Author: Valentina Caimi, Senior Policy Expert (AEIDL)
In September, the European Commission launched the long-awaited European care strategy. It brings forward the EU vision for care as a cornerstone of our societies. Care is indeed everyone’s business. Everyone throughout life is a recipient of care, not only during childhood and in older age, but also when confronted with sickness, accidents, disability or other types of impairment. Everyone is also a care giver at some point in life, being a parent, a sibling, a son or a daughter, a relative, a neighbour, a volunteer or a care professional. If care is such a fundamental matter in our lives, do all people receive the type of care they need, when and where they need it? This is unfortunately a rhetorical question, and this is why the European Commission set out a comprehensive strategy to ensure better access to care for those who need it in the EU.
The strategy sets a framework for policy reforms to guide Member States to transform their care systems to make them more accessible, affordable and sustainable, as well as to improve the quality of care and the working conditions in the sector. The strategy is accompanied by two Recommendations for Member States: on the revision of the Barcelona targets on early childhood education and care, and on access to affordable high-quality long-term care.
This article points out the specific contribution of the social economy and of civil society organisations (hereinafter, social economy actors, for brevity) to the provision of social care in the EU, on the basis of innovative locals experiences and AEIDL’s expertise.
1. Social economy actors improve working conditions and quality service delivery in the care sector
The Communication from the Commission on the European care strategy acknowledges that social economy actors, thanks to the participatory governance model which characterise them, contribute to improving working conditions in the care sector. A 2019 Eurofound study on job quality in cooperatives and social enterprises found that cooperative workers highly value a good social environment, voice and representation in the workplace, work-life balance and task discretion in their jobs, also in comparison to other similar organisations. While a disproportionate number of workers work part-time, often involuntarily, cooperatives prefer to offer full-time, permanent jobs. Furthermore, care and in particular childcare, is one of the sectors in which undeclared work is most common. On the contrary, cooperatives offer legal employment opportunities to care workers, lifting them out of undeclared work and thus offering them a formal source of income, eliminating precarity and guaranteeing labour rights.
A recent study from the European confederation of industrial and service cooperatives (CECOP) provides information about other employment dimensions, such as the involvement of workers in the democratic governance of the cooperatives of which they are members and improved work-life balance, namely for female care workers, who are overrepresented in the sector and often take on more caring responsibilities in their private and family lives. To give some data, in Italy, social cooperatives’ annual assemblies have a members’ participation rate of between 75% and 80%; the presence of worker-members among the board members ranges between 85% to 90%.
|The participatory governance in the Suara cooperative, Spain|
The Spanish cooperative Suara has a sophisticated participation system which allows members to have a say over their daily work, the general affairs of the cooperative (budget, labour conditions, internal rules etc.), the strategic development of the enterprise, and to build a community within the enterprise. Participation takes place via multiple channels, including online. Cooperative’s members and workers have established Associacio Suport Ara – an association which helps them with accommodation, health and education issues in times of hardship, as well as in cases of accidents or death. The cooperative itself is actively using teleworking, because it allows the saving of time and expense on the commute, and has in place a policy of digital disconnection. As the cooperative is emerging from the Covid-19 pandemic, it offers its workers such benefits as psychological help, free coaching and physiotherapy sessions, training programmes which focus on emotions management, and more. In 2020, Suara was awarded by the Catalonian Cooperative Confederation in the category “commitment to the people”.
Furthermore, a survey carried out in 2018 by the French General Confederation of Producers’ Cooperatives shows that the cooperative model is more favourable to workers’ quality of life and well-being than other, more traditional enterprises. The Commission’s Communication also highlights that social economy actors bring an added value to the provision of high-quality care services due to their person-centred approach and the reinvestment of profits into the enterprise’s mission and in local communities.
In addition, it reminds the potential of socially responsible public procurement (SRPP) in boosting social economy contribution to high-quality standards and in promoting fair working conditions in care. AEIDL, together with ICLEI, collected several case study examples of SRPP, including in the care sector.
|Procurement procedure on co-design of child protection services, Municipality of Brescia, Italy |
A very innovative example is the public procurement procedure that the Municipality of Brescia in Italy launched to select the economic operators with whom to co-design improvements in its existing child protection services. This case testifies that public procurement procedures can also be used to promote co-design of services. Two consortia made of three social cooperatives each participated by submitting a tender. From the words of its manager, Massimo Molgora, “Using public procurement to co-design a service for children and their families with relevant partners led to an improved strategic and operational planning of services. It also contributes to the implementation of a preventive approach in the child protection system to avoid situations of hardship, abuse or disorders that might affect children”.
2. Social economy actors providing care foster the link with local communities and territories
Attention should be drawn to another very important dimension that care providers from the social economy embed: the link with the community and territories. Various studies conducted on the impact of COVID-19 have highlighted the limits of health and care systems based on the centrality of hospitals and residential care and have suggested the need to rethink and reorganise health and care provision on a territorial level by putting local communities at the centre. It is important to overcome the idea that health and care are provided only in care centres, clinics, and hospitals. A recommendation is to focus instead on community-based integrated health and care systems, with emphasis on prevention, and which reflect the social, demographic and economic features of the different territories.
|Habitat Micro-areas project, Italy: connecting health and care provision for fragile people with community development to promote solidarity and mutual help.|
The Habitat Micro-areas Project was created to strengthen social cohesion in territorial areas that have traditionally lacked it. It was jointly promoted by the Trieste Health Authority, the Municipalities of Trieste and Muggia, and the Public Housing Authority in collaboration with numerous third sector organisations. This was an interesting experiment that, on the one hand, offered citizens to enjoy common goods in the places where they live and, on the other hand, allowed for the development of a cartography of health needs, both by collecting information in the field and by examining statistical data. The project made it possible to develop a method of intervention that is at once local, plural and global. The voluntary, social promotion, and citizen associations involved play a dual role: on the one hand, they offer support to services in helping fragile people, and on the other, they foster the spread of a culture of solidarity, participation, and active citizenship.
Source: Habitat Microaree – Comune di Trieste
Social economy actors, and cooperatives in particular, fill in the gaps in service provision, and are sometimes the only provider offering care in a given territory and/or towards segments of the population where the public sector struggles and prospects of profit making are low, and therefore not attractive for profit providers. Social economy care providers often collaborate with care recipients, their family members, other service providers, civil society organisations and public authorities, making sure that their services take into account various stakeholders’ needs.
|Education and support to people with intellectual disabilities :CERCIs, Portugal A great example is provided by the Portuguese CERCIs, a movement of cooperatives for the education and rehabilitation of people with intellectual disabilities, initiated in the mid-1970s by groups of parents of children with disabilities and professionals, with the support of local authorities. CERCIs responded to the lack of education, training and work inclusion strategies for people with mental disabilities, both by public and traditional civil society organisations. CERCIs now counts 56 cooperatives providing support to 25 000 persons with disabilities across the country. |
Source: CECOP (2022), Cooperatives care! Advantages of the cooperative model for meeting multiple care-related needs and challenges in the EU, p. 14
In particular, cooperatives, due to their multi-stakeholder nature, guarantee the effectiveness of service delivery and its accessibility. A specific feature of cooperatives is that they actively involve the local community in decision-making. Often the membership of cooperatives providing care includes, alongside workers, care users, their families, volunteers, investors, NGOs, companies or public authorities.
|Flexible and affordable childcare. Filonido, Italy |
Filonido is a nursery centre that was established by the Municipality of Bologna, Emilia Romagna region, and three local companies to give a response to the demand for flexible and affordable childcare close to their workplaces. The municipality provided the land and the region invested two million euro in the project, while the companies pay part of the fees for the children of their employees. The project has been managed by a consortium of cooperatives, Karabak, formed by five cooperatives: two of them are social cooperatives, one offers catering, one is a construction cooperative, and one provides maintenance. Notably, other families living in that area can also send their children to the nursery, paying same fee as for municipal services.
Source: CECOP, ibid, p. 17
3. Social economy actors are often the only care provider in remote and rural areas
As highlighted in the Commission’s Communication on long-term vision for EU rural areas, almost 30% of the EU population lives in rural areas, spread in over 80% of its territory, considering all communes and municipalities of Europe with low population size or density. The population in rural areas is already older, on average, than the population in towns and suburbs and cities.
The big differences in employment and income across the EU encourage people to move to find better job opportunities and escape unemployment and /or poverty. Movements have been predominantly from the EU-13 to the EU-15 and within the EU-13 from rural areas to capitals and other large cities. In several regions, this has led to rapid changes in population, which has put pressure on public infrastructure and services either to up or downscale them.
People living in rural areas and small towns face difficulties in accessing essential services, such as schools and universities, healthcare, transports, banks, cultural centres, and recreational facilities. This leads to worsening of quality of life, increased unemployment, poverty, social exclusion and isolation. Life in rural areas crucially depends on access to quality public services and infrastructure. Essential services and related infrastructure – such as water, sanitation, energy, transport, financial services and digital communications – are key to guaranteeing social and economic inclusion. They also play a crucial role in facilitating access to education, housing, healthcare, labour market and social services, including childcare and long-term care.
Many care professionals, who are predominantly women, move from Eastern European countries to Western countries or from rural to urban areas within the same EU country, attracted by higher salaries or better employment prospects, often leaving older parents and children behind. In these situations, population movement and intra-EU mobility can aggravate already adverse demographic trends and contribute towards care drain in Eastern countries and in rural areas, namely in the regions which are facing population decline. For example, according to the estimates by Bundesverband für häusliche Betreuung und Pflege e.V. (VHBP – Federal Association for Home Care and Nursing e.V.), in Germany there are about 700000 Polish care workers and during the COVID-19 pandemic the demand for homecare workers increased. The Polish Ministry of National Education reported that in 2018 up to 20% of Polish children may be left behind, because parents move to another EU country for work. The other side of this phenomenon is that often the women who remain living in rural areas bear a disproportionate responsibility for unpaid care and domestic work, thus reinforcing gender imbalances.
|FairCare campaign, Diakonie (Germany, Poland and Romania) |
In Germany, most elderly and sick people wish to be cared for at home. Often, they require more than the medical services of a nurse. They also need help for day-to-day activities, such as shopping, cooking, washing and getting dressed. Care givers from Eastern Europe often work under very poor working conditions in Germany. They must be available around the clock and have no health and pension insurance. To tackle this situation and ensure compliance in the employment of caregivers coming from Eastern European countries, with labour and social protection laws, Diakonisches Werk Württemberg started the FairCare campaign in cooperation with the Association for International Youth Work and the Association of Protestant Women in Württemberg. Diakonie Poland and AIDRom in Romania joined this campaign too. In the framework of this project, Diakonie Württemberg in cooperation with the Association for International Youth Work set up a placement service for caregivers from Eastern Europe, who are hired to support elderly or sick people in their day-to-day activities. The caregivers placed through FairCare are legally employed in Germany and in accordance with labour law standards, benefitting from occupational and health protection. With a multilingual team, this service offers counselling and advice to users who need to be cared for at home, to their families, and to caregivers from Eastern European countries.
Source: Eurodiaconia (2022), Research on demographic change and the future of long-term care in Europe, p. 12
Obstacles to using and providing social care and support services in rural areas include:
- Mobility and transport: mobility is often difficult due to lack of public transports; this translates in increased costs in time and transport taken to provide and access services.
- Lack of care specialists in local areas: qualified specialists tend to move to bigger cities because they have a higher demand for their services in densely populated areas.
- Care staff shortages and difficulties in developing a quality workforce, as availability of up-to-date quality training is less available than in urban areas.
- The digitalisation of care services, which is a solution to overcome some barriers in rural and remote areas, is often hindered by poor broadband infrastructure and signal.
- The lack of data and of needs assessment: the lack of data on individual needs of user, as well as the lack of needs assessment, make the provision of quality and innovative care services more difficult than in urban areas.
- Increased costs and coordination efforts for service providers: low number of service users increases the cost of service delivery; the decentralisation of care services to the local level requires service providers delivering services in scarcely populated areas to interact with many different municipalities. For example, in Austria, in Eastern Styria with a population of 300,000 people, the NGO Chance B needs to work with 70 different mayors to deliver its services and share information with service users.
- Limited choice for service users to choose the service they need and/or they would like to receive, as the choice of service providers is usually very limited, as well as the offer of home care services and of integrated social and healthcare.
The lack of social care and support services may drive people living in remote rural areas to leave their homes to seek services elsewhere. Conversely, the availability of quality social care has the potential to improve the quality of life and economic well-being of people living in remote rural areas. Investment in essential services and in care services, including in digitalisation of services, in rural areas can also be an important source of job creation.
|Intergenerational cooperation at the core of the digital literacy training courses for the elderly provided by Simbioza social enterprise, Slovenia|
The Slovenian social enterprise Simbioza, founded in 2011, organises activities focused on intergenerational cooperation, volunteering, lifelong learning, social entrepreneurship and socially responsible and ethical activities. Its activities are spread across the country. One of its flagship activities are training courses on digital literacy for the elderly living in rural areas: Simbioza matches them with young people and children who are able to teach them.
|Adapei 23, France: working in partnership with paramedical services and using e-health solutions to meet the demand for services for persons with intellectual disabilities and elderly people in the department of Creuse |
Adapei 23 is a parents’ association which provides services for persons with intellectual disabilities and elderly people in the department of Creuse, France. In order to meet the demand for the variety of services required by local residents, Adapei has established (together with other organisations) a structure of social and solidarity economy. Adapei had experience using e-health solutions in their work. However, in a person-centred approach, personal contact and a thorough needs analysis is needed, at least during the first visit. To solve this issue, Adapei 23 created a partnership with paramedical services to have more capacities. In recent years there has been an increasing demand for elderly care services. Adapei 23 had to adapt housing and residential facilities to meet this demand.
Source: EASPD (2018), Provision of social care and support services in remote rural areas, p. 9
Care plays a crucial role in addressing social, economic and territorial disparities. It is extremely important to develop innovative solutions for the provision of high quality and accessible care services in a balanced way, throughout all territories of the EU, including in remote, rural areas and small towns. To do so, it is important to make the best of the possibilities offered by digital tools including by promoting place-based solutions and social innovation. As for-profit providers are generally not interested in providing services in rural and remote areas, there is an enormous opportunity for public authorities to mobilise public funding, including EU funding, to invest in the social economy and the third sector providing care.
The EU care strategy reaffirms the essential role of cohesion funds, namely the ESF+, the European Regional Development Fund and the European Agricultural Fund for Rural Development, to invest in care services and other social infrastructures, including in rural and remote areas. This investment should be coupled with investment in efficient transport systems, other essential services, in the development of human capital, as well as in ensuring that rural and remote areas also benefit from the green and digital transitions, including in relation to the provision of care services. This will contribute not only to the creation of jobs in small towns and rural areas, but also to improving the quality of life of residents in these areas.
Care is one key area by the means of which ‘lonely places’ (defined as a plurality of places that present a certain vulnerability in terms of local endowment, accessibility, or connectivity), both in urban and rural areas, can be transformed into areas of opportunities. Thanks to placed-based policies, bottom-up and social innovation initiatives, promoting the right investments in care has the potential to reinvent and transform many lonely places. Social economy actors and civil society organisations can become more vocal advocators of this transformation towards public authorities and other relevant stakeholders.
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 EUROFOUND (2019), Cooperatives and Social Enterprises: Work and Employment in Selected Countries, Luxembourg: Publications Office of the European Union
 EUROFOUND, ‘Long-Term Care Workforce’
 EUROFOUND (2019), Cooperatives and Social Enterprises: Work and Employment in Selected Countries
 CECOP, ‘Lights on! Worker and Social Cooperatives Tackling Undeclared Work’ by Francesca Martinelli (Brussels, 2021), https://cecop.coop/works/cecop-report-lights-on-worker-and-social-cooperatives-tackling-undeclared-work
 International Labour Organization, ‘Providing Care through Cooperatives: Survey and Interview Findings’ (Geneva: ILO, 2016).
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 Revitalising Community-led Innovation in Europe. https://www.aeidl.eu/events/elif-revitalising-community-led-innovation-in-europe/