Care workers, big demands and little rights by Borja Arrue Astrain

Borja Arrue Astrain works at AGE Platform Europe, the European network of organisations for equality and dignity in older age. He is responsible for AGE’s work on care policies: “We build a shared understanding of those issues that allows us to influence European Union’s policies. We also work together with the European offices of providers of care services, trade unions and other groups in the population, for instance people with disabilities, to advance our agenda”.

Are we still living under post war welfare systems, and should we rethink them, especially as far as older persons are concerned?

We certainly are. 

Our welfare systems have proved to have been proven to struggle to address the new social realities. These include longer lives, greater gender equality, a more precarious labour market and a drop in birth rates, among others. All these issues have an impact on both today’s older people and those who will be older tomorrow.

In fact, we should think about welfare across the life course: how you live when you are a child, or a younger adult, determines to a great degree how you will live in older age. Therefore, we need our welfare systems to support everyone all alongthroughout their lives – and preventing hardship and inequalities starts from the cradle. 

Our welfare states still struggle to integrate this life course approach in policies and legislation. It is a pending revolution.

The Equality and Human Rights Commission points out that the combination of frequent lone working and high levels of individual responsibility, coupled with the need for highly developed communication and practical skills required by good home care workers, are found in few other jobs afforded such low value in our labour market. Should we improve the working conditions of care workers?

Absolutely. Because of the stigma around old age and care needs, services are largely undermined and underfunded. The care sector is characterized by very low wages, very low social consideration and extremely difficult working conditions, and this is true all across Europe. Care workers are most of the time women from minorities or minority backgrounds, and their hard work is often insufficient to provide an acceptable standard of living.

We have worked with trade unions in this area, and in our exchanges it became very clear that there is a strong link between working conditions and the quality of care services. 

Therefore, fighting for good working conditions for care workers is also a fight for the rights of older people in need of care.

Underlying this issue, is an ethical problem related to how we regard older people in our society. Should we rethink the role and status of older people in our society, as well as how they are taken care of?

Challenging prejudices and stereotypes about older people is indeed an urgent issue. Ultimately, we will fail to properly address the issues around low quality services, funding and working conditions in care if we do not put an end to ageism – to the prejudices, stereotypes and discrimination on the basis of age.

Most individuals choose to ignore the fact that we all age and may one day need care – and that there is nothing bad about it. 

We need to talk about ageing and about the fact that age should never determine how or whether we enjoy our human rights. If we do not have this conversation at a societal level, we will fail to develop quality care systems and supportive societies and environments.  And this has implications for the wellbeing of each of us, if not now, certainly in the future as we get older.

Not to mention, at a political level, the contradiction between governments wanting to contain the costs in care systems and failing to support people to prevent future care needs. 

To date, care systems are largely based on paternalistic ideas and over-rely on families, mostly women, for the provision of unpaid care, which aggravates long-lasting gender inequalities.

How do the different European countries perform as far as the care for older people is concerned?

It is difficult to compare countries as there is a wide diversity of services within each of them, both in terms of settings – care at home, in institutions or in the community – and types of ownership – public, private for profit and non-profit. Also, there are multinational companies that operate with similar practices across Europe – companies that have too often proved to be detrimental both to workers and older people’s rights.

One could think that the situation in Western and Northern countries with a longer tradition of public involvement in social care would be better. There are serious concerns about Central and Eastern Europe, where in some services no training at all is required to work in care for older people, often on very short-term contracts and long working hours. But even in the wealthier countries there are serious problems, as shown by the social care crisis in the UK or the strikes in French care homes.

How can technology improve the working conditions of care workers and thus the wellbeing of older people?

Technology can play a positive role in many different ways. For example, supporting care workers to perform physically demanding activities (helping someone out of bed or supporting a person with difficulties to move around, for example), which is not negligible as there are many issues around health and safety involved in their work. 

Technology can also support the exchange of information between different workers and service providers to deliver what we call integrated care. This involves impeccable coordination between services and a systematic exchange of information, so that the needs of the person in need of care, and not organizational issues, are at the core of the care process. 

Telemonitoring tools, shared data platforms and apps for mobile devices which both care professionals and the person in need of care can access are some of the technological elements used in such models, which are developing in many regions across Europe.

However, one should never lose sight of the fact that face-to-face contact will always be essential. There are certainly economic opportunities linked with the development of technologies for older people with care needs. But the starting point should be a good quality of life. This involves inclusion and face-to-face social contact – technology should be the means, not the only one and certainly not the end-goal. 

Also, we witness a tendency in the demands for care workers to do even more than before from those who assume technologies should increase their productivity. We should be vigilant not to aggravate this drift, which could turn technology against the rights of care professionals.

What have we learnt from the coronavirus crisis as far as care systems for older people are concerned?

The COVID-19 pandemic has exposed the shortcomings of care systems to everyone’s eyes. Most of the outcomes we have witnessed, including the tragic numbers of deaths of older people and widespread situations of abandonment and neglect were unfortunately foreseeable. They are the tragic outcomes of the long-standing failure to ensure access to quality care services for all.

We have observed an obvious lack of coordination between health and social care, the unavailability of personal protective equipment for professionals and people in need of care, serious staff shortages and the refusal to admit older people into hospitals. Severe shortcomings that require immediate responses to avoid further deaths and neglect.

In the longer term, avoiding this happens again and ensuring the dignity of older people with care needs and the rights of workers requires strong governmental action. But it is also the endeavor of the wider society: we need to reexamine the way each of us thinks and feels about ageing and care.