Care Work in the EU: Support Measures in a Context of Demographic Change

6. Working Carers

The reality for many carers is that long-term care responsibilities arise during the course of working life.

Among carers of working age, a considerable proportion is in employment (Anderson, 2004). There are no official EU data, but figures from national studies indicate that up to half of carers under age 65 combine care with employment. However, among people of working age, both men and women carers are less likely to be in employment than non-carers and carers are more likely to work part-time. Other factors influencing the likelihood that a carer will be in employment include whether the carer lives with the dependent person, the nature of dependency and the availability of other support.

A survey carried out by the European Foundation for the Improvement of Living and Working Conditions in 1998 provides unique data. The survey involved telephone interviews with more than 30,000 people aged between 16 and 64 years across the 15 Member States and Norway. Among those in employment, 9% of men and 12% of women reported ‘care responsibilities’ for elderly relatives or other adults who need assistance due to ill-health or incapacity’. The corresponding figures were higher for people outside employment but seeking work — 13% and 16% respectively, reinforcing the point that care responsibilities act as a barrier to the labour market.

In this survey, among those providing care to adult dependents, one quarter of the women and 15% of the men felt that this care limited their employment opportunities. The proportion who expressed this view ranged from less than 10% in Sweden and Finland, to more than a third in the UK and Ireland.

Research in North America and Europe points strongly to adverse impacts of caring on career, income and pensions. A significant proportion of working carers report missed training or promotion opportunities, difficulties in finding a job if they leave employment, as well as stress-related conditions and fatigue.

Our picture of developments to support the working carers of older people is incomplete. There has been no systematic survey in the EU of initiatives in the workplace, even in larger enterprises; and there are relatively few examples of good practices, particularly in the workplace, that have been designed specifically for carers of older people.

It has been argued that corporate America has woken to the pressures that its (valued) employees face in caring for elderly relatives. To retain skilled employees and to maintain productivity, it does appear that a number of US companies are providing support. These developments are usually characterised as: policies — for work organisation and working time, particularly for different forms of flexible working hours and flexible location, such as homeworking; services — typically for information, advice and referral, but also including support to develop community services, transport for dependent relatives, and some workplace-based care provision; and benefits — such as preferential rates for long-term care insurance that covers the older person, or cash compensation for time taken off to care.

However, some initiatives have been abandoned after failing to meet carer needs because the schemes were too inflexible, or in the wrong place at the wrong time. Other initiatives have been strained by low take-up by carers, particularly of information and care services. Some workers are hesitant about the impression they will create as lacking in motivation or the capacity to cope; others are simply unaware of the available resources, while for others care is a private matter to be resolved by private solutions. This last may also be the view of other staff at work and it seems clear that the success of developments for working carers will depend upon support from line managers and colleagues.

The United States and the European Union of course present different contexts and prospects for reconciliation of working and caring. In general Europeans have more extensive support though social protection schemes and related community and care services — accepting that these are highly variable and may not be directed to the support of carers. Some of the private company initiatives from the US may be neither necessary nor appropriate in the European context and, although specific measures have been developed for carers in European workplaces, company-sponsored services are not widespread. In Europe, the focus — where there is one – has been upon working time and organisation, good communication and explicit management support, rather than the development of special eldercare initiatives.

A survey of leading organisations found that part-time working, family/emergency leave, and job-sharing were the most common approaches; flexitime and homeworking tended to be reserved for certain employee groups and there was little opportunity for temporary reduction of working time. Some specific assistance with eldercare, such as establishing a self-help forum for carers (by a local authority employer), was evident but not common. Success depends on positive attitudes from colleagues and managers; as well as clarity of information on schemes and eligibility conditions. It is also clear that the existence of supportive policy statements should not be misunderstood to represent meaningful options in practice.

Many, if not all, workplace initiatives will be developed by employers in consultation with their workers. More formal collective bargaining agreements also play an important role, especially in improving arrangements, for example for leave, that go beyond legally required minimum standards. There are considerable differences between sectors in the duration of leave allowed, in conditions for entitlement, and in the extent to which leave is paid. For carers, such leave entitlements may be helpful, but also too inflexible to meet regular and unpredictable care needs. In general, these collective agreements to provide leave or part-time work to care for an older person cover rather few carers, and the take-up appears to be low.

Public policies may serve to increase awareness and recognition of the contribution and rights of working carers even when they offer little direct support with either employment or care tasks. Among policy measures, those that enable carers to take time off, albeit unpaid, are important. Eligibility to leave for family care is generally recognised only when the older person is severely ill or for short periods. Again, take-up of these leave entitlements appears to be low and there may be concerns about how employers and colleagues will react when leave is taken.

The development of care insurance schemes in Germany, Austria and Luxembourg or of other schemes, such as dependency benefit in France, which enable older people to employ family members as carers, may influence employment decisions. Although the impact of financial benefits on the carer’s employment requires more study, the numbers who have, for this reason, left formal employment to provide care are likely to be low.

7. Support for Employment in Care Work

A range of people are working and receiving payment for care: undeclared and unregistered workers; family members receiving money derived from insurance schemes, care allowances or direct payments; and workers with some form of employment contracts.

Social care services are considered here as the paid employment of those who provide (non-medical) support to people with health problems and their carers. There is widespread concern across Europe that for the foreseeable future the demand for such social care services will continue to exceed the supply and that too few workers will be attracted to employment in social care services. Care services may be provided by public, voluntary or private sectors in a variety of locations. The concentration is upon non-medical staff providing support in the community, usually but not exclusively in the home of the dependent person. The support may range from everyday practical help such as shopping and cleaning, to more personal and sensitive assistance such as help with bathing and meeting/addressing psychological and emotional needs.

It is difficult to do justice to important diversities in the overall social care workforce; and to the different conditions in Member States affecting the structure and organisation of employment in social care. Countries have varying designations and job description for paid staff in their social care workforces, with different arrangements concerning training and qualifications and who undertakes which tasks and responsibilities. However, the social care sector makes an important social and economic impact; it contributes significantly to employment — jobs in health and social work grew more than any other sector in the EU15 between 2000-2005, creating more than 2 million new jobs, mainly occupied by women. Even so in the face of increasing demand and staff shortages both Finland and Germany have established commissions to examine options for the future supply of social care workers.

Care work in Europe is generally characterised by a number of largely negative features: relatively high rates of turnover of staff, especially in basic care work; high reported levels of stress and ‘burn out’; relatively low pay and prestige; frequently non-standard working hours; and under-developed career structures. It was recently reported in the UK (Guardian, 4/9/08) that social care workers are at the bottom of the pay ladder, earning less than people who sweep the roads or collect refuse. The social care workforce is not only underpaid but undervalued. These and other features are seen as at least discouraging new entrants and leading to premature exit from employment in care work. A better understanding of the attractions of social care (e.g. meaningful and useful work; flexible, part-time employment; reasonable rates of pay) is important for the promotion of social care work and in making proposals for improvements in the labour supply.

Social care faces a daunting task in attempting to address the labour supply issues and to develop a better image. Among the priority areas is the need to improve the work-life balance for care workers. Many care workers combine paid and unpaid family care activities. This unsatisfactory work-life balance particularly concerns independent and ‘personal assistant’ care workers who have to combine several part-time, fixed-term contracts to earn a decent wage. So one proposal for better conditions is to promote job creation measures in more stable sectors of the care labour market where there should be better work-life arrangements for staff. It is also essential to ensure that care staff with informal care responsibilities themselves have full access to services supporting informal carers and their dependents e.g. ‘out of hours’ support, respite and holiday care.

Good working conditions and opportunities to gain qualifications through training are seen as necessary for both the recruitment and retention of social care staff. In this context job satisfaction can be improved through staff having a greater say concerning their work; and not having too high a proportion of routine work. The main tasks can not perhaps be changed but the jobs can be enriched by the introduction and development of training that relates closely to the knowledge and skills of different roles and responsibilities of staff. Training and the acquisition of qualifications should recognise previous experience and related skills. Improvements in pay for social care staff would make a positive impact on recruitment and retention of staff. This is particularly so in times of relatively full employment in competing service sectors.

In all EU countries there is a substantial gender imbalance in their social care workforces. This applies not only to home and residential care staff but is also the case in professional social work. It is not unusual to find a workforce that is 100% female although men are more prominent in management posts in social care. Attracting more men into social care could improve the labour supply problem: it is less obvious how this might be done. Improving pay and career opportunities may seem to be the solution but reasons for the male deficit are more subtle. There is still an image of both informal and formal care work as ‘women’s work’, although there have been some more recent changes in this traditional view, and variations between countries. Social care needs to be portrayed and actively promoted as work that men as well as women can and do find interesting and fulfilling. This requires the use of attractive modern promotional methods as used in other fields. It should be acknowledged that some clients may prefer female care workers, particularly for personal care.

Finally, it is clear that migrant workers particularly from eastern European countries are making a major contribution to the supply of care workers. Without migrant labour there would be serious labour shortages in countries with relatively low unemployment rates. Some countries like the UK have been actively recruiting social care workers from countries such as Romania and Poland, usually within well managed formal schemes. Increasing numbers of migrant workers in Mediterranean countries such as Spain and Greece go to work as live-in carers for single, dependent elderly people. In Italy there is a low level of supply both of residential and public home care services, and a tradition of care payments rather than in-kind services. Dependent persons are entitled to receive care allowances from the state and some local authorities. In recent years, this care allowance has increasingly been used to employ foreign migrant care workers — an arrangement that suits both families and the state. In 1991, 16.% of home care workers were foreign workers. By 2005, the percentage had increased to 86% with the highest rate of employment of migrants being for the most severely dependent elderly people. The two main reasons for employment of migrant care workers were to guarantee constant care; and to keep the older person at home. Not surprisingly, the employment of migrant care workers has become a fundamental pillar of the Italian long term care system. However, safeguards are needed to help protect both migrant workers and to ensure quality for the users of the social care services.

8. Conclusion

In a European Union of 27 Member States it is hardly surprising that there are vast differences in the development of measures and services to support care work. However, all countries are addressing profound demographic challenges and everywhere family care remains — and is likely to continue to be — the cornerstone of systems to meet care needs.

There is growing awareness of care work as an issue for all ages, but this has not triggered policy debate and action in all Member States. There is, however, increasing attention to, and debate about, the sustainability of care at EU level. There are also opportunities for Member States to share experiences and innovative strategies in EU programmes. However, with their different histories, values and resources, there is no single best approach to supporting care work. Although this paper has highlighted a range of policy and practice initiatives much remains to be done to increase awareness and improve the situation of family carers, working carers and care workers in more formal employment.

As recent initiatives in Western Europe illustrate, effective support measures for care work will increasingly depend upon strengthening the links between formal and informal provision.


Alber, J. and Kohler, U. (2004): Health and Care in an Enlarged Europe, European Foundation for the Improvement of Living and Working Conditions, Dublin.

Anderson, R. (2004): “Working Carers in the European Union”, 95-113 in Harper, S. (ed) Families in Aging Societies, Oxford University Press, Oxford.

Directorate-General for Employment, Social Affairs and Equal Opportunities (2008): Discussion Paper: What Can the European Union Do to Protect Dignity in Old Age and Prevent Elder Abuse, Brussels, European Commission.

Eurobarometer (2007): Health and Long-Term Care in the European Union, Special Eurobarometer 283, European Commission, Brussels.

European Commission (2006): The Demographic Future of Europe — from Challenge to Opportunity, COM (2006) 571, Brussels.

European Commission (2008): Joint Report on Social Protection and Social Inclusion 2008, Brussels.

Eurostat (2008): “Ageing Characterises the Demographic Perspectives of the European Societies”, Statistics in Focus, 72/2008, Luxembourg.

Österle, A. and Meichenitsch, K. (2008): Long-Term Care in Central and South Eastern Europe, Vienna, ERSTE Stiftung Studies, No. 4.

Pavolini, E. and Ranci, E. (2008): “Restructuring the Welfare State: Reforms in Long-Term Care in Western European Countries”, 246-259, Journal of European Social Policy, 18(3).

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