Long-Term Care Provision: Current trends and the impact of Covid-19

Long-term care (LTC) refers to a range of health, social, and residential services for individuals who are dependent on assistance with their daily activities over extended time periods. LTC can be provided in residential facilities or at home. Residents of LTC institutions (nursing and residential care facilities providing accommodation and long-term care as a package) are generally more dependent upon the provision of services than those residing at home. Home care is seen as guaranteeing a higher degree of autonomy for persons in need of care and enabling them to remain at home in specially designed or adapted living arrangements.

In both institutional settings and at home, specialised medical support is usually provided by trained personnel, while caregivers support their clients in the organisation of daily life. Home care can be provided by mobile caregivers visiting the client regularly for a certain period of time or by caregivers living in the household of the client and supporting the client during the whole day. The size of the population in need of LTC residing in an institutional setting and at home varies widely in Europe. The exact numbers and correlations are problematic to assess due to a high level of informality of the home LTC sector. Mobile care workers supporting their clients at home for a limited period of time are usually provided by professional care organisations run by e.g. municipalities, charitable organisations or churches. Informal home care is typically provided either by – mostly female - family members, on an unpaid basis, or through private arrangements, on a remunerated basis.

Informal care represents a cornerstone of all LTC systems in European states. As is the case with the precarious employment in other sectors, the LTC work with the least protection and/or access to welfare entitlements tends to be performed by migrants and – within the European Union – by cross border commuters. Concerning the intra-EU mobility Poland, Romania, and Slovakia, but also Bulgaria, Hungary and Slovenia represent sending countries for commuting and short-term migrant careworkers in the live-in long-term care sector.

The COVID-10 pandemic poses new challenges for European States – both on the sending and receiving
end of care labour alike:

• Border closures between the EU Member States have left mobile care workers stranded on both sides. The crisis thus highlights the existing difficult conditions in care work, as well as the need to protect migrant care providers as essential workers.
• The current situation also reveals the shortcomings and vulnerabilities of mobility-based care systems. This may compromise the sending countries’ capacity to deal with a healthcare crisis like the current COVID-19 pandemic. Receiving countries, whose care systems are more reliant on mobility, are experiencing different challenges due to the unprecedented lockdown measures than those with locally organised care provision.
• It is, therefore, crucial to discuss the short-term responses in parallel with a long-term vision to improve the sustainability and resilience of care systems and prevent future crises.