Time, cash and services: Reforms for a future sustainable long-term care

The elder care sector is at the core of a radical restructuring process as all the European countries strive to cope with demographic and social change. While current and prospective rapid population ageing is expected greatly to increase the demand for elder care services, financial constraints, social change and rising female employment all act as obstacles to the provision of an adequate supply of care labour.In their search for a financially sustainable response to these challenges the EU countries have brought in various reforms designed to mobilise resources and achieve more cost-efficient results. The paper presents an analysis of the main objectives of care reforms – making care affordable, favouring the creation of a care market, and making work pay – as well as their possible trade-offs. In fact, entailing as it does a larger role for the family, greater reliance on home care may clash with the goal of a higher female activity rate; good jobs and decent working conditions in the care sector may run counter to the principle of care affordability for the greatest possible numbers, while subsidising demand may conflict with public finance sustainability. These interactions, and the interdependence between the care market and the rest of the economy, are crucial factors that will need to be considered in order to ensure consistency between goals and policies.

► Demographic and social change and financial constraints call for a radical restructuring of the elder care sector.
► Care reforms need to take account of trade-offs.
► Greater reliance on home care may clash with the goal of a higher female activity rate.
► Good jobs and decent working conditions in the care sector may conflict with care affordability.
► Subsidising demand may conflict with public finance sustainability.
► Consistency between goals and policies should consider interdependence between the care market and the rest of the economy.