A human rights approach to long-term and social care: crucial in - - PDF document

Frits Tjadens, HASCA, Presentation during Social Platform Conference We care, how can EU care? December 9, 2011.

A human rights approach to long-term and social care: crucial in times of financial turmoil.

Some remarks alongside the Social Platform’s 2011 document on care

Frits Tjadens, Health and Social Care Associates, the Netherlandsi First of all, let me thank you for inviting me. Second, thank you for efforts and outcomes related to the Social Platform document Recommendations on care, which is both extremely relevant and

• comprehensive. As a person who keeps getting involved in issues about family carers and long-term

and social care, I am especially happy that the document fully includes family carers and their human

• rights. When we discuss social care or long-term care and basic rights we often tend to focus on

clients’ rights and tend to forget family carers’ situations and rights. In that perspective I would like to stress that carers not only need support, in the shape of information and training, to be better able to care for the caree, but also need to have their own (social protection) rights protected and ensured. The document further mentions care workers, who will be the main ‘bearer’ of the message and who have to be empowered to do so within the context of their organizations, but who also need to have their own rights protected and secured. For the risk exists that they caught between conflicting demands of management and caree. I was asked to provide some comments on the first part of the recommendations. I will do so by making some observations. The document by the Social Platform comes in a time of extreme and ongoing crisis and the required results may be easily get squeezed between the forces of financial markets. This can be seen as ‘wrong document, wrong time’. My view, however, is that the document is, especially now, incredibly

• relevant. For guaranteeing fundamental human rights in care often is a continuous challenge in times
• f prosperity and will be much more so in case of lacking funding.

However in a time when serious cutbacks challenge the very fabric of social protection and social care in many Member States, efforts to guarantee fundamental human rights and to enhance the full implementation thereof in social care are not only more difficult but even more important as tendencies may well exist to ‘cut corners’ in all layers of societies that influence and impact on social services. Governments may, for instance, tend to – further - outsource services that were once within the public sphere. Without adequate regulation private service provision may easily lead to non- adherence to human rights as examples in the United States show. Therefore perhaps a relevant addition to the document were to be to stimulate the Commission to endorse Member State

Frits Tjadens, HASCA, Presentation during Social Platform Conference We care, how can EU care? December 9, 2011.

activities that regulate private social care provision, including clear enforcement thereof and to include providers that work on the completely privately paid service markets, in order to guarantee adherence to basic human rights. Moreover, care provider management is often not educated or trained to – on a professional level - deal with issues such as client-, family carer or worker rights and voice. Thus, while the latter can be stimulated and may require empowerment policies, it is also required to develop – preferably on an EU-level where mutual learning and exchange can be endorsed – programs that support social care managers to not only stimulate, endorse and practice a human rights based approach in their management style, but also to teach by example. Examples of such programs exist in England and are

• rganized by their umbrella organization. Such programs, which could include the whole of the
• rganization in a business re-design from the bottom up, are even more urgently required now that

many social care managers feel pressed to re-target their services as a consequence of cutbacks. Thus, while many may feel urged to first answer the call of lack of money, a continuous quest for quality and human rights is required that, indeed, could even lead to new inspiration in the sector. EU-funding, for instance from the available types of Research and Innovation funding, including specific DG EMPL programs such as PROGRESS, could provide good support here. Ideally such a program would include management, worker and client representatives, closely working together towards joint goals and perspectives. However, developing and implementing an integral human rights based approach to care may well require a fundamental cultural change in the way thinking about care develops and subsequently how care is provided to whom, under what circumstances and what care actually implies. As a consequence, such a change may well require a longer lasting, if not enduring, approach, stretching out over a number of years and with focus on not only development, dissemination and first-stage implementation, but perhaps even more important, focus on second and even third stage implementation. This is, however, often not how funding programs work. A second remark relates to the consequences of the financial crisis. It is generally thought that it will cause the fabric of solidarity to crack. To some extent this is correct as services will be re-targeted and solidarity may become redefined in terms of ‘who’s in’ and ‘who’s out’. In as far we think about solidarity as cash-transfers by means of taxes or risk-pooling, the risk is there that this hard solidarity will suffer from already mentioned cutbacks. Indeed, social protection is among the first issues targeted (OECD, 2011). The implicit assumption in these cutbacks, though, is often that societies will find other means to fill the voids. Thus other forms of, what I would like to call ‘soft solidarity’ will need to be (re-)developed and supported. Social care providers can play a role here, but will have to find the inspiration and know-how to do so. Guidance and support may be welcome, also in terms of supportive programs. It is furthermore generally thought that care at home is better geared to deliver required support and care with often better dignity for the caree, certainly better able to prevent hospitalization tendencies and sometimes ‘learned helplessness’. Moreover care at home is often considered to be better able to deliver value for money and cheaper on a macro basis than institutional provisions. With the aid of modern tools there are also more possibilities to provide more care at home. One should realize, though, that by implication, two of the reasons why care at home may be considered both cheaper and better are:

Frits Tjadens, HASCA, Presentation during Social Platform Conference We care, how can EU care? December 9, 2011.

1 Much of the burden of care will be on a family carer. One should realize that in many cases

• verburdening of family carers is a key prior to institutionalization. Thus alleviating burdens

and enabling and empowering family carers when ‘pushing for home’ is crucial. 2 In many countries workers providing care at home are paid and qualified less than those caring in an institutional setting (Colombo et al., 2011). Moreover, in some countries care at home implies that (illegal) migrant care workers are among the key care providers. Thus, substitution to the home situation is not without risks, amongst which increased risks for quality of care. For the intensity of required care in the home situation is likely to increase, caused by ageing of societies and the subsequent increasing multi-morbidity, more advanced technology, and the expected increasing care gap (Tjadens & Colombo, 2011) even without deliberate pushes from institutional settings to the home situation. This will impact on both family carers and other care workers. For care workers providing services at home, these trends may require further and more (continued) education, qualifications and general quality. This consequence may well lead to care services becoming more expensive and could, in that case, lead to additional challenges in already poorly served areas and countries, but may also well impact on the currently better equipped countries. Moreover, the push home is ceteris paribus - likely to especially affect family carers’ situation, rights and options, more than those of any other stakeholder. But while societies tend to increase their attention for family carers if only because they seem a cheap provision of care, actual knowledge about what works to support family carers still is scarce (Eager et al., 2007; Glendinning et al., 2009). Thus quality of life of both family carer and caree can become endangered by unseen but

• verburdened – and therefore even abused or abusive – family carers.

Finally, similar risks may be carried by migrant care workers, often in a 24/7 care situation with limited escape. Their human rights may be easily violated, as there clearly is a demand for their cheap services and they are willing to provide them. But they may be ill-equipped in terms of language, culture and qualifications to deal with intense care situations and may end up working where they are not professionally capable to deal with the requirements of the situation. With these observations I would like to conclude. Thank you for your attention. References: Colombo, F., Llena Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted? Providing and financing long-term care. Paris: OECD. Eager, K. e. (2007). Effective Caring: a synthesis of the international evidence on carer needs and

• interventions. Volume 1: the report. University of Wollongong: Centre for Health Service

Development. Glendinning, C., Tjadens, F., Arksey, H., Morée, M., Moran, N., & Nies, a. H. (2009). Care Provision within Families and its Socio-Economic Impact on Care Providers. Report for the European

Frits Tjadens, HASCA, Presentation during Social Platform Conference We care, how can EU care? December 9, 2011.

Commission DG EMPL Negotiated Procedure VT/2007/114. Working paper EU 2342. York / Utrecht: University of York, Social Policy Research Unit / Vilans.

• OECD. (2011). Restoring public finances. Paris: OECD.

Tjadens, F., & Colombo, F. (2011). Long-term care: Valuing care workers. Eurohealth , 7 (2-3.), 13-17.

i Frits Tjadens career started, in 1987, with one of the first quantitative research projects in the Netherlands on

family care, and which then led him through the wider areas of health and care research. In 1998 he co-edited an international comparative study on support for family carers and in 2000 he co-authored a book for the general (Dutch) audience on caring for a loved one suffering from dementia. After becoming internationally active, he was project leader for several EU-twinnings on the area of free movement of health professionals and was - as Dutch correspondent – involved in the first SSGI-report. In 2009 he was asked to join the OECD for what was to become its 2001 Help wanted? Report on long-term care. Afterwards, he re-joined HASCA, a research and consultancy firm on (international) aspects of health, care and

• welfare. He can be contacted through f.tjadens@hasca.eu