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Following the Care Conference “Does Europe Care?”

The two-day care conference on the future of long-term care in European countries ended a month ago. This event was held in two venues, Lutherse Kerk and Felix Meritis, on 28 and 29 April. Cordaan, European Foundation Asklepios, the University of Amsterdam and the Public Health Authority of Amsterdam look back on this conference with great satisfaction.


Over 270 guests participated, either with an active role, or as “ordinary” visitors to the conference. Together, they represented 12 countries of the European Union. Participants from The Netherlands formed the majority, but substantial groups from the United Kingdom, Norway and Greece, could be welcomed. There were workshop presentations from a number of Eastern European countries, including Serbia, Bulgaria, and Ukraine. Two countries from outside the Union also contributed to the workshops: Turkey and Morocco.


During the conference it became abundantly clear once again that, in all European countries, the appreciation for care in the home situation is on the upswing, whereas care in intramural structures is increasingly less appreciated. This development was backed up by similar conclusions of the University of Amsterdam in their recent study into the characteristics of long-term care in different European countries, presented on the first day of the conference. It also became clear that the sheer capacity of informal care is greater, Europe-wide, than that of formal care and that it is already implemented on a larger scale.


There are many indications that long-term care in the (near) future will involve a combination of formal and informal care on a structural basis. What is still widespread practice in Southern Europe appears to receive new emphasis in Northern and Western Europe in the form of “refamilization”. The self-evident assumption that there will (always) be a government system that will take responsibility for the care of one’s next-of-kin is crumbling. Moreover, national authorities (including the Netherlands central government) now take the position that (direct) relatives of patients will increasingly fill the gap between the (indicated) need for care and the formal care that is available and affordable. With dwindling possibilities for individuals to lay claim to formal care, and the increasing complexity encountered when trying to “cash” the need for formal care, “Social Citizenship” (so called during the conference) is arising, characterized by the personal ability to avail oneself of care packages. Persons with a learning disability and clients with a psychiatric background, not to mention elderly persons, will often find themselves lacking in this competence and are at risk of being disadvantaged.


To what extent special care arrangements are offered to persons who belong to specific population subgroups was the theme of the second conference day. What is important here is the question whether such arrangements are better in catering for the diversity in care needs and are thus of better quality and effectiveness. Europe shows a wide variety of initiatives in this field. For elderly clients, it has become plausible that a care offer that is more in line with elements such as culture, religion and sexual identity, is qualitatively a better offer overall. Further study is needed, however.

A special subject focused on during the conference was the phenomenon of migrants who act as caretakers within the family structure in all European countries (except The Netherlands), often as resident of a family, and against relatively modest payment. Especially in Italy this is a strongly growing form op paid informal care. “Migrant care workers” are primarily of Eastern European origin, where shortages in support facilities resulting from this migration are in turn counteracted by an influx of migrants from elsewhere. Together, this has led to a chain of migration within Europe, involving ever more countries. Especially since countries “at the lower end of the chain” are seriously affected by this process, regulation within the European Union would seem inevitable.

The spirit of active enthusiasm exhibited by guests, speakers and presenters of workshops until the very end of the conference left a deep impression on the representatives of the European Union. At the closing of the conference it was agreed, in concertation with them, to organize a follow-up conference in Brussels, in 2013. The goal of this new conference will be to work towards the further strengthening of a coherent European policy with a view to safeguarding the structural availability and financial viability of long-term care. Shortly, in a meeting in Brussels, it will be discussed how, in two years’ time, such a follow-up can be given shape, borne by the European Union, and supported by the European Mental Health Association and others. In Brussels the focus will be on what can be done to strengthen long-term care in the home situation, how bottlenecks resulting from increasing shortages in the labour market in Europe can be solved, how the availability of care can be safeguarded for vulnerable groups in the population and how the darker sides of the increased employment of underpaid and often illegal immigrants can be offset.


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