P9_TA(2022)0278

Towards a common European action on care

European Parliament resolution of 5 July 2022 towards a common European action on care (2021/2253(INI))

(2023/C 47/04)

The European Parliament,

— having regard to Articles 2 and 3 of the Treaty on European Union (TEU),

— having regard to the objectives established under Article 3 TEU, in particular combating social exclusion and discrimination, promoting social justice, equality between women and men, solidarity between generations and the protection of the rights of the child, as well as economic, social and territorial cohesion,

— having regard to the Article 8 on gender mainstreaming, enshrining the EU’s aim to eliminate inequalities and promote equality between women and men, and to the horizontal social clause in Article 9 of the Treaty on the Functioning of the European Union (TFEU),

— having regard to the social policy objectives set out in Articles 151 and 153 TFEU,

— having regard to the revised European Social Charter, in particular its articles 15,on the right of persons with disabilities to independence, social integration, and participation, and 23 on the right of older persons to social protection,

— having regard to the Charter of Fundamental Rights of the European Union (the ‘Charter’), in particular its Article 25 on the right of older persons to lead a life of independence and dignity and Article 26 on the integration of persons with disabilities, and the European Convention for the Protection of Human Rights and Fundamental Freedoms, as referred to in Article 6 TEU,

— having regard to the principles of the European Pillar of Social Rights (EPSR), in particular principle 17 on inclusion of persons with disabilities and principle 18 on the right to long-term care,

— having regard to the UN Decade on Healthy Ageing 2021-2030 and the WHO Framework for countries to achieve an integrated continuum of long-term care (1),

— having regard to the EPSR Action Plan and its 2030 headline targets,

— having regard to the UN Sustainable Development Goals (SDGs), in particular goals No 3 on ‘Good Health and Well-being’, No 5 on ‘Gender Equality’, No 8 on ‘Decent Work and Economic Growth’ and No 10 on ‘Reduced Inequalities’,

— having regard to the thematic report of the UN Independent Expert on the Enjoyment of All Human Rights by older Persons of 22 July 2020 on the impact of the coronavirus disease (COVID-19) on the enjoyment of all human rights by older persons A/75/2020 (2),and her statement on Autonomy and care of older persons to the 30th Session of the UN Human Rights Council (3),

— having regard to the International Labour Organization (ILO) conventions and recommendations, and in particular C149 Nursing Personnel Convention of 1977 and its accompanying Recommendation No. 157, C183 Maternity Protection Convention of 2000 and its accompanying Recommendation No 191, C189 Domestic Workers Convention of 2011 and its accompanying Recommendation No 201, C190 Violence and Harassment Convention of 2019 and its accompanying Recommendation No 206, and Social Protection Floors Recommendation No 202,

— having regard to the 19 December 2019 ILO report entitled ‘The Employment Generation Impact of Meeting SDG Targets in Early Childhood Care, Education, Health and Long-Term Care in 45 Countries’,

— having regard to the ILO Resolution concerning a global call to action for a human-centred approach from the COVID-19 crisis that is inclusive, sustainable and resilient, adopted at the 109th Session of the International Labour Conference in June 2021,

— having regard to the ILO report of 7 March 2022, entitled ‘Care at work: Investing in care leave and services for a more gender equal world of work’,

— having regard to the UN Convention on the Rights of Persons with Disabilities (UN CRPD),

— having regard to the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW),

— having regard to the UN Convention on the Rights of the Child (UNCRC),

— having regard to Commission President Ursula von der Leyen’s political guidelines,

— having regard to the Commission’s work programme for 2022,

— having regard to Regulation (EU) 2021/1057 of the European Parliament and of the Council of 24 June 2021 establishing the European Social Fund Plus (ESF+) (4),

— having regard to Regulation (EU) 2021/241 of the European Parliament and of the Council of 12 February 2021 establishing the Recovery and Resilience Facility (5),

— having regard to Regulation (EU) 2020/2221 of the European Parliament and of the Council of 23 December 2020 amending Regulation (EU) No 1303/2013 as regards additional resources and implementing arrangements to provide assistance for fostering crisis repair in the context of the COVID-19 pandemic and its social consequences and for preparing a green, digital and resilient recovery of the economy (REACT-EU) (6),

— having regard to Regulation (EU) 2021/522 establishing a Programme for the Union’s action in the field of health (‘EU4Health Programme’) for the period 2021-2027 (7),

— having regard to the OECD and European Commission joint ‘State of health’ initiative,

— having regard to Directive (EU) 2019/1158 of the European Parliament and of the Council of 20 June 2019 on work-life balance for parents and carers and repealing Council Directive 2010/18/EU (8),

— having regard to Directive 2000/43/EC of the Council of 29 June 2000 implementing the principle of equal treatment between persons irrespective of racial or ethnic origin (9),

— having regard to Directive 2006/54/EC of the European Parliament and of the Council of 5 July 2006 on the implementation of the principle of equal opportunities and equal treatment of men and women in matters of employment and occupation (10),

— having regard to Directive (EU) 2022/431 of the European Parliament and of the Council of 9 March 2022 amending Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens or mutagens at work (11),

— having regard to Council Recommendation (EU) 2021/1004 of 14 June 2021 establishing a European Child Guarantee (12),

— having regard to the Commission’s Communication of 5 March 2020 entitled ‘A Union of Equality: Gender Equality Strategy 2020-2025’ (COM(2020)0152),

— having regard to the Commission’s communication of 26 April 2017 entitled ‘An initiative to support work-life balance for working parents and carers’ (COM(2017)0252),

— having regard to the Commission Action Plan to boost the social economy and create jobs of 9 December 2021,

— having regard to the Commission’s Green Paper on Ageing of 27 January 2021 (COM(2021)0050),

— having regard to the Commission's communication entitled ‘A Long-Term Vision for Rural Areas’ of 2021,

— having regard to the Ministerial Declaration adopted at the fourth UN Economic Commission for Europe Ministerial Conference on Ageing in Lisbon on 22 September 2017 entitled ‘A Sustainable Society for all Ages: Realizing the potential of living longer’,

— having regard to the Commission proposal of 4 March 2021 for a directive of the European Parliament and of the Council to strengthen the application of the principle of equal pay for equal work or work of equal value between men and women through pay transparency and enforcement mechanisms (COM(2021)0093),

— having regard to the Commission proposal of 28 October 2020 for a directive of the European Parliament and of the Council on adequate minimum wages in the European Union (COM(2020)0682),

— having regard to European Economic and Social Committee (EESC) Opinion SOC/687-EESC-2021 of 19 January 2022 entitled ‘Towards a New Care Model for the Elderly: learning from the COVID-19 pandemic’,

— having regard to European Economic and Social Committee (EESC) Opinion SOC/535- EESC-2016 of 21 September 2012 entitled ‘The rights of live-in care workers’,

— having regard to the 2021 Long-term care report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL) on ‘Trends, challenges and opportunities in an ageing society’,

— having regard to the opinion of the Expert Panel of 23 June 2021 on effective ways of investing in health on supporting mental health of health workforce and other essential workers,

— having regard to the EPSCO Council conclusions of 14 June 2021 on the Socio-Economic Impact of COVID-19 on Gender Equality (ST 8884/21),

— having regard to its resolution of 15 November 2018 on care services in the EU for improved gender equality (13),

— having regard to its resolution of 21 January 2021 on the gender perspective in the COVID-19 crisis and post-crisis period (14),

— having regard to its resolution of 21 January 2021 on the EU Strategy for Gender Equality (15),

— having regard to its resolution of 10 March 2022 on the EU Gender Action Plan III (16),

— having regard to its resolution of 21 January 2021 on access to decent and affordable housing for all (17),

— having regard to Council recommendation of 22 May 2019 on high-quality early childhood education and care systems (18),

— having regard to its resolution of 11 March 2021 on children’s rights in view of the EU Strategy on the rights of the child (19),

— having regard to its resolution of 10 July 2020 on the EU’s public health strategy post-COVID-19 (20),

— having regard to its resolution of 16 February 2022 on strengthening Europe in the fight against cancer — towards a comprehensive and coordinated strategy (21),

— having regard to its resolution of 17 December 2020 on a strong social Europe for Just Transitions (22),

— having regard to its resolution of 7 July 2021 on an old continent growing older –possibilities and challenges related to ageing policy post-2020 (23),

— having regard to the Commission communication of 3 March 2021 entitled ‘Union of Equality: Strategy for the Rights of Persons with Disabilities 2021-2030’ (COM(2021)0101),

— having regard to its resolution of 18 June 2020 on the European Disability Strategy post 2020 (24),

— having regard to its resolution of 29 November 2018 on the situation of women with disabilities (25),

— having regard to the Commission communication of 28 June 2021 entitled ‘EU strategic framework on health and safety at work 2021-2027 — Occupational safety and health in a changing world of work’ (COM(2021)0323),

— having regard to its resolution of 10 March 2022 on a new EU strategic framework on health and safety at work post 2020 (including better protection of workers from exposure to harmful substances, stress at work and repetitive motion injuries) (26),

— having regard to the ETUI/EPSU report on Pay transparency and role of gender-neutral job evaluation and job classification in the public services,

— having regard to the Council recommendation of 8 November 2019 on access to social protection for workers and the self-employed (27),

— having regard to the activities of the ELA and in particular its collaboration with Member States in tackling undeclared work,

— having regard to the European Institute for Gender Equality (EIGE) Gender Equality Index 2021 and its thematic focus on health,

— having regard to Rule 54 of its Rules of Procedure,

— having regard to the report of the Committee on Employment and Social Affairs and the Committee on Women’s Rights and Gender Equality (A9-0189/2022),

A. whereas social rights are part of human rights and constitutional rights, women’s rights are fundamental human rights, and whereas the Venice Commission of the Council of Europe, the ECtHR and the Charter underline that human rights are part of the rule of law; whereas the EPSR Action Plan sets out concrete initiatives for the implementation of principles that are essential for building a stronger social Europe for just transitions and recovery, such as gender equality, equal opportunities, work-life balance, childcare and support to children, inclusion of persons with disabilities and long-term care; whereas expanding and strengthening the value and the rights of the care workforce will be a prerequisite for the implementation of these initiatives, including those pertaining specifically to both principles 17 and 18; whereas the European Semester and the Social Scoreboard should be used to step up a fairer, equal, sustainable and resilient society; whereas the enjoyment of the highest attainable standard of health is a fundamental right and a high level of health protection is to be ensured and implemented through all Union policies and activities; whereas access to quality public services is a decisive factor in quality of life as a part of care strategy and increased investments in the sector;

B. whereas children represent 18,3 % of the EU population (28); whereas in 2020, there were 47,5 % of households in the EU that had at least one child and 14 % of the households consisted of children and a single parent (29), the majority of which were women;

C. whereas the large majority of care givers and providers, both formal and informal, paid and unpaid, are women; whereas care responsibilities within the household shape the ability, duration and type of paid work women can undertake throughout their working life-cycle thus influencing their participation in the social, economic, cultural and political life; whereas stereotypes surrounding women being better care givers and the perception of unpaid care and domestic work being ‘women’s work’ reinforce the ‘male breadwinner — female carer’ model, which continues to shape access to social rights hence impacting women`s economic independence; and contributing to the undervaluation and economic invisibility of care, especially contribution of family carers, as well as undervaluation of care workers in private and public institutions;

D. whereas 80 % of all long-term care in Europe is provided by informal carers (30), overwhelmingly women, deprived of fair working conditions, mostly unpaid and/or without adequate social support, which makes care an extremely gendered issue; whereas informal care provision is associated with lack of rights such as sick leave and annual leave, as well as maternity, paternity and parental leaves reduction of employment rates, increase of poverty and social exclusion rates, reduced mental health and increased feelings of social isolation and loneliness, which negatively impacts on their physical and mental health, well-being and social inclusion; whereas women’s contribution in unpaid care work adds an estimated USD 11 trillion (31) to the global economy each year, which is equivalent to 9 % of global GDP (32);

E. whereas 15,4 % of young people not in employment, education or training (NEET) are in this situation because they are caring for children or incapacitated adults or have other family responsibilities; whereas 88 % of those NEETs are women (33);

F. whereas it is necessary to recognise that all human beings rely on care to different degrees depending on, among others, age, socioeconomic status, physical endowment and personal background from childhood to old age; whereas care should be differentiated from support for persons with disability or health condition; whereas the societal and economic value of care work, both paid and unpaid, is not valued and recognized and needs to be reassessed and put into the heart of economic policies; whereas social, gender equality and economic impacts of those with caring responsibilities should be urgently addressed, particularly in view of demographic changes;

G. whereas all Member States and the EU are bound by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), including its Article 19 on adopting effective and appropriate measures guaranteeing equal right of all persons with disabilities to live independently, to participate and be included in the community; whereas equal and effective access to affordable quality care and support services is an essential prerequisite for the independent living of persons with disabilities, their participation in the community life and social inclusion;

H. whereas care encompasses all services supporting autonomy and independence of persons in need of care, as well as the physical, psychological, emotional, social, personal and household needs of individuals and groups in vulnerable situations; whereas care should be recognised as a right that guarantees the equal exercise of the rights, dignity, autonomy, inclusion and well-being of people in need of care; whereas the European Union can complement and support Member State action in improving care services, for those who are cared for and those who provide care;

I. whereas care work means a variety of services carried out by individuals, families, communities, paid service providers, public organisations and state institutions in different types of settings, ranging from institutions to private households;

J. whereas the Commission defines personal and household services (PHS) as ‘a broad range of activities that contribute to well-being at home of families and individuals, including childcare, long term care and for persons with disabilities, household chores, remedial classes, home repairs, gardening, ICT support’; whereas PHS include care and non-care, direct and indirect services; whereas at global level, PHS are usually described under the term domestic work; whereas the inclusion of domestic workers in the care workforce therefore recognises that care provision includes not only personal care, but also non-relational indirect care, which provides the necessary preconditions for the provision of personal care; whereas in personal and household services, care and non-care activities are highly intertwined with a vast proportion of workers performing both and thus belonging to the care workforce;

K. whereas access to quality care and creation of age-friendly environments are essential for a longer, healthy and active life; whereas the number of persons in the EU in need of the long-term care is projected to rise from 30,8 million in 2019 to 38,1 million in 2050 (34); whereas several Member States already face labour shortages in the long-term care sector that only risk increasing as demand for long-term care increases, and whereas this requires investments in the labour force and their decent employment and working conditions;

L. whereas the COVID-19 crisis highlighted the key role played by workers in personal and household services within our societies, demonstrating the urgent need to ensure full recognition for these workers in all Member States together with collective bargaining rights, social security and social protection; whereas due to the persisting lack of proper recognition of these workers in several Member States, many of them have lost their job during the COVID-19 pandemic without being able to benefit from state wage compensation and job retention schemes; whereas the pandemic resulted in the loss of accommodation for many workers in personal and household services, as well as exposed them to violence and harassment at work;

M. whereas despite the fact that throughout the life course, each individual at least once assumes the roles of a carer and of a care recipient, there is stigma and stereotypes surrounding interdependence, physical or mental disability, disease and frailty and the need for care and support that intersect with other grounds of discrimination, above all gender, sexual orientation, age, disability, nationality, colour, ethnic or social origin, genetic features, as well as socio-economic or immigrant and other disadvantaged backgrounds, aggravating the risk of poverty or social exclusion;

N. whereas the EU population is ageing with 19 % of EU citizens being 65 or older in 2018 (35); whereas age discrimination and unmet, unseen and unrecognized care needs are still a persisting problem in care in Europe; whereas the number of people who are dependent on the assistance of others or have health and long-term care needs increases with age;

O. whereas rheumatic and musculoskeletal diseases (RMDs) are among the world’s most prevalent, disabling and burdensome non-communicable diseases, affecting over 100 million Europeans, and account for over 50 percent of Years Lived with Disabilities (YLDs) in Europe; whereas due to their prevalence, disabling consequences, and links to high incidence of co-morbidities, people with RMDs are a significant source of demand for long-term formal and informal care in Europe;

P. whereas many care and domestic workers have an ethnic minority background or are migrants (36) facing a highly precarious situation and experiencing intersectional discrimination due to their race or ethnicity, gender, socioeconomic status and nationality and provide live-in care work with often unlimited hours, violating working time legislation in the formal and informal economy; whereas these workers are mostly women who do not have an official job contract, are thus more vulnerable to exploitation and often lack access to their rights in particular to decent work and social protection;

Q. whereas there is a lack of high quality, accessible, available and affordable care services in all Member States, including in rural regions especially affected by ageing population; whereas the monitoring of formal and informal care and form and means of existing care services are hampered by the lack of data, including disaggregated data, the lack of quality indicators, such as the European Time Use Survey (ETUS) of evaluation and monitoring of services provided, implementation roadmaps, the lack of knowledge among healthcare providers about temporary disabling diseases;

R. whereas one of the most fundamental rights regarding care and support is the right to choose the type and location of service; whereas the right to choose one’s type of care is often undermined by the insufficient availability of in-home support and personal assistance; whereas personal assistance is too rarely sufficiently supported by the Member States and remains unaffordable for too many; whereas as much as 75 % of older persons in need of long-term care report that they would find themselves below the risk-of-poverty threshold if they were forced to purchase homecare services at the full market cost (37); whereas even in the majority of the most economically developed countries, social protection systems cover less than 40 % of the total costs of long-term care for people with moderate needs (38); whereas Member States must ensure the provision of quality and adequately funded and functioning care services, social protection systems and better integration of quality long-term care in them which is of crucial importance for improving social fairness and will contribute to gender equality;

S. whereas the COVID-19 pandemic has exacerbated and made more visible the existing inequalities and challenges showcasing the many structural problems, entrenched in Europe's social care system, i.e. such as under-resourced care facilities and health care systems or lack of investment; in terms of access to formal care and domestic services, including to timely, affordable and high-quality medical treatment, and has highlighted pre-existing crises in the care sector due to heavily increased workload in the sector, care workforce shortages, underfinanced, strained health-care systems, overreliance on informal unpaid care or undeclared work; whereas these lead to increases in psychosocial risks faced by the care workers that remain in the sector, who are predominantly women; whereas the challenges of the pandemic resulted in loneliness and social isolation and increased the risk of abuses, neglect, deteriorated physical and mental health of people in need of care, and the general well-being of all generations across the EU, particularly where pre-pandemic levels of investment in care were lower (39); whereas these long-term effects on individuals’ health and well-being as well as social and economic consequences are yet to be fully assessed and mainstreamed in the relevant policy areas;

T. whereas the needs of informal carers are unmet in Europe and the COVID-19 pandemic shed light to the difficulties of informal carers and of people receiving informal care and revealed the disproportionate reliance on women and girls (40); whereas the lack of recognition of personal and household services workers and/or the misclassification of their employment status has meant that many who lost employment during the COVID-19 pandemic were unable to access social protection measures;

U. whereas the COVID-19 pandemic has aggravated existing gender inequalities, especially in terms of an increase in unpaid care work and work-life imbalance and resulted in a double burden for many women, who had longer shifts at work and additional informal care at home; whereas before the COVID-19 pandemic (41), 37,5 % of women in the EU cared for children, older persons, or people with disabilities every day, compared with 24,7 % of men; whereas the pandemic added up to an average of some additional 13 hours of unpaid work per week for women (42); whereas women who are working from home, part-time or are unemployed have faced vaster pressure, as they have continued to perform the majority of family caring responsibilities and domestic work (43); whereas all effects of the COVID-19 pandemic are not yet fully known and its socio-economic impact on women will continue;

V. whereas according to the World Health Organization up to half of the COVID-19 deaths in Europe were of residents in long-term care facilities (44); whereas more than 70 % of the social and health workers fighting COVID-19 on the front line were women, many of whom have faced the effects and also long-lasting effects of the COVID-19 infection, were isolated, and experienced unprecedented levels of stress, anxiety, depression, suicides and even post-traumatic stress disorder; whereas, in 2021, 30 % of nurses were leaving the profession in the EU (45); whereas high incidence and mortality rates due to COVID-19 in long-term care facilities, including by lack of access to protective equipment, testing and medical treatment, highlighted the systemic weaknesses related to the too slow transition from institutional care to family- and community-based care services, staff shortages arising from difficulties in attracting and retaining the workers, poor employment and working conditions, lack of career development opportunities for workers in the care sector, difficulties for the cross-border carers, as well as the lack of support and access to social security for informal carers;

W. whereas in addition to the unmet medical needs, the COVID-19 pandemic has had a dramatically negative impact on the access to education, decent housing and services that are essential for the well-being and development of children, generating an additional burden in care and education duties for all parents, above all women and single parents (46); whereas the empirical evidence confirms that the reduction of care services and increase in unpaid care work carried out by women during the COVID-19 pandemic has re-established and reinforced gender inequalities;

X. whereas the provision of quality care depends on the existence of a sufficiently large, well-trained, motivated and specialised workforce, the creation of attractive and decent working conditions through social dialogue and collective bargaining, adequate and fair wages, as well as integrated services and adequate public funding; whereas the care sector has long been facing workforce shortages and in the years 2019 to 2020, 421 000 workers left the residential care sector (47); whereas quality care work is a skilled occupation, requiring training and experience and demand for skilled care workers will only increase in the coming years; whereas employment and ongoing training in the workplace through professionalization of the sector can contribute to an increased quality of provision of care services; whereas in a context of longer care pathways and evolution of practices and technologies, caregivers are accumulating expertise which has to be recognised; whereas the Acquired Rights Directive (2001/23/EC) must be applied whenever employee contracts are transferred to an acquiring care provider;

Y. whereas in the European Union at least 3,1 million personal and household service workers are employed undeclared, lacking recognition and fundamental workers’ rights such as collective bargaining, social security and social protection (48); whereas undeclared work leads to lower protection for workers, facilitating labour exploitation and abuse, while representing as well a loss of income for Member States; whereas the conditions of undocumented third country nationals working in the care sector, are particularly challenging, in terms of their social rights and access to decent work conditions;

Z. whereas the European Platform tackling undeclared work has become a permanent working group of the European Labour Authority (ELA), with the aim of increasing cooperation with Member State authorities in tackling undeclared work;

AA. whereas studies show that more than 90 % of older people would like to live in their own homes at an advanced age; however only 20 % spends the last years of their life in their private accommodation and many of them live in institutional care facilities (49); whereas there is a lack of care services that are tailored to individual’s needs and preferences; whereas this requires (50) structures of care to be changed from centralised institutions to patient-centred, family and community-based care to better support the autonomy of persons in need of care and support, bringing tangible economic and social benefits and increasing the level of well-being of care recipients; whereas residential care often fails to meet the standards on supporting the independence of persons using these services, and is often associated with the end of one’s life, rather than as a place to live with dignity, flourish, and further participate in social and cultural life; whereas that shift has been non-existent or too slow and lacking resources and needs to take into consideration different needs and vulnerabilities of communities, such as in terms of income and others inequalities; whereas Member States should invest towards this direction;

AB. whereas it is important to conduct further research on abuse in all care settings, to inform about the factors leading to these practices, promote awareness, training, detection, and fight against abuse for all professions involved in care, and create public platforms for reporting such practices;

AC. whereas the labour-market tends to be gender segregated and undervalues sectors in which women represent the majority of the workforce; whereas in 2020, women's gross hourly earnings in the EU were on average 13,0 % below those of men (51);

AD. whereas care often remains undervalued, receives little recognition, insufficient and often no financial compensation for informal carers; whereas the undervaluation in terms of pay and working conditions as well as the lack of visibility of care and domestic work are closely linked with prevailing gender roles and norms of women as caregiver and men as breadwinners and with a vicious circle of ‘double devaluation’, where care is often relegated to the most disempowered groups of society because of its lack of value and, in turn, the activity of care becomes devalued because it is carried out by the most disempowered groups and due to the fact that homecare and other personal and household care services are provided behind closed doors;

AE. whereas feminisation of the care sector contributes to the gender employment, pay and pension gaps due to the proportion of women working in formal and informal care and can lead to an increased risk of poverty as well as reduced taxes paid to Member States, with a EUR 370 billion annual loss of GDP for Europe (52);

AF. whereas women and migrants, in particular EU and non-EU mobile workers, dominate in the care sector, women representing 76 % of 49 million documented care workers in the EU (53) and more than 85 % in unpaid care in all Member States when considering both daily and weekly engagement (54);

AG. whereas 6,3 million professionals work in long-term care, among whom women (81 %) are overrepresented and there are increasing numbers of workers aged 50+, part-time, precarious and platform workers, as well as migrant, informal and mobile workers, including live-in carers, (8 % of workers in the care sector are non-natives); whereas in 2020 migrant and mobile workers represented 28 % of personal care workers (55); whereas the care deficits in some regions of the EU are aggravated by this ‘care drain’ and the phenomenon of global care chains; whereas this makes it impossible to think of care along national borders only; whereas there are still obstacles that hamper the free provision of care services in the EU; whereas these workers are essential to our societies in terms of both public health and social inclusion for care recipients, who are sometimes isolated;

AH. whereas in all the Member States, pay in the care and domestic work sectors is well below the average pay and lower than the pay that workers get for the same job in other sectors, especially in healthcare (56); whereas this is due to informal work, lower collective bargaining coverage in those sectors as well as the undervaluation of female-dominated sectors, such as care; whereas those employees working in the for-profit and non-profit sectors often do not have access to a workers representation and collective bargaining; whereas the difference in relation to the average pay is smallest in the Member States with collective agreements for parts of the sector (57); whereas workers representation, including trade unions, and collective bargaining are critical in representing and defending workers’ rights and interests in all care settings, as well as raising and maintaining standards across the care sector;

AI. whereas the COVID-19 crisis has emphasised several challenges regarding the terms and conditions of employment of long-term care workers; whereas long-term care workers were at even greater risk of contracting COVID-19 than healthcare workers in hospitals due to lack of personal protective equipment and appropriate training to implement infection protocols and other prevention activities;

AJ. whereas despite being emotionally gratifying for a large majority of carers, care often generates negative effects on carers’ physical and mental health and difficulties in reconciling care with paid work, which is particularly significant in the case of female carers (58); whereas formal and informal carers’ mental health have been disproportionately affected during the COVID-19 pandemics; whereas mental problems have increased during the pandemic increasing the care burden; whereas care work is often associated with working in shifts, at short notice and with long working hours; whereas health risks and poor working time quality are the main causes of relatively high absenteeism in the long-term care sector; whereas 38 % of care professionals believe that due to the adverse effects of their work they will not be able to continue working until they are 60 (59);

AK. whereas in Europe, 33 % of long-term care workers have been exposed to some type of adverse social behaviour (including verbal abuse, threats and humiliating behaviour) and only 22 % of long-term care workers feel very satisfied with their working conditions (60);

AL. whereas there are various forms of employment of formal live-in carers such as via care companies or temporary employment agencies and intermediaries;

AM. whereas women represent the majority of the people receiving care and 44 million people in the EU provide informal long-term care to family members, neighbours or friends (61),most of them being women, and 12 % of women and 7 % of men providing informal long-term care do so for more than 40 hours per week (62); whereas almost 30 % of people over 65 are living with two or more non-communicable diseases (NCDs); whereas NCDs have a substantial and growing burden on patients, carers, societies and health systems;

AN. whereas the high numbers of care recipients who are in need of informal care are directly linked to the unavailability, inaccessibility and unaffordability of quality professional services adjusted to their needs as well as the default choice of many Member States of unpaid informal care as the major source of care provision (63); whereas provision of informal care should be a choice and not a necessity due to lack the of available care services;

AO. whereas a significant share of the formal live-in care sector operates in grey zone which affects badly quality of home care; whereas there is lack of data that allows to identify precisely number of carers in grey zone;

AP. whereas women in the EU carry out 13 hours more of unpaid care and domestic work per week than men (64); whereas access to affordable and quality formal long-term care services for the dependent family members and unequal distribution of unpaid care and household work between men and women present crucial factors in determining whether women enter into and stay in employment and the quality of the jobs they have; whereas 7,7 million women in the EU remain out of the labour market owing to their informal care responsibilities, compared to just 450 000 men, and 29 % of women employed part-time refer to care duties as the main reason for taking up part-time work (65); whereas only 6 % of men say that the main reason for working part-time is because of caring responsibilities, compared to 29 % of women and only 64 % of fathers in EU provide care on a daily basis (66);

AQ. whereas women also experience more career interruptions, tend to work shorter hours and are more likely to be in part-time, precarious or temporary employment; whereas sectoral segregation, unequal distribution of unpaid care and housework represent the key causes of the persisting employment, wage and pension gap, as well as greater risk of poverty and social exclusion of women; whereas the gender pension gap averages at 27 % in 2020 (67); whereas an equal distribution of unpaid care and household work, meaning an equal involvement of men, has a clear positive impact on the proportion of women in paid employment and reduction of the gender pay gap; whereas childcare responsibilities are a cause of change in employment for 60 % of women compared to 17 % of employed men and lead to reduction of working hours for 18 % of employed women and as little as 3 % of men (68); whereas the availability, accessibility and affordability of high-quality childcare facilities are crucial for enabling people, especially women with caring responsibilities to participate in the labour market; whereas public health challenges such as migraine are more common among women (69) and a large share of affected women are still in the front line for childcare and household chores;

AR. whereas these discrepancies are confirmed at the global level with women dedicating on average 3,2 times more (201 working days per year) time than men (63 working days) to unpaid care work and are most pronounced in the case of girls and women living in middle-income countries, with lower educational achievements, living in rural areas and with children under school age (70);

AS. whereas women are overwhelmingly represented among the essential workers (4 out of the 16 other professional categories deemed essential have more than 50 % of women in their workforce in the EU) (71), such as care professionals, whose tasks largely cannot be performed in telework modalities, and in the sectors that have been most severely hit by the pandemic, and have thus been exposed to high risks of contagion, heavy workloads, disrupted work-life balance and loss of employment; whereas working and living conditions have been particularly undermined for women with young children in paid employment (72);

AT. whereas care remains one of the main fields of reproduction of gender archetypes, which are further reinforced by the lack of investment in quality services and gender bias in other policies that disproportionally affect women’s self-determination in social and professional life, such as tax benefit system;

AU. whereas social economy enterprises can have a significant potential and contribution in facilitating the re-integration of caregivers in the labour market;

AV. whereas several Member States and regions in the EU are still failing to meet the goal of providing childcare for 90 % of children between the age of three and mandatory school age and for 33 % of children aged three and under; whereas a lack of sufficient infrastructure offering quality and accessible childcare for all, especially early childhood services, particularly affects children from disadvantaged families, reflecting in enrolment rates below the average of children with disabilities, children from the Roma and other minority communities, migrant children, children living in poverty and children rom other disadvantaged groups, who would have benefitted the most from early childcare (73);

AW. whereas in 2020, 24,2 % of children in the EU — almost 18 million were at risk of poverty or social exclusion; whereas children from low-income families, homeless children, children with a disability, children with a migrant background, children with a minority ethnic background, particularly Roma children, children in institutional care, children in precarious family situations, single-parent families, LGBTIQ+ families, and families where parents are away to work abroad face serious difficulties, such as severe housing deprivation or overcrowding, barriers in accessing fundamental and basic services; whereas children with disabilities in the EU are disproportionately more likely to be placed in institutional care than children without disabilities, and appear far less likely to benefit from efforts to enable a transition from institutional to community and family-based care (74); whereas the European Child Guarantee is an EU instrument whose objective is to prevent and combat poverty and social exclusion by guaranteeing free and effective access for children in need to essential care services, such as early childhood education and care, educational and school-based activities, healthcare and at least one healthy meal per school day, and effective access for all children in need to healthy nutrition and adequate housing (75);whereas accessibility of affordable quality childcare and education is crucial for children’s personal development and well-being; whereas there is a unambiguous positive correlation between the access to childcare services on one hand and employment and income of men and particularly of women on the other (76);

AX. whereas access to quality care services, especially long-term care, is increasingly preconditioned on individual and family income, their place of residence, availability of services and delivery capacity and geographical availability as well as free capacities of the providers; whereas two in three persons in need of care are estimated to not have access to care services, mainly due to their unavailability and unaffordability (77); whereas households with low incomes, lower educational levels, and migrant households experience the greatest difficulties in accessing formal home-based long-term care services; whereas across the EU, one third, and in five Member States even more than half of the households, report that they are in need of professional long-term care services but cannot access them due to financial reasons (78); whereas access to healthcare and care should be universal, effective, irrespective of economic conditions or their different residence or administrative situations and status; whereas persons with lower incomes are also a group in which care needs are more prevalent (79);

AY. whereas digital technologies have the potential to support both formal and informal carers and reduce the burden they face, for example, in transporting patients to consultations that could be held online; whereas a 2021 Eurocarers survey suggests that 78 % of informal carers never used care-related technologies (80); whereas digitalisation and the Internet of Things in the care sector need to be taken into account but should not substitute completely the irreplaceable human interaction related to care; whereas research and pilot projects should be encouraged, to test practicability and effectivity of digital services; whereas older people, including those receiving care, have difficulties in accessing digital services; whereas access to digital services, including access to digital literacy, should be seen as a right of care recipients; whereas the drastic shift to telework revealed the need to better enforce, review and update the legislation related to working conditions in the digital environment and the use of artificial intelligence in professional life;

AZ. whereas women facing intersectional discrimination face additional barriers in accessing healthcare and care services and special attention must be put to address the effects of implicit biases in accessing private and public services generated due to persisting stereotypes and the underrepresentation of certain groups in these institutions;

BA. whereas particular attention should be paid to the very old in order, where necessary, to help people who have lost their independence and prevent them from becoming isolated;

BB. whereas the importance of prevention and geriatric rehabilitation for healthy and dignified aging should be taken duly in account;

BC. whereas there is a need to reshape nursing care by providing, where possible free, or affordable in-home nursing support;

BD. whereas the increased investment in the care economy in line with Sustainable Development Goals would result in almost 300 million additional jobs globally by 2035 (81); this would be made up of 96 million direct jobs in childcare, 136 million direct jobs in long-term care, and 67 million indirect jobs in non-care sectors; whereas this level of job creation would require an investment of 3,2 % of global GDP, taking into account total costs minus tax revenue (82); whereas the European Commission estimates that 8 million new jobs are expected to be created in the EU in the care sector by 2030 (83);

BE. whereas demographic change and accompanying ageing of the population will increase the demand for care services; whereas care jobs are not likely to be replaced or reduced by automation; whereas this should motivate the EU and Member States to invest into the care economy as a promising job creating sector, in the framework of the digital transition, in order to increase the number of qualified staff and attract more people to this sector;

BF. whereas quality standards for care, especially for social care services, remain absent or inadequate;

BG. whereas the care sector needs significant investment, resources and reform; whereas in 2018, the estimated annual investment gap in social infrastructure in Europe stood at EUR 100-150 billion (84); whereas the 2021 Ageing Report projects the increase of public expenditure needed to cover the costs of long-term care and support at up to 2,9 % of GDP annually in 2070, compared to 1,7 % in 2016, while a ‘healthy ageing’ scenario can significantly lower this cost and full coverage of long-term care needs significantly increases it;

BH. whereas it is crucial to understand the interaction between formal and informal care; whereas formal care services can provide support to informal carers, for example, by making it possible for them to take time off as well as by giving them training; whereas the lack of official recognition of informal carers and related lack of data about them and their needs is a barrier to this interaction;

BI. whereas the delivery of care depends on well financed and properly functioning public services and social protection systems;

BJ. whereas there is significant diversity in the population of informal carers; whereas their needs vary based on their socio-economic context, their labour market participation, the needs of their care receivers and the amount of time they spend caring for dependants;

BK. whereas neurodegenerative diseases, such as Alzheimer’s disease and other forms of memory disabling diseases, remain underdiagnosed in most European countries; whereas there is a clear indication that the current number of 9 million confirmed cases of people with dementia is going to double by 2050; whereas women continue to be disproportionately affected by dementia (85);

BL. whereas in February 2021, the European Ombudsman opened an own-initiative inquiry into the role of the Commission in the process of deinstitutionalisation in the EU, focusing on the fulfilment of Commission’s obligation to ensure that the Member States use the EU funds in a manner that promotes transitioning away from residential care institutions and towards independent living and participation in community life;

BM. whereas the mechanism provided for by the 2001 directive on temporary protection has been activated for the first time as a response to the mass influx of refugees, above all women with children and other dependant persons, who are fleeing the war in Ukraine, guaranteeing the displaced persons equal access to the labour market and housing, medical assistance, and access to education for children; whereas activation of the aforementioned mechanism will have significant direct impact on the care sector, increasing the number of persons in the EU in need of comprehensive and personalised care services but also the numbers of both informal and formal carers;

BN. whereas the data on quality of care services is almost exclusively based on non-standard client satisfaction surveys;

BO. whereas difficulties associated with the provision of adequate, decent and affordable housing, especially for older people, single persons, persons with disability, persons at risk of poverty and social exclusion, families with young children and single parents, significantly hinder access to quality care services;

BP. whereas across 11 OECD countries, long-term care workers’ median wages are just 9 euro per hour, while wages of hospital workers—a majority of whom are men—average 14 euro per hour (86);

BQ. whereas more than half of care workers say they do not earn enough to cover basic needs such as housing and food, and 31 % do not have adequate access to personal protective equipment (87);

BR. whereas the majority of care workers do not earn enough to afford a decent standard of living for themselves and their families (88);

A Europe that cares

1. Notes that it is vital to ensure dignity, independence, autonomy, well-being and participation in social life through quality care across the life course from early childhood care and education, to care services for older people and support to persons with disabilities, bearing in mind that human beings are interdependent and that anyone may need care at some point in their lives;

2. Underlines the importance of accessibility and availability of public care and the quality, accessibility, availability, affordability and adequacy of care, and that all people in need of care and their carers should have the right to a genuine choice when it comes to care services suitable for them and their families and their form (family care, community-based care, patient-centred care, personalized care or other forms), the place of its provision and its intensity, with a special attention to the provision and access for those living in remote areas (433) such as rural areas or outermost regions; considers that investment in the provision of quality public and social services are essential levers for preventing the transfer of disadvantage from one generation to the next;

3. Notes that care and its differing policy approaches need to be developed and redesigned according to individuals’ needs, recognises that models and patterns of organising care are diverse in the Member States and emphasizes every person’s right to choose best suitable quality care services for their individual situation and the need to guarantee it by Member States and the EU throughout its policies; highlights that according to the principle 18 of the European Pillar of Social Rights (EPSR) ‘Everyone has the right to affordable long-term care services of good quality, in particular family- and community-based care services’, and stresses that in order to fulfil this principle, care provision should be expanded;

4. Notes that women represent the majority of the workforce (76 %) in the formal care sector and perform the main part of informal care work while also representing the majority of care recipients, that care remains undervalued, unrecognized and guarantees insufficient or often no financial compensation for carers and that this undervaluation in terms of pay, working conditions and lack of visibility is closely linked with the feminisation of the sector due to the high proportion of women working in formal and informal care; highlights that this gender aspect has to be taken into account when designing care strategies and policies;

5. Expresses its concern on the impact of structural limitations and financial constraints in the type of care services available to individuals and recognises that integration of care across Europe is limited due to lack of appropriate incentives and structures;

6. Stresses the importance of an integrated and rights-based approach to common European action on care that pays equal attention to people’s physical, mental, psychological and social, personal and household needs; highlights the importance of paving the way for a more coherent approach between health and social systems as well as between formal and informal care and coordination between local, regional and national care policies within the EU Member States, alongside horizontal and sectoral integration;

7. Underlines the necessity of developing an ambitious and inclusive European Care Strategy that ensures equal access to care for all with special attention to individuals in vulnerable situations, contributes to social justice;

8. Considers that prevention is key; calls for primary secondary and tertiary prevention ( 89 ) including adequate use of relevant education and information, screening, early detection, prevention and adequate follow-up for non-communicable diseases (NCDs) to be among the components of a holistic European Care Strategy; urges the Commission to adopt a comprehensive and holistic approach to care;

9. Urges the Commission to strengthen the EU's resilience and capacity-building in health crises; Urges the Commission to promote research and innovation, by establishing priority areas for future R&D based on current and future diseases as well as the further development of care sector related opportunities, including for private actors;

10. Stresses that promoting an equal-earner/equal carer model, where men and women engage equally in paid work in the labour market and unpaid work in domestic and care responsibilities, should be a goal of all EU actions in the field of care, labour markets and social services; reminds of the importance of applying gender mainstreaming to all policies;

11. Calls on the Commission and Member States to invest into the care sector, strengthen and ensure sustainable, increased and adequate investment and funding to guarantee equal access for persons in need of care to affordable and adequately staffed quality care and household services, as well as an active and fulfilling professional life for carers with adequate wages providing a decent living and career opportunities in the sector through skills certification and validation;

12. Calls on the Commission and Member States to improve the availability of funding for all types of care services and make the best use of the European structural and investment funds for investment in childcare and care for older people and others in need of care, through the ESF+, InvestEU and other financial instruments encouraging social investment as well as the Recovery and Resilience Facility, EU4Health Programme and the European Structural and Investment Funds for investing in publicly guaranteed care and facilitating accessible and affordable services for all; calls on the Commission to measure up to and create synergies with gender equality, inclusion of persons from vulnerable groups and the standards set for investment in digital and green transition, for example to support greening of care and of care projects and start an initiative on environmentally sustainable care, seeing that care infrastructures have significant negative environmental impacts that need to solved and mitigated, within the guiding principles; calls on the Commission to develop guidelines and a roadmap for common standards for Member States in this sense; calls on the European Investment Bank to consider including in its annual budget the development of the care sector and care economy as part of the implementation of its own Strategy on Gender Equality and Women’s Economic Empowerment;

13. Calls for a dedicated investment package to promote the EU care sector and care economy as well as to ensure coordination among the different programmes and initiatives towards an effective implementation of the Strategy; calls once again for the development of gender budgeting tools in the MMF and related programmes that allow to track down the specific funding allocated to promoting gender equality;

14. Recalls the obligations and commitments of the EU and the Member States for transition from segregated institutional settings to community and family based care and the promotion of different models of independent living and support; calls on the Member States to use the available European and national funds to accelerate this transition and to support individual autonomy and independent living by supporting ways to enhance independence, such as home adaptation or installation of digital detection systems and assistive technologies at home, with full adherence to the provisions and objectives of the UNCRPD; urges the Commission to take effective measures to make sure that EU funds are used to transition from institutionalized care to community and family-based care, while ensuring the family care in all its diversity;

15. Underlines that in order to reduce undeclared work in the formal care it is important to provide public funding for genuine care service providers within social security systems or through tax expenditure which will make legal and fair care service provision affordable;

16. Calls on Member States to ensure universal health coverage, increase investments in healthcare, and prioritise funding towards community and primary care; Calls on member states to urgently remove existing barriers to healthcare for all, including for undocumented migrant and with special attention to women facing intersectional discrimination; Calls to ensure higher and fair pay and decent working conditions for care workers, healthcare assistants and other support staff;

17. Emphasises that a substantial proportion of care models, services and facilities are based on an institutionalized, outdated model below modern quality criteria and do not meet the physical, social and psychological needs and wishes of care recipients; highlights that people in need of care should be placed at the centre of care plans throughout all stages of the design, implementation and evaluation of care policies and services, through exploring innovative solutions, new models and tools for care delivery, promoting social inclusion and multi-generation understanding for individual needs of people in need of care, having as an objective the transition from institutional to family and community-based care and promotion of different models of independent living and support;

18. Believes that person-centred and individualised care is necessary to ensure the dignity of care recipients and their carers, as well as their full participation and inclusion in the community; stresses that this move towards a person-centred approach requires increased integration of care to more holistic care pathways, to improve benefits to care recipients as well as quality of care;

19. Stresses the need to fully utilise digital solutions to support people in need of care to live independent and autonomous lives, the need to improve the respect of their right to self-determination, to develop autonomy both for care professional sand care recipients, through a personalised approach to the design and budgeting of care, including tailored health and person-centred care through suitable tools, while ensuring that there is quality human contact for persons in need of care and support;

20. Believes that the development of care should take into account all categories of users and their differences; states that those planning, programming and providing care services have the responsibility to be aware of those needs, of the empowerment of service users and of the importance of a user-based approach in developing services and that care services for older people and persons with disabilities must be planned and developed with the participation of users;

21. Calls on the Member States to exchange information and best practices with a view to developing a common European quality framework for formal and informal care, based on the rights to independence, autonomy and well-being, and inspired, amongst else, by the WHO framework to support countries achieving an integrated continuum of long-term care encompassing all care settings, encouraging upward social convergence, guaranteeing equal rights for all citizens and strengthening quality of life;

22. Calls for the Commission to support Member States in improving their data collection infrastructures in line with this quality framework;

23. Calls additionally to exchange best practices on the best way to support groups with particular care needs (such as single parents who are mainly women, parents with children with serious illnesses and older people);

24. Emphasises that the increase of care needs demands a joint EU approach and calls for a concrete European strategy on preventive healthcare as part of the solution to the growing pressure on the healthcare system; notes that care services should be developed so as to enhance the continuity of care, preventive healthcare, rehabilitation and independent living and underlines the importance of programmes for lifelong health promotion and education, disease prevention and regular examination, together with more effective health care programmes to stimulate the process of healthy ageing; calls on the Commission and the Member States to actively engage in the WHO Decade of Healthy Ageing by drawing up healthy ageing plans in the EU that cover access to health and care services, as well as strategies for health promotion and prevention;

25. Calls on the Commission to take leadership in the realm of care by setting ambitious targets at EU level for funding, access, quality, efficiency and sustainability of care services in consultation with the Member States as well as with relevant stakeholders including social partners, and to develop harmonized definitions and indicators to assess those targets for children, older people or persons with disabilities;

26. Underlines the need for a scoreboard to monitor the implementation of right to quality care in public, private, formal and informal contexts;

27. Recalls that the EU should make use of the ILO’s 5R framework for decent care work (recognise, reduce and redistribute unpaid care work, reward paid care work) together with guaranteeing care workers’ representation, social dialogue and collective bargaining;

28. Recalls that progress should be made towards a care economy that takes an integrated, holistic, gender-sensitive and life-long approach to care; stresses that this should include legislative measures and investment at EU level in order to promote as well decent working conditions and attractiveness of work in the care sector;

29. Stresses the importance of highlighting the need for a European approach to care in the follow-up conclusions of the Conference on the Future of Europe, as care is a key sector for Europe’s future;

30. Calls on the Commission to present an ambitious, robust and future-proof European care strategy that builds on everyone’s right to affordable, accessible and high-quality care, as well as on other principles set out in the EPSR and EU strategic documents, and the individual rights and needs of both care recipients and carers, and that encompasses the entire life course, targeting and responding to the needs of people at critical periods throughout their lifetime, laying the ground for continuity of care services throughout the lifespan and fostering solidarity between generations;

31. Stresses that this strategy should be based on reliable, comprehensive and comparable data, publicly accessible, on the situation and the categories of both carers and care recipients, disaggregated by gender, age, nationality, ethnic origin ( 90 ) , disability, socio-economic status, availability and affordability, type of care provided or received and different care settings (private or public, institutional, family or community-based) and include concrete and progressive goals with a timetable and indicators to evaluate progress and tackle inequalities taking into account the care needs in European societies; Repeats the call on the Commission and the Member States to update the statistical framework for collection of reliable, comparable and disaggregated data, while ensuring full respect of privacy and fundamental rights standards; Calls on the Commission to develop centrally managed detailed time use surveys, disaggregated by aforementioned parameters, to assess the value of unpaid work across the Member States;

32. Emphasises the need to consult all relevant stakeholders at EU, national and local levels, including informal carers representatives and patients organisations, in the preparation of the European Care Strategy to take into account the diversity of their situations and needs and stresses that the strategy should identify its target groups;

33. Calls on the Commission to include comprehensive measures against violence and harassment, in particular the fight against all forms of abuse of older persons and abusive acts against carers in the European Care Strategy in order to combat worrying phenomena, such as non-assistance, neglect and the undue use of physical or chemical restraints, particularly in the field of long-term care and support; calls on the Member States to develop training for informal and formal carers to prevent, prohibit, and combat care related violence and harassment as well as to establish independent and effective mechanisms for reporting and redressing it;

34. Calls on the Member States to ensure that earmarked investments for the care economy are included in (revised) national Recovery and Resilience Plans, Cohesion Funds and all other relevant EU financial instruments;

35. Underlines that the emerging silver economy could turn into one of the main economic drivers, particularly in rural areas, and could provide opportunities for the health and long-term care sectors to offer high-quality care in a more efficient way;

36. Calls the EU Commission to establish an EU Equal Care Day, every leap day of 29 of February, in order to raise awareness about the undervaluation and invisibility of caring and carers in our societies;

37. Calls on the Commission and the Member States to, alongside responding to the immediate care needs, adopt the policies and measures to tackle their causes, such as poverty, social exclusion and other structural barriers that stand in the way of universal and equal access to quality care, above all the challenges related to employment, education and training, as well as decent and affordable housing;

Quality care for every child

38. Welcomes the Commission’s plans for the revision of the Barcelona objectives as part of the European care strategy package; calls for upward convergence to be encouraged and for more investment in high-quality public care for every child in the EU, inter alia by revising targets and significantly raising the level of ambition for accessibility of quality childcare for all children, including under 3 years of age and for those facing poverty, social exclusion and intersecting forms of discriminations, and setting specific refined indicators to monitor access to childcare for children aged below 1 year; calls on the Commission to integrate in the objectives a new target for provision of childcare after school hours; calls on the Member States that are lagging behind the 2002 Barcelona objectives to adopt all the necessary measures to reach the target of providing childcare to at least 90 % of children between 3 years old and the mandatory school age and at least 33 % of children under 3 years of age as soon as possible;

39. Reminds that EU funds (ESIF and notably the European Social Fund +, as well as the RRF) should be used to complement Member States’ investments in childcare; calls on the Commission to promote investments in child care services in Member States’ use of the EU’s financial instruments; underlines public investments and the quality employment and working conditions of the workers in the childcare sector are essential for the provision of quality childcare;

40. Calls on the Member States to design childcare, education, including after-school activities, and other policies and measures in support of all children and their families in an inclusive and integrated manner, using a child-centred approach with a particular attention to children in vulnerable situations, such as in or at the risk of poverty and social deprivation, as well as children with disabilities, migrant children and children from minorities, and one that upholds the swift and efficient implementation of the European Child Guarantee, including the commitment to guarantee effective and free high quality early childhood education and care for children in need ( 91 ) ;calls on the Member States to develop personal assistance services for children with disabilities and ensure decent and quality working conditions to those professionals working with children with disabilities;

41. Highlights that the COVID-19 crisis and the arrival of refugees following the war in Ukraine may further exacerbate the situation of children at risk of poverty and social exclusion or children who need access to quality care; therefore reiterates its calls ( 92 ) on the Member States and the Commission to increase the funding of the Child Guarantee with a dedicated budget of at least EUR 20 billion, to combat poverty affecting children and their families and to contribute to the goal of reducing poverty by at least 15 million by 2030 — including at least 5 million children in all Member States;

42. Recalls that social protection and support to individuals and families, with the special focus on groups in vulnerable situations, such as big families, single parent families or families with a child with disabilities, are essential and calls on the competent national authorities to ensure universal, adequate and accessible social protection systems for all and integrated child protection systems to leave no one behind, including effective prevention, early intervention and family support, in order to ensure safety and security for children without or at risk of losing parental care, as well as measures to support the transition from institutional to quality family and community-based care; calls on the Member States to scale up investment in child protection systems and social welfare services as an important part of implementing the Child Guarantee;

43. Calls on the Member States to provide continuous holistic and integrated support to parents, including maternity, paternity and parental paid entitlements and measures, also reflected in pension schemes, low-threshold social services, such as day care, counselling, mediation or psychosocial support, that encourage a more substantial role and thus ensure equal participation of men in unpaid care and domestic responsibilities, including care for very young children, as well as children with disabilities; underlines the importance of adequate, accessible and affordable care structures and services particularly for single parents, the vast majority of whom are women, and to families with low and unsteady incomes, at risk of poverty and social exclusion; calls on the Commission and Member States to collect standardized equality data, disaggregated by the grounds protected under Directives 2000/43/EC, 2000/78/EC and 2006/54/EC, based on voluntary participation, confidentiality, self-identification and informed consent, while respecting the key principles and standards of EU data protection and fundamental rights;

44. Underlines the importance of ensuring accessible, available, affordable and inclusive quality childcare, using a rights- and child-centred approach, that meets the demands during the parents’ working hours and school holidays, and facilitates equal opportunities for parents to return to work, strikes work-life balance, as it is one of the major factors of women’s full participation in the labour market; underlines that it should at the same time respond to the specific needs of children and their parents, related to e. g. disability, illness and work in a specific sector; reminds that gender imbalances in care and employment have life-time negative consequences on many women’s labour market participation and career progressions, resulting in an important gender gap in pensions and high differences in poverty rates in older age;

Equal access to quality care services

45. Calls on the Member States to recognise the right to care and to reform and integrate their social services and protection systems in such a way as to provide effective, comprehensive equal and timely access to care services and treatments throughout the life course, incorporating in their social protection systems solutions ensuring a personalised approach and greater autonomy of users in choosing the services and the type of employment models that suit the needs and protect the rights of both care recipients and carers best, including personal household services, personal assistantship and other employment models for home care services, in order to enhance the continuity of care, preventive healthcare, rehabilitation, better prevention, diagnosis and treatment of occupational diseases, autonomy, independent living and inclusion in the community; draws attention to the necessity of access to care entitlements independent of eligibility for other social transfers and eliminating structural barriers, which lead to non-take-up or postponement of care and other support services; points furthermore to the needs of all carers, particularly the migrant workers with various statuses, who may face particular barriers in accessing care, intersectional discrimination, marginalisation and in-work poverty;

46. Notes that accessibility of care derives from a combination of factors, such as availability of customised services of a diversified spectrum, cost and flexibility but also adequate care staffing, decent working conditions, waiting time, geographical distances to the closest care facility, adequate public infrastructure and transport; believes that in this respect different forms of care service provision should be available, promoted, valued and recognised, in particular that provision of in-family and community-based care settings should be upscaled and prioritized towards transition from institutional to family and community-based care; points to the demographic change as an important factor of increased care needs, which will require significant investments from the EU and Member States as well as identification and elimination of the administrative barriers that stand in the way of a timely and effective access of care recipients and their families to the adequate care and support solutions;

47. Stresses the impact of green environments, daily access to different forms of nature and outdoors in good quality living conditions of people needing care, notes that studies show that access to nature has substantial benefits for both physical and mental health of all people, especially those needing care, and highlights the need to facilitate access to nature and outdoors for people dependent on care as well as to support nature-based solutions in the care sector;

48. Notes that digital technologies are a promising development in supporting care provision but only if they are developed from a user-based starting point and are modular ( 93 ) and tailor-made; highlights in this respect the need for the Commission and Member States to address the digital skills gap amongst formal and informal carers as well as amongst care recipients by having specific programmes that target these groups; stresses that this should be complemented with improvement of internet access and especially user-friendly, customisable digital solutions accessible to all care recipients and carers, in order to support the development of digital health and online care services, as well as support the potential of technological developments in reducing the inequalities in access to health and care services and the barriers for their cross-border provision; calls on the Member States to make use of the EU4Health and Digital Europe funding to support and increase digital literacy of both care recipients and carers;

49. Stresses the need to ensure that care is not commodified;

50. Calls on the Commission and the Member States to develop the tools required for the regular assessment of the accessibility, availability and affordability of care services and treatments; underlines that the principle of accessibility equally applies and should be vigorously enforced in all care and support services, which ensure dignity and autonomy, both in physical and digital environment; calls on the Commission and the Member States to prioritize outcome-based indicators for access to care, such as reported unmet needs for care;

51. Stresses the importance of timely investment in care facilities, identification of skills gaps, evaluation of future staffing and training needs at the level of individual professions, sectors as well as regions, with special attention to the density and care needs of the population, as a means of ensuring adequate and sustainable staffing levels and tackling inequalities in access to services and care; calls on the Commission and the Member States to put forward comprehensive quality standards and indicators for both formal and informal care services, home-based, private and public settings, including carers’ competences and training requirements, as well as the tools for effective monitoring of their implementation;

52. Emphasises that cross-border care services, including live-in care, provided by both intra-EU mobile workers and non-EU migrant workers, are often crucial for meeting the growing care needs; recalls that most of these migrant workers are women and that they are affected by global care chains; stresses that the free movement of persons and workers is one of the key pillars of the EU, but that challenges to cross-border care remain; calls for the protection of the social security rights of all care workers and care receivers as part of the right to free movement of persons in this sector as well as ensuring both decent working conditions and eradicating undeclared work; encourages the Member States to develop cross-border training, notably in cross-border regions, to facilitate cross-border care and to share best practices in the care sector, amongst else as a means of tackling the care drain and the lack of access to quality care in regions or countries where the care providers come from;

53. Repeats its call for a common definition of disability, as well as mutual recognition of disability status in the Member States in line with the concluding observations of the UNCPRD Committee on the initial report of the European Union adopted in 2015 with the aim of removing the fundamental obstacle for intra-EU mobility of persons with disabilities and enabling their access to health, care and other services that facilitate independent living, as well as equal education and employment opportunities; calls for the implementation and expansion of the European Disability Card to all Member States, paving the way to a European definition of disabilities and allowing the persons with disabilities to exercise their right to free movement in a barrier-free Europe;

54. Calls for the prioritisation and mainstreaming of mental health within public health and care policies at EU and Member States' level; calls on the Commission to put forward a European mental health strategy, with the aim of ensuring good mental health for all, identifying the challenges pertaining to mental health of all generations in all the relevant settings, as well as combating stereotypes and associated stigma in relation to mental health; stresses that this should be done in a gender-sensitive manner, with special attention to those invulnerable situations and the most deprived groups; underlines the importance of quality mental health and care across the life course, encompassing early age, education, the world of work, as well as strategies for prevention, detection and prompt access to effectively available, affordable and adequate quality treatment that contributes to quality of life of all adults, including persons in need of long-term care;

55. Emphasises the importance of emotional, psychological, social and spiritual care and support as well as mental health services beyond medication in improving the quality of life of persons receiving palliative care; calls therefore on the Commission and Member States to advance access to integrated palliative care services to ease the pain and discomfort as well as maintain dignity and quality of life of persons suffering from terminal illness once all means of active care have been properly considered and found ineffective, and to ensure adequate support to their carers;

56. Calls for nurses to have easier access to services offering support for mental and physical health;

57. Calls on the Member States to guarantee immediate and full access of persons enjoying temporary protection to quality care services, without discrimination on any ground and with special attention to their physical and psychological needs generated by the circumstances of war and their displacement, and to secure, at the same time, equal and decent working and employment conditions and fair pay for the persons enjoying temporary protection who will seek employment in the care sector; underlines that additional capacities and investment in the care sector are essential to this end;

Quality long-term care for a long and quality life

58. Calls on the Commission to establish a comprehensive, ambitious, and rights-based set of targets and corresponding indicators for long-term care, reporting mechanism and tools for disaggregated data on and monitoring the accessibility, availability, affordability and quality of care treatments and services, as well as staffing levels, applicable to all types of facilities and providers, similar to the Barcelona objectives for childcare; highlights the need for targets and indicators on decent working conditions as well as women’s continued participation in the labour market that would guide investment, funding and training to ensure better access to quality services for those in need as well as ensuring women’s continued participation in the labour market facilitated by equal caring responsibilities;

59. Is convinced that the Commission should set as the main target equal and universal access for all to quality long-term care services based on the individual needs of people receiving care and support, paying special attention to the elimination of inequalities and to people in vulnerable situations, such as older persons, persons with disabilities and women undertaking informal and undeclared care work; notes that long-term care needs are not limited to older persons and that they instead extend to different groups in need of care throughout the lifecycle, such as people with rare diseases, majority of which have their onset during childhood; stresses that equal, effective and timely access to care services and support can be best achieved by involving care recipients and by integrating long-term care into national social protection systems, as recommended by the Social Protection Committee, which are for equity and efficiency reasons best placed to deliver ( 94 )

60. Stresses the need for quality indicators for all social and health services that are based on the rights of the persons in need for care, the maintenance and enhancement of their independence and autonomy as well as social inclusion, and focusing on the aspirations of long-term care, such as the improvement of well-being and quality of life of people in need of long-term care and support services, the evolution of healthy life years and other indicators putting entire care experience in the centre of attention; calls on the Commission and the Member States to recognise the benefits of integrated care approaches in prevention of physical and cognitive decline and prolongation of autonomy of the care recipients; stresses that older age, disability, severe illness or any other circumstances leading to long-term care needs shall not present an obstacle for active participation of individuals in the society and community life; reminds that social exclusion of persons in need of care and support is above all a product of widely spread negative perceptions, socially constructed self-images and the persisting structural discrimination;

61. Calls on the Commission to organise a Care Summit to feed into the work of the High-Level Group on the future of social protection and of the welfare state in the EU after the summit for a thorough and inclusive discussion with all relevant stakeholders, such as, social partners, interest groups, patient organisations, carers organisations, care recipients and their representatives, public authorities, civil society, non-profit organisations, service providers and other experts on the community-based care fit for 2030 with a view of creating a long-standing platform, to create innovative care solutions, ensure future-proof care systems, phase out institutionalized care and replace it with community-based or family-based care and/or use of personalized budgets and personalised design of care; calls on the Commission to guide public investments in long term care services in the use of the EU’s financial instruments and to present a framework directive on long-term, formal and informal, care that would lay down fundamental principles and provide evidence-based criteria for accessible and integrated quality long-term care and support services across the EU;

62. Calls on the Member States to establish national, mutually recognised registers of care service providers, in order to monitor minimum compliance with the standards and legal requirements for care services provision; takes note of certification systems or mechanisms in some MS recognizing long-term care givers’ qualifications and competences in specific fields of care provision; insists on the pivotal role of training for formal and informal carers as well as stronger quality controls and whistle-blower systems for non-profit and for-profit care chains for the delivery of quality long-term care;

63. Points out that the risk of having their long-term care needs unmet is particularly high for older women, who represent a majority of the population in need of long-term care; highlights that also women experience the greatest difficulties in covering the long-term care expenses due to persisting gender pay and pension gaps, female poverty, horizontal and vertical segregation of the labour market, having more career breaks and interruptions due to persistent traditional gender roles where women continue to take up most of the care obligations, labour market structures and stereotypes, as well as their overrepresentation in precarious or part-time work; is concerned about the fact that particularly the choice of the initial care provider by care recipients and their close ones tends to be made in a context of stress, financial constraints and limited availability of services ( 95 )

Informal care

64. Notes that throughout the EU, between 40 and 50 million people are providing informal care on a regular basis and 44 million long-term care at least once a week ( 96 ) , the majority of whom are women including women with disabilities who make up around 60 % of informal carers and provide informal care for more hours than men ( 97 ) , notes that this acts as a brake on gender equality and may limit the possibility to work formally especially for younger carers;

65. Notes that informal care is often a consequence of the lack of availability and accessibility of professional services, among others, tends to continue for a long time and can have repercussions on the enjoyment of the informal carers’ political, civil, economic, social and cultural rights, including fewer career opportunities or acceptance of jobs below their level of skills and hindering or ruling out formal labour market participation; is particularly concerned about the negative impact of care responsibilities on women’s financial independence as well as the increased risk of poverty, social exclusion, mental and physical health issues;

66. Notes that performing informal care can lead to a loss of income, aggravation of gender-based discrimination, such as the gender pay and pension gaps, old-age poverty and the feminisation of poverty; stresses that these detrimental effects are closely associated with the intensity of care provided and highlights the need to better share unpaid domestic and care work mainly performed by women and strengthen the fight against gender stereotypes, as well as to introduce working arrangements respecting work-life balance;

67. Notes that in the EU, out of older persons aged 65 and above, more than 7 million people, 8 %, receive informal care in the EU and for people aged 75 and above, the number of people relying on informal care amounts to 11 % ( 98 ) ; notes that the majority of older people in need of care are women;

68. Notes that to enable people to continue to be cared for in their own homes, mobile care and support need to be expanded and further developed to relieve the care tasks of family caregivers, especially women, not only through awareness-raising activities but also through adequate support including financial compensation, thus allowing relatives who provide care to carry on their employments and to work towards the compatibility of care and paid work; emphasizes the pivotal role of informal carers and the need of informal carers to be closely involved and supported by care professionals, and stresses that informal carers must have their needs assessed and addressed in their own right, without being conditional on the services or supports of the cared-for person;

69. Notes that at least 8 % of all children in Europe are involved in the provision of informal long-term care, which has a negative impact on their mental and physical health, educational attainment, social inclusion and their future participation to labour market ( 99 )

70. Highlights the need to develop a common European minimum definition for informal care, commitment by Member States, and Council Recommendations on informal care including national recommendations; stresses that this definition should emphasise that providing informal care must be a choice and not born out of the necessity and lack of available care services, and include the respect for the right to self-determination of persons receiving care in their choice of the form of care they want to receive;

71. Calls on the Commission to come up with common European guidelines and status of and support to informal carers as informal care is currently not adequately recognized and acknowledged in all its diversity; urges the Member States to promote active labour and employment policies aimed for unpaid informal carers to support their reintegration and progress in the labour market and to recognise the skills acquired in informal settings;

72. Urges the Commission to present to the Parliament and the Council a European Carers Programme and as a part of it a European Informal Carers programme with a package of actions at EU level on informal care, and, where the competences are at the national level, calls on the Member States to support this European strategy by ambitious and coordinated actions and national programmes to identify, recognise and acknowledge the different types of informal care provided in Europe, and identify different needs of different groups of carers including young carers and mobile carers to facilitate employment to be declared and ensure insurance and social protection coverage, regardless of their different residence or administrative situations and status;

73. Calls on the Member States to consider the formalisation of informal care and different financial support options based on their different needs and realities, with a view of guaranteeing carers good standards of rights, financial support and social protection;

74. Recalls that the above could be achieved through for example care or pension credits to protect those taking a break from employment to provide care to a family member or someone else in need of care, and through recognising the value of the work that these carers do for society as a whole by other additional support services (counselling or peer exchange), clearly stipulated time off for carers, a healthy work-life balance, leave, replacement services in case of illness, day-care services, job-reintegration services, psychological and rehabilitation services for carers and care recipients, and access to education, training and life-long learning and underlines the importance of non-transferrable parental leave; in this regard, calls on the Member States to consider and exchange as well on the best practices on how to reflect periods spent on care responsibilities in pension schemes and to swiftly and fully transpose Directive (EU) 2019/1158 of 20 June 2019 on work-life balance for parents and carers, which introduces leave for carers and the possibility to request flexible working time arrangements, minimum amount of days of carers’ leave in order to provide personal care or support to a relative or to a person who lives in the same household as the worker;

75. Calls on Member States to examine how best to formalise provision of informal care and therefore revenue collection in this area ( 100 ) , including tax deduction systems and the use of service vouchers;

76. Underlines that this package of actions on informal care needs to include both legislative and non-legislative proposals and adequate investment to acknowledge informal carers’ rights and obligations as part of their role, while respecting the right to self-determination of the persons receiving care and set a certain criteria for carers’ access to social and other additional support services (including time-off and sick leave); reiterates the mental and physical health stress, associated with caregiving, and stresses the importance of ensuring carers' access to information and advice about care and care-life balance; underlines that the package of actions additionally needs to set out reporting responsibilities for Member States, create single points of contact where informal carers can access the support they need in all Member States and promote interoperability between health and social security systems in order to make use of existing data and reduce the administrative burden faced by informal carers;

77. Urges the Commission and the Member States to support civil society organisations and social partners to assure the representation of informal carers in order to take their contributions into account in the design, implementation and evaluation of policies concerning informal care, including in drafting the European Care Strategy;

78. Stresses the importance of addressing the over-reliance on informal care through formalisation and recognition of carers' skills via a certification process and promoting training and skills validation schemes, allowing for the advancement, of mutual recognition of skills, as well as implement targeted upskilling and reskilling activities; highlights that these efforts should make use of, among others, the European Skills Agenda, the Pact for Skills, ESF+, the Youth Employment Initiative, the Just Transition Fund, and EU4Health; Calls on the Member States to facilitate the labour market reintegration of workers who took a long career break to provide care to relatives;

79. Calls on the Commission to recognize challenges limiting access to appropriate care for persons with specific diseases that require increased level of care like rheumatic and musculoskeletal diseases (RMDs); Highlights that for persons with RMDs, the biggest obstacle in accessing appropriate care is the lack of rheumatologists and medical training in rheumatology in the Member States; Calls therefore on the Member States to make Rheumatology a standard element of the medical training curriculum and to increase the number of practicing rheumatologists;

Decent working conditions for all workers in the care sector

80. Urges the Member States to place adequate staffing levels and investment in care staff at the centre of their care policies; calls on Member States to increase the attractiveness of the care occupations by ensuring social recognition, decent working conditions and fair remuneration, including adequate working hours, which would as a consequence help to tackle the existing labour shortages and diminish the need for short-notice work, rapid and severe workforce outflows, especially in the regions and Member States facing significant challenges due to the care drain, and increase resilience of the care systems for the future while creating jobs in the sector;

81. Calls on the Commission and the Member States to support the creation of such quality jobs in the sector with among others clear, sustainable and attractive career paths and opportunities for training and the improvement of skills, that allow for permanent professional and personal development; calls on Commission and Member States to take concrete initiatives and provide incentives that make work in the care sector more appealing also to young people and encourage a gender balanced distribution of care professions;

82. Takes note of additional challenges related to the increasing share of platform work in the care sector; stresses that the European directive on platform work and national legislation reg