mainly women and – in some countries – increasingly migrant women. The risks of older European citizens in need of care to be excluded from the right to care as well as the risk of female caregivers, in particular migrants, to work in unprotected and precarious jobs have increased in recent years, and the European Union seems so far not to be able to address these risks. The right to free movement of labour has been recognised by European member states as essential for integrating the European market and was established as one of the fundamental principles of the European Union. In fact, the preamble to the Amsterdam Treaty was “[c]onfirming [member states’] attachment tofundamental social rights as defined in the European Social Charter signed at Turin on 18 October 1961 and in the 1989 Community Charter of the Fundamental Social Rights of Workers.”  In relation to this, “[o]ne of the most important conditions for achieving the free movement was considered to be the co-coordination of the national social security systems of the Member States.”

This policy brief is based on the assumption of the right to give and receive
care,  which appeared to be an accepted solution by many member states during the 1990s for dealing with a) an ageing population and b) unpaid female care work, though in different shapes and degrees. This extension of citizenship rights, from the definition postulated by T.H. Marshall as the right to work, income, housing, education, and health5, to the right to care got shape
during that decade by the implementation of cash-for-care schemes in many European Union member states. These schemes exemplified the understanding of care-giving as a paid-for-time-spent activity contributing to the general wellbeing as well as to the right to receive care of citizens in need. However, various national interpretations of the right to give and receive care, made possible
by the rather weak European Union guidelines and the prioritisation of the principle of subsidiarity over the principle of gender equality, have resulted in harmful side effects for care receivers and care givers. An example is the Italian way of non-regulated cash-for-care schemes that set no standards on work conditions, payments etc., and which are mainly used to substitute female kin by unprotected migrant care workers. Another example is provided by the cutbacks in public care provisions in the Netherlands and Sweden in reaction to the economic and financial crisis, and to European Union budget rules.

In practice, effects are negative for all actors involved in care work because processes of austerity, privatisation, and localisation go hand-in-hand with severe budget cuts in the field of care. Reduced care budgets foster the employment of cheap unskilled care workers, some of them migrants, lead to reduced working weeks of female kin and/or the re-introduction of unpaid care
work. Two examples might illustrate this tendency. In the Netherlands, various new measures are currently being fleshed out in consultation with municipalities, health insurers, health providers, and other stakeholders. The government reduces large parts of Long-Term Care, such as personal assistance and care, from the Exceptional Medical Expenses Act, while adding a reduced budget to the municipalities (gemeente fonds). In addition, activities of a curative nature, such as long-term mental health care and home care by district nurses, are transferred from the public security fund Exceptional Medical Expenses Act to the collective Health Insurance Act. The number of people receiving intramural long-term care is further reduced by treating more new patients in the intensity home care packages. This leaves uncovered a clearly defined core Exceptional Medical Expenses Act scheme for the elderly and the handicapped, who requireintensive intramural care, amounting to roughly a third of the previous Exceptional Medical Expenses Act clients. Finally, the budget for municipalities to finance household help is reduced and payments by patients are increased. In Sweden and also in Denmark, care budgets have decreased and assessment follows stricter criteria, leaving an increasing number of elderly people to the care of their mainly female family members.