Care Work in Europe

Current Understandings and Future Directions

Claire Cameron, Peter Moss

• Publisher: Routledge
• Year: 2007
• ISBN:
  9781134159840
• Edition: 1
• Topic: Médecine
• Subtopic: Prestation de soins

Care Work in Europe provides a cross-national and cross-sectoral study of care work in Europe today, covering policy, provision and practice, as well as exploring how care work is conceptualized and understood. Drawing on a study which looks at care work across the life course in a number of European countries, this book:

• explores the context and emerging policy agendas
• provides an analysis of how different countries and sectors understand and structure care work
• examines key issues, such as the extreme gendering of the workforce, increasing problems of recruitment and turnover, what kinds of knowledge and education the work requires and what conditions are needed to ensure good quality employment
• considers possible future directions, including the option of a generic professional worker, educated to work across the life course and whether 'care' will, or should, remain a distinct field of policy and employment.

This groundbreaking comparative study provokes much-needed new thinking about the current situation and future direction of care work, an area essential to the social and economic well-being of Europe.

1 Introduction

Context and methods

Care Work in Europe: current understandings and future directions is the title of a research study undertaken in six European countries. The study was funded by the European Commission and took place between 2001 and 2005. This book offers findings, reflections, conclusions and questions raised by a study that was border crossing, complex and provoking, and went to the heart of one of the most important issues confronting affluent post-industrial societies – who will do the caring, under what conditions and what will this care work entail?

The overall objective of this research was to contribute to the development of good quality employment in caring services that are responsive to the needs of rapidly changing societies and their citizens. As the reference to ‘employment’ suggests, the focus was on paid caring, caring as a job, or what might be termed ‘formal’ caring. A decision was also made to focus on ‘front-line workers’, working on a regular (often daily) basis in direct contact with people needing care.

This meant excluding many groups who are active carers. First and foremost were the family members, neighbours and friends who every day and night undertake a vast and invaluable amount of caring and who, research consistently shows, account for the greater part of care work undertaken in Europe. These informal carers were not, however, entirely excluded from consideration. As we shall see in Chapter 2, their availability and willingness to undertake care work have an important bearing on formal care work, though we shall also argue that formal care work is not a simple substitution for the care of family or friends: it is often a different relationship with different practices, calling for particular qualities and competencies.

Even among paid front-line care workers, there were boundaries to be drawn. Numerous workers have an element of care in their jobs, including many in the grey economy such as domestic workers. Research on domestic workers has shown that many are also expected to care for children or elderly people. Research also highlights the global dimension of this labour, much of which is undertaken by migrant women (Anderson 2000; Hochschild 2000; Hondagneu-Sotelo and Avila 1997). Other domestic workers may be full-time carers, working in the homes of those they care for, but without regulation, an increasingly numerous and (officially at least) invisible band of care workers.

We also exclude a wide range of occupations that can be found working in, or providing other inputs to, formal care services. There are, for example, those workers who provide specialist knowledge and skills, but who are not working with people on a regular and frequent face-to-face basis: for example, paediatricians and other doctors, social workers, psychologists and various types of therapist. On this basis, we also exclude managers in care services. As with many of the exclusions, this is not always a clear-cut matter: the border lines are not necessarily the same in all countries and cases. For example, our Swedish partner in the project argued for including middle managers in services for elderly people: ‘due to the low educational level in elder care, [this manager] has an important role as a supervisor and organiser of care work . . . [and] has an education at university level’. In some cases, members of professions we have generally excluded are, in fact, ‘front-line workers’: for example social workers in Sweden are the main workers in residential child and youth care services, while some nurses meet our criteria as care workers, playing an important role in nursing homes and home care.

Even with these exclusions, we are left with a numerous and diverse range of workers, employed in a large and wide-ranging cluster of services, crossing the life course and many types of setting, from home-based work through to work in a variety of day and residential institutions. We term this cluster of services the ‘care work domain’, equivalent to what in Britain would be termed ‘childcare’ and ‘social care’. It includes three main groups:

• childcare and out-of-school care (including nursery education for children below compulsory school age since, as we argue later, the border between ‘childcare’ and ‘early education’ is increasingly blurred);
• child and youth residential and foster care;
• care services, both domiciliary and residential, for adults with disabilities including frail elderly people.

We do not claim to have paid equal attention to all the care work and workers within this vast area, for example paying far less attention to child and youth residential and foster care than the other two groups. But this ‘care work domain’ was the starting point, the field the project began by mapping. We have also tried to keep in mind the full domain when thinking about the future of care work.

Taking such a broad and cross-sectoral approach is unusual (though not unknown) in research and policy, where normally attention is focused on one part or another of the care work domain. It has led to questioning many boundaries between occupations and to ask whether the future of care work might not reside in a generic profession, educated to work across the life course and in many settings. In this, we were also influenced by coming across just such a profession, the Danish pedagogue who is qualified to work with people from ‘birth to 100’. While no one can doubt the need for some specialist knowledge, what emerges from Care Work in Europe are the many requirements and competences shared across care work in Europe.

Why?

This study was funded by the European Commission, as part of its Fifth Framework Programme. These programmes involve a major investment by the European Union in a wide range of research, mostly in the physical sciences, but also in the social sciences. There are two strategic objectives. First, to strengthen the scientific and technological bases of industry and encourage its international competitiveness. Second, and particularly relevant for Care Work in Europe, to promote research in support of EU policies. What policies was the study supporting? What has the EU to do with care work?

The answer is primarily about employment. Comparisons with other affluent regions of the world, notably the US and Japan, reveal that the EU has lower levels of employment, one reason for which is relatively low levels of female employment. Central to EU policy today is the aim of increasing employment in Europe, especially among women: the so-called Lisbon employment target, agreed by EU member states in March 2000, is 70 per cent employment overall by 2010, with 60 per cent among women. This target forms part of the EU’s strategy for economic, social and environmental renewal whose overall aim is for the EU to become ‘the most competitive and dynamic knowledge-based economy in the world by 2010’, based on sustained growth, more and better jobs and greater social cohesion (Presidency Conclusions 2000, 2001).

Care work has an important role to play in boosting employment. The EU has long recognised that most informal care is provided by women, especially as mothers and carers of older relatives. If more women are to work, and if there is to be greater gender equality in the labour market – another EU goal – then more care services are needed, both for children and for older people (though the EU has also long recognised that it requires other conditions, including changes in working practices and men assuming more responsibility for caring). For this reason, the EU has long had an interest in ‘childcare’ services.

As far back as 1974, the (then) European Community in its Social Action programme called for ‘action for the purpose of achieving equality between men and women as regards access to employment and vocational training and advancement and as regards working conditions including pay’ and noted that one of the causes of inequality between men and women is ‘the lack of adequate facilities for working mothers’. One of the aims of the European Commission’s First Equal Opportunities Action programme (1982–85) was ‘to extend parental leave and leave for family reasons and at the same time to build up the network of public (childcare) facilities’. Several actions have followed since, including the establishment of an expert network – the European Commission Childcare Network – that, between 1986 and 1996, undertook a range of studies on childcare services, leave policies and gender issues; a Council Recommendation on Childcare, in 1992, in which member state governments supported a range of objectives and principles to promote more and better services; legally binding directives setting minimum standards for maternity and parental leave (1992 and 1996); and member states’ agreement in Barcelona in March 2002 to targets for childcare services: ‘Member States [should strive] to provide childcare by 2010 to at least 90% of children between 3 years old and mandatory school age and at least 33% of children under 3 years of age.’

The EU sees care work not only as a precondition for increased employment, but also as a source of that employment. Between 1980 and 1996 service sector employment in the EU increased by around 19 million: ‘the largest area of growth has been in the ‘care’ services’ (health, social services, education), various business services and environmental activities’ (Anxo and Fagan 2001: 94). Despite this growth, service sector employment in the EU still lags behind US levels, suggesting that the employment potential in services has yet to be fully realised. Shortly before the start of the study, the European Commission had identified care work as one of five growth sectors in services ‘meriting particular attention because of their size and growing importance’ (European Commission 1999: 12), the others being education, business activities, hotels and restaurants and retail trade.¹

But at the same time as wanting more jobs, the EU has emphasised the importance of these jobs being of ‘good quality’. Quality of employment is ‘central’ to the EU’s objective of becoming a knowledge-based economy (European Commission 2001a), and within a short time, quality of work has ‘become a major subject of discussion, one which has been at the top of the European political agenda [since the Lisbon summit in 2000]’ (European Foundation for the Improvement of Living and Working Conditions 2002: 4). Otherwise, the argument runs, an expansion of employment might simply produce more poor quality jobs, with detrimental consequences for employees and society alike (Esping-Andersen et al. 2001).This interest in quality as well as quantity of employment has been maintained. The European Commission has recently emphasised the importance of promoting ‘quality – of employment, social policy and industrial relations –, which, in return, should make it possible to improve human and social capital’ (European Commission 2005a: 2): rather than seeing a choice needing to be made, the EC is clear that Europe ‘needs to address both the quantity and quality of jobs’ (ibid.: 6). We shall return later, in Chapter 6, to consider the meaning of ‘quality’.

The changing context of care work

The increasing emphasis – at European, but also national levels – on care work as a precondition and a source of increased employment is one part of a shifting context that is affecting not only the demand for care work but also the supply of care workers and the nature of the work, how it is understood and practised. We turn now to consider different aspects of this changing context which, cumulatively, are raising new questions about care work and its future, questions to which we return at the end of this book. Who will do the work? Who will pay for it? How will it be structured and understood? Should ‘care work’ remain a separate field of policy, provision and practice?

Changing demand and supply

The demand for care work is increasing at a time when the major source of supply of care workers for many years is dwindling. Demand is increasing for three main reasons. Two are well documented and due to labour market and demographic change. First, women are still responsible for most care-giving within the household. But as more women are employed, and as men continue to have high rates of employment,² care work moves from the informal to the formal sectors – though much is also absorbed by informal care from relatives and friends. However, this change does not occur at a uniform pace across populations. Some groups appear to be more wary of formal services – ‘care by strangers’ – preferring either to care directly themselves (for example, by foregoing employment or seeking part-time employment that can be ‘fitted round’ caring responsibilities) or turn to family members. Two examples can illustrate the point.

A report by the Organisation for Economic Cooperation and Development (OECD) on early childhood services puts forward a number of reasons why some minority ethnic groups make less use of childcare services, including lack of information and limited proficiency in the language of the country in which they live. But it also suggests another contributory factor: ‘many new immigrants do not share the idea that very young children spend most of their day away from home’ (OECD 2001: 60). Research in the UK with nursery workers and childminders shows that these groups of women, most of whom have relatively low educational qualifications, are generally opposed to the idea of leaving their own children in the care of non-family. This is the major reason why women enter childminding (to have paid work that they can combine with the care of their own children); while it is the reason most nursery workers say that, when they have their own children, they would prefer not to do paid work or to work only part time or at home (Cameron et al. 2001; Mooney et al. 2001).

Changing attitudes feed increasing demand for formal care services. This can be seen in the almost universal use today by European parents of nursery schooling and kindergartens for their children from 3 years to compulsory school age – even though this service is usually offered on the basis of voluntary attendance. In countries like Denmark and Sweden, acceptance and, indeed, demand for services for children under 3 years now reflects the view of many parents that very young children enjoy attending and benefit educationally from what is increasingly seen as the first stage of ‘lifelong learning’. Jensen and Hansen note that, from a Danish perspective:

there has been a tendency towards regarding early childhood care and education as part of lifelong learning which means that parents more and more want their children to attend a childcare facility, not only for the reason that they are being taken care of when parents are working, but as a place for play, socialisation and community . . . [T]he policy that childcare is an offer to all children and not dependent on their parents’ attachment to the labour market has meant an increase in demand. It has become more of a cultural norm that children from one or two years of age are attending a public facility. Informal care is by many parents not seen as a real alternative to public care.

(Jensen and Hansen 2002a: 8, 38)

While a UNESCO report by two Swedish researchers similarly concludes that

[in Sweden] early childhood education and care during the 1990s became the first choice for a majority of working and studying parents . . . It has become generally acceptable to enrol your child in institutional full-day pre-schooling at the age of one. What was once viewed as either a privilege of the few for a few hours a day or an institution for needy children and single mothers has after 70 years of political vision and policymaking become an unquestionable right for children and families. As such, families expect a holistic pedagogy of health care, loving care and education throughout the pre-school age. . . . [T]he acceptance of the full-day pre-school and school has come hand in hand with the idea of lifelong learning.

(Lenz Teguchi and Munkammar 2003: 31)

Here can be seen new constructions emerging of what it means to have a ‘good’ childhood and to be a ‘good’ parent; neither envisage full-time parental care in the earliest years as a norm. But similar changes may occur among other recipients of care. Some elderly people may prefer professional care services to relying on relatives, both because they prefer the standards of care and because they do not want to be dependent. Or the process may be rather more complex, more ‘and/also’ than ‘either/or’: as more services become available, older people can exercise more choice over the care they receive, opting for formal services to provide them with certain types of care while they look to relatives for other support. We consider this possibility further in the next section.

A second source of growing demand for care work is the rapid increase in the population over 80, an age group where care needs are particularly high. Within the EU, the number of people aged 80 years or over is predicted to increase by 181 per cent between 2005 and 2050, from 19 million in 2005 to 53 million (European Commission 2005b). This will involve increasing numbers of older people with severe disabilities. In England, for instance, ‘the number of people with cognitive impairment, such as dementia, is predicted to increase from 461,000 in 1998 to 765,000 in 2031’ (English Department for Education and Skills/Department of Health 2006: 20).

Increasing demand may also arise from there being more younger adults with disabilities. Commenting on the growing numbers enrolled in services for people with substantial disabilities, Danish research partners suggested that one reason for this may be a rise in the total number of disabled people because they are living longer (the report also suggests other reasons including policy changes, illustrating the complex interaction of factors) (Jensen and Hansen 2002a). In Sweden, the proportion of people aged 16 to 64 years with disabilities has increased between 1988/89 and 1998/99 (Johansson and Norén 2002a). While in England, the number of people with a severe learning disability is expected to increase by between 1 and 2 per cent per year over the next 15 years (English Department for Education and Skills/Department of Health 2006).

There is a third reason for growing demand for care work, and this has received less attention: the reduced availability of non-parental, kin carers, who are usually unpaid. Falling birth rates over time bring about more ‘beanpole families’, with fewer relatives in each generation due to decreasing family size. At the same time, employment among women of older working age is increasing. An OECD study concludes that the availability of informal care ‘is likely to be reduced in case of higher participation rates of women in paid work’ (Jacobzone et al. 1998: 7). A UK study of women and men in their 50s found that grandparents ‘did not want to be tied to regular care commitments. Often they did not want to give up work or reduce hours, preferring the status, job satisfaction and financial resources (pensions as well as income) available through employment’ (Mooney and Statham 2002). So while informal care continues to be the main source of care for young children and older people, labour market trends point to its diminution.

Yet as demand is growing, the supply of care workers is at risk. An ageing population not only means increasing demand for care services but a potentially falling ‘working age’ population, so that by 2050 ‘the working-age population (15–64 years) is projected to be 18% smaller than the current one, and the numbers of those aged over 65 years will have increased by 60%’ (High Level Group 2004: 13). ‘Potentially’, because what counts as working age may well be redefined upwards as retirement is pushed later, while the working-age population may also be swelled by migrant labour.

However, even if such changes do prevent the projected fall, the supply of paid care workers may still decrease for other reasons. For this supply has relied heavily on a particular group in the population, women with lower levels of education, and this source of supply is contracting for reasons that are not only demographic. This shift, and its possible consequences, is described vividly by a French labour market expert:

Our economic system [in Europe] was based over the last two centuries on an abundant labour supply, [but] the era that is opening implies moving rapidly to scarcity of human resources. This will change thoroughly the behaviour of the labour market and force us to unheard of organisational innovation . . . The number of young people aged 15–24 [in the EU] will be b...