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Analysing the importance of older people's resources for the use of home care in a cash-for-care scheme: evidence from Vienna
- Author:
- SCHMIDT Andrea E.
- Journal article citation:
- Health and Social Care in the Community, 25(2), 2017, pp.514-526.
- Publisher:
- Wiley
Older people of lower socioeconomic status (SES) are disproportionately affected by chronic conditions, yet less able to compensate health limitations through use of formal long-term care (LTC) at home, a preferred type of care for most. Some, like older women and single people, are particularly vulnerable. Under the Austrian public cash-for-care scheme, which aims to incentivise care at home and empowerment of LTC users, this study analyses: (i) interdependencies between SES, gender and ‘informal’ or family care, and (ii) how these factors associate with the use of old age formal home care in Vienna. An adaptation of Arber and Ginn's theory is used to identify material resources (income), health resources (care needs) and informal caring resources (co-residence and/or availability of family care). Gender aspects are also considered as a persistent source of inequalities. Administrative and survey data, collected by public authorities between 2010 and 2012 in Vienna, serve to compare home care use in old age (60+) to other support forms (residential and informal care) using logistic regression analysis. Results show a pro-rich bias in home care use among single-living people, with high-income single people being less likely to move to a care home, while there are no significant income differences present for non-singles. Second, traditional gender roles are salient: female care recipients co-residing with a partner are more likely to use formal care than men, reflecting that men's traditional gender roles involve less unpaid care work than women's. In conclusion, in an urban setting, the Austrian cash-for-care scheme is likely to reinforce stratifications along gender and class, thus implementing the general policy objective of care at home, but more likely for those with higher income. A support mechanism promoting empowerment among all older people might contribute to unequal degrees of choice, especially for those with fewer resources to manage their way through a fragmented system of LTC delivery. (Publisher abstract)
Paying for long-term care
- Authors:
- RODRIGUES Ricardo, SCHMIDT Andrea
- Publisher:
- European Centre for Social Welfare Policy and Research
- Publication year:
- 2010
- Pagination:
- 21p., bibliog.
- Place of publication:
- Vienna
The aim of this policy brief is to present information on the current picture of private and public expenditure on long-term care for older people, and to discuss the challenges of financing care. It describes the background context of demographic ageing across the European Union. It discusses public funding of long-term care, including the rationale behind public funding and the current picture of public expenditure, private funding arrangements and expenditure on long-term care, possible equality considerations of long-term care benefits and whether high income groups are more likely to receive home care. The authors conclude that despite concerns over the sustainability of long-term care systems, public resources devoted to this area of social policy are much lower than what is spent in other areas such as health or pensions, and that while there are several options available to provide those in need of care with the means to secure the care they require, policymakers should be aware of the potential inequalities associated with the different ways of financing and providing long-term care.
Lessons for regulating informal markets and implications for quality assurance: the case of migrant care workers in Austria
- Authors:
- SCHMIDT Andrea E., et al
- Journal article citation:
- Ageing and Society, 36(4), 2016, pp.741-763.
- Publisher:
- Cambridge University Press
The rising number of private care arrangements in which live-in migrant care workers are engaged as a functional equivalent to family care calls for special attention by policy makers and formal long-term care providers on their implications for quality assurance and professional standards in the long-term care sector. Austria is one of the first countries in Europe where tangible legal measures have been taken to regulate this area under the heading of ‘24-hour care’, typically provided by middle-aged women. Reform measures went beyond policing and control mechanisms, including also incentives and tangible subsidies for all stakeholders. This paper contributes to a better understanding of their impact on the transition from informal to formal economy, focusing on quality assurance and working conditions. Based on empirical data and findings from semi-structured interviews with relevant stakeholders, a framework for the analysis of ‘illegal markets', based on Beckert and Wehinger's theory, is used to discuss potential implications in terms of valuation, competition and co-operation for policy in Austria, and to draw lessons for other countries. Results indicate that even after efforts to ‘legalise’ migrant care, the sector remains a ‘grey’ area within modern labour market legislation and quality management. This is due to the very nature of personal care, low professional status associated with care work and the reluctance of political stakeholders to regulate private household activities. (Publisher abstract)
Fractures in the Austrian model of long-term care: what are the lessons from the first wave of the Covid-19 pandemic?
- Authors:
- LEICHSENRING Kai, SCHMIDT Andrea E., STAFLINGER Heidemarie
- Journal article citation:
- Journal of Long-Term Care, February 2021, pp.33-42. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: The COVID-19 pandemic highlights limitations of long-term care (LTC) systems in Europe, which continue to be divided between health and social care, and between formal and informal care. Objective: This article focuses on Austria’s LTC sector and its critical features that became visible during the outbreak of the COVID-19 pandemic. Method: The analysis was carried out via desk-research, which covered literature, on-going qualitative analysis of media coverage, and statements and reports by interest organisations and governmental agencies between March and August 2020. Where necessary, useful and feasible, update information on ensuing developments until the end of 2020 was added during a final revision. Findings: In Austria, the number of cases as well as the number and share of deaths in care homes were lower than in other countries until August 2020. Yet, the crisis brought several idiosyncrasies to the fore, most prominently a lack of support for informal caregivers and lack of acknowledgements of the rights of live-in personal (migrant) carers. We find that the COVID-19 crisis has shed light on the fact that existing inequalities are being aggravated by gender and migration issues. Implications: (i) The crisis highlights the need for better communication, integrated care and health information flows between health and social care; (ii) Clear guidelines are required to balance older people’s right to self-determination versus (public) health concerns; (iii) Increasing reliance on migrant carers from Eastern Europe has led to a dualisation of the LTC labour market in the past decades, which needs to be countered by increased quality standards and endeavours to fundamentally change the employment situation of live-in carers; (iv) Informal carers are vulnerable groups that deserve special attention and call for expansion of community services in long-term care. (Edited publisher abstract)
Juggling family and work: leaves from work to care informally for frail or sick family members: an international perspective
- Authors:
- SCHMIDT Andrea E., FUCHS Michael, RODRIGUES Ricardo
- Publisher:
- European Centre
- Publication year:
- 2016
- Pagination:
- 19
- Place of publication:
- Vienna
In response to the numbers of people who are both in employment and caring for sick, disabled or frail family members, some countries in Europe have put regulations in place that allow employees to provide and/or organise care for family members while remaining attached to their workplace. This Policy brief draws some lessons for the design of care leave policies, Based on an in-depth analysis and international comparison of 22 different care leave regulations in six different countries (Australia, Germany, Netherlands, France Canada and Italy), it highlights lessons for the design of care leave policies. It defines seven key objectives to develop or improve care leave policies, including labour market attachment of caregivers, their income security, and gender equality between caregivers. It then evaluates the success of the regulations, particularly in terms of take-up rate. It found that structural factors such as payment, duration, circle of eligible family members, and minimum care needs for which a leave is granted are crucial in convincing caring employees to take up care leave. However, societal and psychological considerations were also found to be at least equally important, including the need to reduce stigma for caregivers at the workplace, and to maintain both complexity and financial risks at a minimum. (Edited publisher abstract)
Analysing equity in the use of long-term care in Europe
- Authors:
- RODRIGUES Ricardo, ILINCA Stefania, SCHMIDT Andrea
- Publisher:
- European Commission
- Publication year:
- 2014
- Pagination:
- 39
- Place of publication:
- Brussels
There are significant differences across social protection systems in Europe in the scope, breadth and depth of coverage of the risk to need long-term care in old-age. Together with other factors, such as education, household structure or societal values regarding care for frail older people, these differences can have a significant impact on the use of long-term care. Using SHARE data, this Research Note compares differences between European countries in the use of long-term care across income groups, for older people living at home. It analyses not only inequalities in the use of long-term care, but also differences in use that persist after differences in need have been taken into consideration, i.e. horizontal inequity. For this purpose, concentration indices, concentration curves and horizontal inequity indices are estimated for home care services and informal care. The countries analysed here are Austria, Germany, Sweden, the Netherlands, Spain, Italy, France, Denmark, Greece, Belgium and Czech Republic. The findings suggest that differences in use of home care services across income groups mostly reflect differences in need between those same groups. For informal care, the differences in use persist even after accounting for needs, and less affluent individuals are much more likely to use informal care. Some possible causes for these differences and policy implications are considered.