ABSTRACT

Introduction The personal care sector has been one of the fastest growing sectors in terms of employment creation, and its growth is projected to continue in the future. Rapid population ageing has dramatically increased the demand for long-term care (LTC) for dependent elderly people, exerting enormous pressure upon public and private finances. Projections of future spending on LTC brought increasing awareness of the need for public involvement and LTC reforms, so that the number of countries addressing LTC with comprehensive reforms has increased in Europe. An increasing number of countries are addressing the question by favouring a shift towards home care and market provision. The greater care load shifted upon families, at a time when demographic and social transformations may impact on the availability of informal/family carers, has resulted in an increasing share of care being outsourced to the market. The increase in demand for affordable market care has far outstripped supply. In many countries the shortage of care workers has been met by a large inflow of migrant, mostly female, workers, while the substantial difference in cost between regular and irregular care diverted most of this demand towards the grey market. The extent of recourse to migration and the modalities of care workers’ involvement in the labour market differ widely across countries and across the various segments of the care labour market, with obvious consequences on the quality of care and care work. How to make care work pay – that is, how to solve the dilemma between affordability of care and quality of care work – is an essential issue for the long-term sustainability of LTC. This chapter investigates the ways in which different countries have addressed the question of making market care affordable to families, while keeping public costs under control. We first analyse the conditions regulating the care market and its division into regular and irregular work. The latter does not necessarily coincide with immigrant work. While in some countries the two figures coincide, this is not the case in others: we start from the premise that the extent of the grey care market is related to the employment regime, so that policies aimed at regularising care workers reflect the more general frame of employment policies. The first section analyses the issue of the cost of care and the following section looks

at the role played by migration in filling the gap between demand and supply. The fourth section focuses on the policies that have been implemented in order to make market care affordable to families. It distinguishes between policies aimed at encouraging the development of a regular care market and/or reduce irregular work in home care through subsidies, or the debasing of care labour.2 The final section assesses the different solutions towards overcoming the costquality trade-off, arguing that some form/degree of subsidisation is needed if ‘low road’ solutions based on either irregular or badly paid care work models are to be avoided.