industry & policy
Caution, not comfort, from Europe
Recent developments on the continent suggest it may not hold the road map for the sector that it has in the past.
By Michael Fine
The most recent edition of the Journal of Social Services Research is devoted to discussing developments in aged care over the past decade in Europe. For those who advocate that we head in the same direction, the news from that continent is sobering.
We are, of course, accustomed to looking to Europe for inspiration in the aged-care field. Just think of the way European countries showed us the way with community care as an alternative to residential care as early as the 1960s and’ 70s. Think of the universal programs we admired for so long.
More recently, consumer directed care, or‘ cash-for-care’ as it was long called in the UK, has also been operating in most European countries for well over a decade. It developed first in the US, but its early advocates in Australia were keen to point out that in this country we were lagging well behind Europe in adopting the approach.
Developments over the past decade, however, should give us pause for thought before following Europe’ s lead.
After decades of expanding services to meet demographic growth, austerity measures and policy reforms to marketise aged care have led to some serious restructuring on the continent. The research mentioned previously, consisting of eight detailed articles from a wide and representative range of countries across the European Union, reports on the changes in far more depth than I can go into here.
There is much to suggest that the European experience is not all rosy. Two sets of ideas seem common to just about every jurisdiction covered in the journal.
The first is that of marketisation, which the authors define as“ the introduction of markets and market competition”, reshaping the way aged-care services are provided. The point that most struck me is that because markets are about selling and buying goods, governments across Europe have used them as a way of reducing the support they provide older people who need care.
Older consumers in Europe are increasingly being asked to pay more from their own savings. Some seem to do well out of the arrangements. Others have just had to learn to go without or to put up with services that are much reduced, both in amount and quality. Despite the rhetoric, research from Finland shows that choice does not seem to be available in the way it is for many other products, such as mobile phones or cars, where a wide range of products, used and new, are available for the discerning purchaser.
The second is‘ refamiliarisation’, an awkward word that I suspect is unfamiliar to most Australians. It refers to the adoption or re-adoption of policies that give preference to family care. While we traditionally associate this approach with southern European countries such as Italy, Spain and Greece, it has now been extended, adopted and promoted in both northern and eastern European nations. It is pushed along by high rates of unemployment, as well as by funding crises of central governments.
In the gentle version of the approach, means-tested care payments are made to consumers and families, in place of access to services. The alternative approach is simply that eligibility for services is reduced, disguised as supporting a preference for care by family members.
Think this sounds familiar? Or does it sound crazy to suggest that this could be where we are heading in Australia? Certainly there is plenty of room for comparison with the situation in the UK.
The section on the UK in the research paper on Europe uses a decade of detailed research studies to examine in quite a detailed way the developments in the region of Leeds. There, policy changes were made with the explicit intention of developing a more market-based approach and providing consumers with more choice.
One of the main differences is that we now know what the results were in Leeds. Here, they are still promises, visions and roadmaps.
While we consider the prospect of a European experience, it is also important to remind ourselves of some of the good things back home that have made us different.
April 2016 is the 40th anniversary of the publication of the groundbreaking study of the contribution of unpaid family carers to aged care in Australia. The report, Dedication, was compiled by Clare Stephenson, then research officer at the Council of the Ageing( NSW), who went on to establish the Carers Association of NSW with the help of Averil Fink and others – one of the first such organisations in the world. A copy of the original report can be downloaded from the Carers NSW website if you search for its title.
Although we still have a long way to go, that is a truly remarkable report and something to celebrate! And I’ ll bet they wish they had Carers NSW in Europe. n
Michael Fine is an adjunct professor, sociology, at Macquarie University.
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