COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS on the European care strategy
Date: 2022-09-07
Institutions: Directorate-General for Employment, Social Affairs and Inclusion, European Commission
Subjects: child care, early childhood, home care, home help, long-term care, poverty, pre-school education, service occupation, social facilities, work-life balance

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 7.9.2022  COM(2022) 440 final  COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS on the European care strategy {SWD(2022) 440 final}  
 
 
 ‘‘For nights on end [during the pandemic], we all stood at our windows and doors to 
applaud critical workers. We felt how much we relied on all those women and men who work 
for lower wages, fewer protections and less security. The applause may have faded away, but 
the strength of feeling cannot. […] 
We will come forward with a new European care strategy 
to support men and women in finding the best care and the best life balance for them.’1 

Ursula von der Leyen, President of the European Commission 

1. 

INTRODUCTION 

Care  concerns  us  all.  It  creates  the  fabric  that  holds  our 
together. 
together  and  brings  our  generations 
societies 
Throughout our lives, we and our loved ones will either need 
or provide care.  

With  creches  and  kindergartens  temporarily  closed,  and  the 
disproportionate impact the pandemic had on our older people, 
the  COVID-19  pandemic  highlighted  the  importance  of 
having robust formal care services to ensure continuity of care. 
the 
By  exposing 
pandemic has put a magnifying glass on the need to improve the 
resilience  of  our  care  systems.  It  also  had  a  significant  impact  in  terms  of  mental  health 
problems and resulting care needs to be addressed.  All of this is particularly crucial for the 
well-being of care receivers and care givers, for women’s participation in the labour market 
and the achievement of work-life balance.  

its  pre-existing  structural  weaknesses, 

High-quality care services have clear benefits for all ages. Children need care to develop 
their cognitive, language and physical skills and competences. Participation in early childhood 
education has a positive impact on their development, boosts their employment opportunities 
later in life, their ability to lead fulfilling lives and careers and helps reduce the risk of poverty 
and  social  exclusion.  As  such,  it  contributes  to  breaking  the  cycle  of  inequality  and 
disadvantages.  Quality  early  childhood  education  and  care  promotes  healthy  and  active 
lifestyles early in life, which has a positive impact throughout adulthood all the way to old age. 
At  the  same  time,  high-quality  and  affordable  long-term  care  empowers  older  people  by 
helping them to maintain their autonomy and to live in dignity. This is particularly important 
in a context of demographic change, where Europeans are living longer and healthier lives, 
and the demand for care is increasing exponentially. Active ageing policies, as well as early 
intervention, health promotion and disease prevention can further support longer independent, 
healthy and active living and delay the onset of care needs.   

1 State of the Union speech, 15 September 2021. 

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Despite the clear benefits of high-quality care services, for many people they are still not 
affordable, available or accessible. Around a third of children below the age of 3 and close 
to 90% of children aged between 3 and compulsory school age are in early childhood education 
and care, but still many parents are not able to enrol their children because the services are 
simply not available, or they are too expensive. Similarly, almost half of people aged 65 or 
over  with  long-term  care  needs  have  an  unmet  need  for  help  with  their  personal  care  or 
household  activities.  In  many cases, care services are not  available where and when people 
need them, and long waiting lists and heavy procedures are a reality. Despite having a better 
healthy-life-expectancy  than  ever  before,  as  people  get  older,  the  higher  the  chances  of 
developing a frailty, illness or a disability, meaning that they would require long-term care. For 
many  persons  with  disabilities,  insufficient  care  services,  support  for  families  and  personal 
assistance undermine their right to independent living, which is enshrined in the United Nations 
Convention on the Rights of Persons with Disabilities. 

Inadequate care services have a disproportionate impact on women as supplementary or 
informal care responsibilities still fall predominantly on them and this affects their work-life 
balance and options to take on paid work.  

This  leads  to  women  taking  long  absences  for  family  leave,  reducing  working  time  and 
withdrawing  early  from  the  labour  market.  For  many  women,  it  results  in  fewer  career 
opportunities and lower wages and pensions than those enjoyed by their male peers. As they 
live longer on average but less often in good health than men, they need more intense long-
term care and for longer periods of time. But they are often less able to afford it due to gender 
inequalities in pay and pensions accumulated over their lifetime.  

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Good working conditions in the care sector are vital to the resilience and attractiveness 
of the sector, and for gender equality. Women make up 90% of the care workforce, often in 
low paid, precarious jobs. Even if it involves the care of those who are most dear to us, care 
work is often undervalued. Moreover, care workers often lack prospects for career progression 
and the training available is not commensurate to their upskilling needs. The high prevalence 
of part-time work in the care sector means that many workers are earning even lower monthly 
incomes.  For  some  vulnerable  groups  of  care  workers,  such  as  live-in  carers  or  domestic 
workers, working conditions can even be exploitative.  

The  inadequacy  of  care  systems  has  an  economic  cost  and 
undermines  the  sector’s  potential  to  create  jobs.  Investment  in 
care services helps more women to join the labour market and yields 
more revenues for public budgets.  

This strategy sets an agenda to improve the situation for both carers 
and care receivers. It calls for boosting access to quality, affordable 
and accessible care services and improving working conditions and 
work-life balance for carers. It will help making the principles on 
access to good quality and affordable care of the European Pillar 
of Social Rights a reality and contribute to achieving the headline 
targets  on  employment  and  poverty  reduction  for  2030  across  the 
EU, welcomed by EU leaders at the Porto Summit in May 2021 and endorsed by the European 
Council. 

Two proposals for Council Recommendations are at the centre of this strategy: on the 
revision of the Barcelona targets on early childhood education and care, and on access to 
affordable high-quality  long-term care. They  provide policy frameworks for  reforms and 
investments at national, regional and local levels. Both cover adequacy, availability and quality 
of  care  as  well  as  the  working  conditions  of  carers.  This  Communication  sets  out  further 
supportive actions at European level and calls for action at national level2. 

The Strategy responds to calls from various stakeholders at EU and national level. The 
European  Parliament3,  the  Council,  the  European  Economic  and  Social  Committee,  the 
Committee of the Regions, the social partners, and civil society have all called for reinforced 
EU action in this area4. It builds on experience with the Barcelona Targets in the past period, 
in  particular  the  lack  of  progress  in  meeting  the  target  in  a  number  of  Member  States.  The 
Strategy also responds to the Conference on the Future of Europe proposal5 on the demographic 
transition that calls for quality affordable and accessible long-term care that meets the needs of 
both care receivers and care givers and for ensuring quality, affordable and accessible childcare 
across the EU, so that mothers and fathers can confidently reconcile their work and family life. 

2  A  Commission  Staff  Working  Document  accompanying  the  Commission  proposal  for  a  Council 
Recommendation  on  access  to  affordable  high-quality  long-term  care  (SWD(2022)  441)  provides  evidence 
underpinning the key challenges in the sector and specific examples of how to address the challenges, inspired by 
measures taken across the EU Member States. 
3 European Parliament resolution of 5 July 2022 towards a common European action on care (2021/2253(INI)) 
4  Commission Staff Working Document (2022) 440. 
5 Conference on the Future of Europe, Report on the final outcome, May 2022, Proposal 15. 

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2. 

IMPROVING CARE SERVICES 

Care services should be expanded to meet current and future needs for care. Increasing 
the availability of care services needs to go hand in hand with improving their quality, 
affordability, and accessibility.  

Quality encompasses not only infrastructure and services, but also the interactions and human 
relations between carers and the people receiving care.  

Early  childhood  education  and  care  services  must  be  of  high  quality,  inclusive,  and  non-
segregated to bring full benefits to all children. Additionally, quality is key to increase parents’ 
trust  in  services  and  to  ensure  that  these  services  contribute  to  a  healthy  emotional  and 
educational development of the child.  

Quality  long-term  care  promotes  the  well-being,  dignity  and  fundamental  rights  of  care 
recipients, including by preventing and alleviating isolation, loneliness and their physical and 
psychological impacts. To achieve these goals, high-quality standards are needed. They should 
apply equally to public and private care providers and should be underpinned by strong quality 
assurance,  enforcement  mechanisms,  monitoring  practices  and  comprehensive  quality 
frameworks  that  are  often  lacking.  Innovative  care  settings,  such  as  shared  housing  where 
people with long-term care needs share domestic support and care services, as well as adapted 
housing  or  multigenerational  housing  facilities  can  foster  intergenerational  contacts  and 
solidarity while supporting independent living and social interactions, with a positive impact 
on the wellbeing of those in need of care and social cohesion. Care settings adapted to climate 
change can also protect vulnerable people, like older people, from meteorologically difficult 
conditions like heat waves. 

Improving the affordability of care services leads to fairer access to care. High costs are 
one  of  the  most  significant  barriers  to  parents  enrolling  their  children  in  early  childhood 
education  and  care.  Lack  of  affordability  is  also  a  challenge  for  long-term  care,  as  social 
protection  coverage  for  long-term  care  is  patchy  and  in  general  limited,  making  care 
unaffordable for many people. Around a third of households with long-term care needs do not 
use home care services because they cannot afford them and many people with long-term care 
needs and their families face the prospect of high out-of-pocket costs. As a result, many are at 
risk of income poverty and of falling into financial hardship if they develop long-term care 
needs. 

Making care services accessible means enabling and providing the means to the people 
who need care (and their families) to actually make use of the services available. This may 
require adapting the facilities to enable physical access for care receivers and caregivers with 
disabilities. Actions under the Strategy for the Rights of Persons with Disabilities 2021-2030 

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will contribute to improving the quality and accessibility of care and supporting independent 
living and inclusion in the community. Furthermore, making the services accessible means that 
different  working  time  patterns  might  require  care  at  atypical  hours,  e.g.  for  shift  or  night 
workers. Having care facilities at a reasonable distance and within easy commuting time to 
access care services are also important factors. Having such facilities at or near the workplace 
may reduce the logistical challenges of parents, in particular for jobs where physical presence 
is  required.  Finally,  cumbersome  administrative  registration  processes,  including  in  online 
registration procedures, should not be a barrier for parents seeking to enrol their children in 
early childhood education and care, including families at risk of poverty or social exclusion. 
Likewise, the overly complex application procedure for benefits may be disproportionate with 
the time and ability of people in need of care to cope with this. 

Rural and remote areas and regions with low population density are particularly affected 
by the lack or shortage of available care services, both early childhood education and care as 
well as long-term care, due to long distances or limited public transport options. Access to and 
the variety of long-term care options are insufficient, raising equity concerns. The traditional 
choice of care options has been between informal care (usually provided by family members 
or friends, very predominantly women) and residential facilities. Other options such as home 
care and community-based care, have started to expand, though not evenly, across the EU. 

2.1. EARLY CHILDHOOD EDUCATION AND CARE 

Principle  11  of  the  European  Pillar  of  Social  Rights  recognises  children’s  right  to 
affordable  early  childhood  education  and  care  that  is  of  good  quality.  The  Council 
Recommendation  on  high-quality  early  childhood  education  and  care  systems6  supports  the 
Member States in their efforts to improve access to and the quality of early childhood education 
and care, and encourages them to adopt a quality framework. The EU strategy on the rights of 
the child7 and the European Child Guarantee8 form a new comprehensive EU policy framework 
to protect the rights of all children and secure access to basic services for children in vulnerable 
situations  or  from  disadvantaged  backgrounds.  Specifically,  the  European  Child  Guarantee 
aims to ensure that all children in Europe at risk of poverty or social exclusion have free and 
effective access to high-quality early childhood education and care. It requires Member States 
to draw up national action plans to put these aims into practice.  

As part of the European Semester, the EU monitors progress on early childhood education and 
care, the link between childcare and women’s participation in the labour market and progress 
on social inclusion, notably for children from disadvantaged backgrounds. It supports Member 
States’ reforms and investment through EU funds.  

In  2002,  the  European  Council  set  the  Barcelona  targets9,  which  aim  to  remove 
disincentives to women joining the labour market by increasing childcare provision. In 
the last 20 years, considerable progress has been made and the initial targets were on average 
reached at EU level. However, large differences remain across Member States with many not 
having reached the targets, in particular for the youngest group of children and children from 
disadvantaged  backgrounds.  The  Commission  is  therefore  proposing  to  revise  the 
Barcelona  targets  to  set  new  ambitious  yet  realistic  targets  and  to  stimulate  upward 
convergence across the EU, ensuring real progress in all Member states and regions.  

6 Council Recommendation of 22 May 2019, OJ C 189, 5.6.2019. 
7 COM(2021)142 final 
8 Council Recommendation of 14 June 2021 OJ C 223, 22.6.21. 
9 Barcelona European Council, 15 and 16 March 2002. (2002), SN 100/1/02 REV 1  

5 

 
 
 
                                                           
Graph 1: Early childhood education and care enrolment rate for children below 3 years old (current target 33%, 
EU SILC data 2019)  

Graph 2: Early childhood education and care enrolment for children above 3 years (current target 90%, EU SILC 
data 2019)  

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The proposed revision of the Barcelona targets adds new dimensions: 1) the participation 
of children at risk of poverty or social exclusion, and 2) the time-intensity of participation in 
early childhood education and care (i.e. the number of hours attended per week). 

These new aspects are particularly important for children in vulnerable situations or from 
disadvantaged backgrounds and their families. This notably includes children with disabilities, 
children  at  risk  of  poverty  or  social  exclusion,  children  from  homeless  families,  Roma 
children10  and  those  from  minority  groups,  children  with  a  migrant  background,  refugee 
children  and  children  fleeing  armed  conflict.  Encouraging  participation  in  early  childhood 
education and care is in the best interest of the child in terms of their future life outcomes, to 
promote social inclusion and to break the cycle of disadvantage. At the same time, mothers in 
low-income  households  may  face  higher  barriers  to  find  a  job  if  they  have  a  low  level  or 
obsolete  professional  skills  or  experience.  They  can  also  face  deterrents  to  (re)entering 
employment, such as relatively high childcare costs and potential disincentives from the tax-
benefit system. Encouraging a higher share of children from low-income households to attend 
early  childhood  education  and  care  may  therefore  also  have  a  beneficial  impact  on  their 
mothers’ return to work. 

Early  childhood  education  and  care  should  be  provided  for  a 
sufficient  number  of  hours  to  enable  parents,  in  particular 
mothers,  to  meaningfully  engage  in  paid  work.  A  very  low 
intensity of early childhood education and care is not conducive 
to  a  strong  attachment  to  the  labour  market.  Progress  in  the 
provision of early childhood education and care in the Member 
States  therefore  needs  to  be  assessed  considering  both  the 
overall participation and the number of hours of childcare, as 
they highlight different aspects.  

One  way  to  ensure  adequate  provision  of  early  childhood 
education and care is by establishing a legal entitlement to it, by 
which  public  authorities  guarantee  a  place  for  all  children 
whose  parents  demand  it.  In  most  Member  States,  such  legal 
entitlement  exists,  but  the  starting  age  varies  significantly.  Ideally,  there  should  be  no  gap 
between the end of  adequately paid  family leave and a legal  entitlement to  a place in  early 
childhood education and care. 

10 COM(2020) 620 final, 7.10.2020, OJ 2021C 93/01. 

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Care responsibilities for children do not stop when they enter primary school. Where parents’ 
working hours are not compatible with schooling hours, affordable and quality out-of-school 
care plays an important role for children. This could include other support services, such as 
help for homework, particularly for children from disadvantaged backgrounds. Additionally, 
children should grow up, play and socialise in environments that promote an all-round healthy 
lifestyle. 

Together  with  this  strategy,  the  Commission  puts  forward  a  proposal  for  a  Council 
recommendation on the revision of the Barcelona targets, which invites Member States to: 

- meet the revised targets for participation in early childhood education and care, by 2030: 
at least 50% of children below the age of three and at least 96% of children from age 3 until 
mandatory primary school age should participate in early  childhood education and care, 
the latter in line with the European Education Area target; 

- provide a sufficient number of hours of early childhood education and care to allow parents 
to meaningfully engage with paid work; 

- close the gap between attendance in early childhood education and care of children at risk 
of poverty or social exclusion and the overall population of children; 

-  take  measures  to  improve  the  quality,  accessibility  and  affordability  of  inclusive  early 
childhood  education  and  care  for  all  children  and  introduce  a  legal  entitlement  to  early 
childhood education and care, taking into account the availability and length of adequately 
paid family leave; 

-  improve  the  working  conditions  for  staff  in  early  childhood  education  and  care,  while 
taking measures to improve the work-life balance for parents and closing the gender care 
gap. 

The Commission will: 

-  continue  to  robustly  support  Member  States  in  their  individual  efforts  to  design  and 
implement  reforms  in  the  area  of  early  childhood  education  and  care  via  the  European 
Education Area Strategic Framework and the Technical Support Instrument, including to 
ensure the accessibility, affordability, quality and inclusiveness of early childhood education 
and care, and the development of sound monitoring and evaluation systems. It will continue 
to monitor and guide Member States action in this area through the European Semester with 
targeted analysis  and  support  and through  the promotion and facilitation of exchange of 
good practices, mutual learning and technical capacity-building activities.  

2.2. LONG-TERM CARE 

Several EU-level instruments and initiatives provide a foundation for a shared strategic 
vision for long-term care in the EU. The Charter of Fundamental Rights of the EU recognises 
the rights of older people to lead a life of dignity and independence and to participate in social 
and cultural life.  It enshrines the right of persons with disabilities to benefit from measures 
designed to ensure their independence, social and occupational integration and participation in 
the life of the community. Principle 18 of the European Pillar of Social Rights spells out the 
right to access quality and affordable long-term care, in particular home care and community-

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based services. The Commission helps Member States meet the challenges of long-term care 
by carrying out joint analytical work, exchanging best practice and mutual learning. It monitors 
policy  developments  during  the  European  Semester  and  supports  reforms  and  investment 
through EU funding.  

However, more targeted EU action is needed to stimulate policy reform. Long-term care 
services are often not commensurate to the needs, are unaffordable and do not respect high 
levels of quality. In addition, significant challenges remain with regard to ensuring respect of 
the principles of equality, freedom of choice, the right to independent living, and prohibition 
of all forms of segregation for persons with long-term care needs. Working conditions in the 
care sector are difficult and the wages are low, which partly explains the staff shortages in the 
sector.  To  help  overcome  these  structural  weaknesses,  the  Commission  proposes  a  Council 
recommendation  setting  out  a  comprehensive  policy  framework  to  guide  investment  and 
reforms for long-term care and several additional support measures. 

Together  with  this  strategy,  the  Commission  puts  forward  a  proposal  for  a  Council 
recommendation on long-term care, which invites Member States to take action to address 
shared long-term care challenges. In particular, the proposal for a recommendation: 

- encourages Member States to strengthen social protection for long-term care and improve 
the adequacy, availability, and accessibility of long-term care services; 

-  puts  forward  a  set  of  quality  principles  and  quality  assurance  guidance,  building  on 
previous work of the Social Protection Committee in this area; 

- calls for action to improve working conditions and upskilling and reskilling opportunities 
in the care sector, while highlighting the significant contribution made by informal carers 
and their need for support; 

- sets out several principles of sound policy governance and sustainable financing. 

A strategic and integrated approach to care is needed. Approaches that are person-centred 
and conducive to independent living are often lacking, exacerbated by insufficient integration 
between  long-term  care  and  healthcare,  or  between  informal  care,  home  care,  community-
based and residential care. Person-centredness entails offering a choice of services in line with 
people’s  needs  and  improving  the  transition  from  institutional  care  to  home  care  and 
community-based services.  Long-term  care  services that are  well integrated with  healthcare 
and provide good care solutions, including for people in palliative care, improve quality of life 
and health outcomes and can foster cost-effectiveness while helping to reduce the burden on 
hospitals and other healthcare facilities. Targeted  expert assistance  can help  Member States 
devise and roll out integrated care approaches benefitting both long-term care and healthcare 
systems. 

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The  digital  transition  also  offers  multiple  opportunities. 
Though  technology  cannot  and  should  not  replace  human 
interaction, which lies at the heart of care work, innovative digital 
solutions  such  as  information  and  communication  technology, 
assistive  technology,  telecare,  telehealth,  artificial  intelligence 
and robotics can improve access to high-quality affordable care 
services and aid independent living. They also have the potential 
to enhance labour productivity in the sector by taking over certain 
laborious  or  hazardous  tasks  of  care  workers,  improving  case 
management and occupational safety and health at work, helping 
the  remote  monitoring  of  care  recipients  and  facilitating  the 
training  and  recruitment  of  care  workers.  Investments  in  these 
technologies need to be accompanied by investing also in digital 
skills, 
for  persons  with 
disabilities, and improving connectivity in rural and remote areas. 

removing  accessibility  barriers 

The Commission supports a wide range of research and innovation on digital tools for 
active and healthy living and on integrated and person-centred care.  European policies 
promote  the  digital  transformation  including  the  digitisation  of  public  services  through 
Europe’s  Digital  Decade  and  digital  public  services  that  are  inclusive  of  and  accessible  to 
persons with disabilities. The proposal to establish a European Health Data  Space11 aims to 
empower individuals to share their own health data with care providers of their choice for better 
healthcare delivery. Although numerous successful practices exist and innovation in this sector 
is steadily growing, scaling up the use of innovative technology and digital solutions for care 
requires putting in place an enabling framework to help transfer good practice. 

Policy  reforms  can  also  be  supported  by  international  cooperation.  The  COVID-19 
pandemic  and  demographic  challenges  have  put  long-term  care  high  on  the  global  policy 
agenda. Internationally available expertise can strengthen evidence-based policy development 
also at EU level. The 2021 International Labour Organization (ILO) ‘Global Call to Action for 
a human-centred recovery from the COVID-19 crisis that is inclusive, sustainable and resilient’ 
underscored the significant opportunities for decent work in the care economy. It highlighted 
the need to invest in the care sector, address the issue of under-resourcing and improve working 
conditions.  The  ILO’s  work  on  social  protection  and  working  conditions  for  care  workers, 
including domestic workers and live-in carers, provides a good analytical base of the challenges 
in the sector across the world and the relevant international standards. Integrated care and long-
term care are also at the core of the actions rolled out by the World Health Organization (WHO) 
under  the  United  Nations  Decade  of  Healthy  Ageing.  Close  coordination  between  Member 
States can help increase the impact of these initiatives and position the EU in taking a more 
prominent  role  in  addressing  global  demographic  challenges.  The  analytical  work  by  the 
Organisation  for  Economic  Cooperation  and  Development  (OECD),  supported  by  the 
Commission, on measuring the effectiveness  of social protection can  also  help  guide sound 
policy making in increasing social protection for long-term care. 

The Commission will: 

- offer direct technical support from the Technical Support Instrument to the Member States 
under a new flagship project “Towards person-centred integrated care”. Such support aims 
at facilitating reforms in line with the proposal for a Council Recommendation on access to 

11 COM(2022) 197 final 

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affordable high-quality long-term care. The flagship will help Member States, upon demand, 
to  design  and  implement  reforms  aimed  at  strengthening  the  coordination  between  health, 
social care and long-term care and the integration of the different levels of care provision, by 
putting the person at the centre of services to ensure better access and better quality of care 
at every stage of life; 

- finance, under the upcoming Horizon Europe partnership ‘Transforming health and care 
systems’, a knowledge hub for innovative technologies and/or digital solutions in health and 
care provision. The hub will support assessment and transferability of good practices and act 
as a community-building and exchange forum. Complementing this, funding for research and 
innovation for person-centred care and uptake of digital solutions will be available under the 
Horizon Europe and Digital Europe programmes; 

- set up a strategic partnership with the WHO to provide country-specific support to design 
and implement policy measures for high-quality long-term care, including through integrated 
care services. These will be complemented by an open-access repository of knowledge and 
support for inter-disciplinary exchanges of stakeholders.  

The Commission calls: 

-  on  the  Member  States,  social  partners  and  civil  society  to  tap  the  potential  of  and 
mainstream  digital  solutions  when  designing,  implementing  and  monitoring  policies  and 
related funding for care. 

3. MAKING THE CARE SECTOR MORE RESILIENT AND GENDER BALANCED 

3.1. IMPROVING WORKING CONDITIONS IN THE CARE SECTOR 

The  care  sector  has  a  high  potential  to  create  more  jobs,  driven  in  particular  by 
population ageing. More than 1.6 million long-term care workers would have to be added by 
2050 to keep long-term care coverage at the same level. To respond to the increasing demand 
for care, the sector needs not only to retain staff but also to attract more workers with the right 
skills.  

Graph 3: Number of (full-time equivalent) long-term care workers per 100 people aged 65+, 2019 

14
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8
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Residential care

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Source: EU Labour Force Survey, 2019, in: Barslund, M., et al., 2021. 

11 

 
 
 
 
 
However,  labour  shortages  in  the  EU  are  increasingly  prominent,  including  in  the  post-
pandemic labour market recovery. They reflect structural challenges such as ageing, the twin 
transition on digitalisation and combatting the climate crisis, poor working conditions in some 
sectors and occupations, and skills shortages. The care sector is particularly affected by labour 
shortages due to frequently difficult working conditions and low wages.  

As  the  care  sector  is  one  of  the  most  gender-segregated  sectors,  attracting  a  more  diverse 
workforce, in particular recruiting more men, can help reduce segregation on the labour market 
and counter gender stereotypes at all levels of care. While the job creation potential is higher 
in  rural  areas,  where  populations  are  on  average  older,  labour  shortages  are  also  more 
pronounced there, since the working age population is more reduced and women, in particular, 
tend to move away12. 

Better working conditions and wages, supported by strong social dialogue, education and 
training, will make care jobs more attractive. Long-term care and early childhood education 
and care workers should be able to effectively exercise their social and labour rights, regardless 
of the type of employment or whether they are employees or self-employed, including those 
who work through digital labour platforms. Providing care workers with career development 
opportunities  via  reskilling  and  upskilling  helps  increase  the  resilience  of  the  sector  to 
unexpected  shocks,  such  as  the  COVID-19  pandemic,  and  helps  workers  progress  in  their 
careers.  Better  working  conditions  will  also  help  attract  more  people  to  the  profession, 
including men, thus improving gender balance in the sector. 

Care workers are essential to meet society’s care needs, but their work is undervalued. 
The COVID-19 pandemic showed a mismatch between the level of pay and the essential value 
of  care  work.  Low  pay  may  also  be  linked  to  gender  stereotypes  that  equate  the  soft  skills 
required for care, such as communication, empathy or cooperation, as skills that would come 
naturally to women and that are not properly recognised in the economic value of their work13. 
Challenges relating to the affordability of care can exert downward pressure on wages. Given 
the  large  proportion  of  women  working  in  the  sector,  increasing  wages  could  contribute  to 
reducing the overall gender pay gap, and therefore also the pension gap.  

The care sector needs better social dialogue processes at national and EU levels. Social 
services, including early childhood education and care and long-term care, represent a large 
economic  sector.  But,  for  a  variety  of  reasons,  including  the  prevalence  of  irregular 
employment in this sector, large swathes of the long-term care workforce are not represented 

12 See SWD(2021) 167final  
13 See SWD(2021) 41 final. 

12 

 
 
 
 
                                                           
by social dialogue processes in  many Member States. This  can create a vicious circle, with 
unfavourable working conditions and low wages resulting in high turnover rates among care 
workers,  leading  in  turn  to  lower  worker  representation  and  a  lack  of  pressure  to  improve 
working conditions. Effective social dialogue and collective bargaining, including at EU level, 
can help address workforce challenges in the care sector.  

Other EU initiatives contribute to improving the situation of care workers. The European 
Skills Agenda14, in particular via the Pact for Skills partnerships, has a high potential to support 
upskilling  and  reskilling  in  the  care  sector.  EU  law  on  transparent  and  predictable  working 
conditions15 and minimum wages benefit carers across the EU. The EU strategic framework on 
health  and  safety  at  work  for  2021-202716  sets  out  actions  to  improve  workers’  health  and 
safety.  Following  the  Council  Recommendation  on  access  to  social  protection17,  Member 
States committed to extending access to social protection systems to workers in non-standard 
forms of employment, including people in part-time work. The Commission also put forward 
legislative proposals on improving working conditions in platform work18 and strengthening 
pay transparency19, which, when adopted by the European Parliament and the Council, could 
contribute to better working conditions in the sector.  

Nonetheless,  recent  reports  and 
the  COVID-19  pandemic 
highlighted  the  difficult  working  conditions  in  the  long-term  care 
sector.  Care  workers  are  regularly  exposed 
to  physical  and 
psychological  health  risks.  Challenging  social  behaviour,  including 
verbal  and  physical  violence,  bullying  and  sexual  harassment  is  a 
frequent  problem,  in  particular  for  long-term  care  workers.  Atypical 
contracts  and  the  steady  expansion  of  platform  work  play  an 
increasingly significant role in the care sector. This brings challenges, 
such as workers having limited access to social protection, labour rights 
and  adequate  occupational  health  and  safety.  There  is  a  need  to 
undertake  a  thorough  review  of  enforcement  gaps  in  the  EU  legal 
framework regarding working conditions in the long-term care sector. 
The ILO Convention 190, together with the accompanying Recommendation 206, provide an 
international framework to prevent, remedy and eliminate violence and harassment in the world 
of work. Further, given that social economy actors are important providers of long-term care 
services and its participatory governance model, there is scope for more in-depth research into 
the contribution of the social economy to improving working conditions in the care sector.  

Domestic workers, many of whom are women and often with a migrant background, are 
subject to some of the poorest working conditions in the long-term care workforce. They 
often  work  undeclared  or  as  bogus  self-employed,  earn  extremely  low  wages,  and  are 
sometimes denied basic labour rights, such as adequate rest periods and pay. ILO Convention 
189 provides standards for decent working conditions of domestic workers, including live-in 
carers, but ratification is lagging behind, with only eight EU Member States having done so. 

The Commission will: 

14 COM/2020/274 final. 
15 Directive (EU) 2019/1152 of 20.06.2019.  
16 COM/2021/323 final. 
17 2019/C 387/01. 
18 See COM/2021/762 final. 
19 See COM/2021/93 final. 

13 

 
 
                                                           
- together with social partners, continue to explore the modalities for the setting up of a new 
sectoral social dialogue for social services at EU level; 

- propose increasing support for capacity building for social dialogue at national level in 
the care sector via social dialogue calls for proposals and European Social Fund+ funding; 

- fund projects under the Citizens, Equality Rights and Values programme to identify criteria 
to assess the social and economic value of work in different sectors, including in the care 
sector; 

- review the application of EU standards governing working conditions, including for live-
in  carers,  in  cooperation  with  EU  decentralised  agencies.  The  review  will  build  on  the 
forthcoming analysis on occupational safety and health for the health and long-term care 
sector. The findings of the review will feed into debates and support better enforcement at 
national level, possibly backed by guidance on improving the working conditions in the long-
term care sector; 

- use all the possibilities to fund research under Horizon Europe on working conditions in 
the social economy, including in the care sector. 

The Commission calls: 

- on the Member States and EU-level and national social partners to foster effective social 
dialogue and to conclude collective agreements for the care sector with the objective of 
providing care workers with fair working conditions and adequate wages; 

- on the Member States to address gaps in implementation and enforcement of EU labour 
law  and  working  conditions  acquis  in  the  care  sector  and  to  ratify  and  implement  ILO 
Convention 189 on domestic workers. It also calls on the Member States to take steps to 
formalise and regulate the specific situation of domestic workers and live-in carers; 

- on the Member States to address workplace risks related to violence and harassment in 
the care sector and adopt the Council Decision authorising the Member States to ratify the 
ILO Convention 190 concerning violence and harassment in the world of work. 

Legal  migration  can  be  a  key  driver  to  remedy  labour  shortages.  Already  today,  many 
people from non-EU countries work in the care sector. But migrant care workers often work 
undeclared or in precarious conditions. The communication ‘Attracting Skills and Talent in the 
EU’20 underlines that sustainable and legal pathways for migration from non-EU countries to 
work in the care sector could provide an opportunity both for migrant care workers to start a 
career in the EU, and for EU countries to help meet their demand for jobs. These opportunities 
may  also  be  valuable  to  people  fleeing  the  Russian  aggression  in  Ukraine,  especially 
experienced care workers, who want to seek employment while residing in the EU. There is a 
need to assess whether and to what extent EU tools could help in improving the admission of 
migrant care workers to the EU, to the mutual benefit of all Member States and countries of 
origin, while ensuring the ethical recruitment of migrants.  

20 COM/2022/657 final. 

14 

 
 
 
                                                           
improve  the 
Upskilling  and  reskilling  opportunities  will 
attractiveness  and  quality  of  care  work.  In  order  to  achieve 
improved quality in the provision of care as well as to reduce turn-
over of staff, it will be necessary to ensure that all kinds of care staff 
are  able  to  participate  both  in  high-quality  initial  education  and 
training as well as continuing professional development programmes 
over the course of their careers. Most long-term care workers have a 
medium level of qualifications and the skills required are constantly 
evolving  and  becoming  increasingly  complex.  The  sector  needs 
workers with soft skills, digital skills and specialised knowledge (e.g. 
on certain types of diseases such as Alzheimer’s or chronic diseases, 

or on diagnostics and treatment methods, for instance via telecare).  

The Commission will: 

- by the end of 2022, launch a study mapping the current admission conditions and rights 
of long-term care workers from non-EU countries in the Member States. The Commission 
will also explore the added value and feasibility of developing EU-level schemes to attract 
care workers, taking into account the ethical dimension of such schemes, as set out in the 
initiative  “Attracting  Skills  and  Talent  in  the  EU”.  Talent  partnerships  could  also  be 
developed  for  several  economic  sectors,  including  long-term  care,  on  a  demand-driven 
basis, while remaining mindful of the risks of brain drain; 

- promote the opportunities available for early childhood education and care staff under 
the Erasmus+ programmes to continuously develop their professional competences through 
the design of early childhood education and care programmes, innovative teaching methods 
and new material to support children’s learning; 

- promote the establishment of a skills partnership under the Pact for Skills for the long-
term  care  sector.  The  partnership  should  include  digital  skills  and  development  of 
corresponding  training  and  education  curricula,  in  the  context  of  the  European  Skills 
Agenda  and  build  on  synergies  with  large  scale  partnerships  in  relevant  sectors  (e.g. 
healthcare,  proximity  and  social  services).  Calls  under  the  Erasmus+  programme  will 
support sectoral cooperation on long-term care (e.g. Alliance for sectoral cooperation on 
skills); 

-  take  specific  action  on  digital  skills  in  health  and  care  sectors  under  the  Digital 
programme by launching calls for proposals for Master courses and short-term training and 
under  the  EU4Health  work  programme  by  providing  professional  development  training 
opportunities for health workers, including nurses; 

- bring  forward  skills  intelligence on current and future skills  needs  and trends for  the 
long-term care sector, in close cooperation with CEDEFOP. This work should build on the 
CEDEFOP innovative Skills Online Vacancy Analysis Tool for Europe (Skills OVATE) and 
the toolkit for labour market intelligence. 

The Commission calls: 

- on the Member States and EU-level and national social partners to take action to facilitate 
the upskilling and reskilling of care workers, in line with the European Skills Agenda and 
its actions, in particular the Pact for Skills. 

15 

 
 
 
 
3.2. A BETTER BALANCE BETWEEN WORK AND CARE RESPONSIBILITIES 

Investing in the care sector would help ensure that informal care is a choice rather than 
a necessity. Caring for loved ones has a high societal and economic value. For example, the 
value of hours of long-term care provided by informal carers is estimated to be around 2.5% of 
EU GDP higher than the public expenditure on  long-term care.  Further,  people with  caring 
responsibilities should have a choice about the extent to which they want to combine care with 
paid work. Therefore, they should have access to services that enable them to reconcile their 
caring responsibilities with their professional lives.  

Providing  care  has  major  consequences  for  informal  carers, 
including negative effects on their  current and  future  income 
and on their mental health. Women provide the bulk of care and 
this  often  leads  them  to  adapt  their  work  patterns  to  care 
responsibilities,  including  by  taking  career  breaks,  working  part-
time, or leaving the labour market entirely and prematurely. This is 
particularly challenging for single parents, the vast majority being 
women. Some face a double burden of caring for children and other 
dependent family members at the same time. In pre-pandemic 2019, 
about one third (32.6%) of women aged 25-49 outside the labour 
force indicated that care responsibilities were the main reason for 
not seeking employment, compared to 7.6 % of inactive men.  

Care services are essential to enable people to combine work and care duties, but they are 
not sufficient on their own. This is why Principle 9 of the European Pillar for Social Rights 
states  that  parents  and  people  with  caring  responsibilities  have  the  right  to  suitable  leave, 
flexible working arrangements and to have access to care services. Work-life balance measures 
should help workers to balance their care responsibilities with work, while care allowances can 
partly compensate for the hours of care provided. Increased access to special and family leave 
and flexible working time arrangements, such as part-time work, telework and flexitime, can 
help workers improve their work-life balance. 

One of the root causes of the difference in time devoted to unpaid care work by women and 
men are stereotypes about the roles and responsibilities of women and men in the private and 
professional spheres. This can only be tackled by taking a transformative approach that aims 
to revalue care work and tackle stereotypes so that men and women are perceived as equally 
capable of providing care, and of being professionals or leaders in the care sector.  

16 

 
 
The Work-Life Balance Directive21, which the Member States had to transpose into national 
law by August 2022, fosters a more equal sharing of care responsibilities. It introduces non-
transferable rights to family leave and flexible working time arrangements for both women and 
men. It is specifically designed to encourage the uptake of these rights by men. The Directive 
also  states  that  carers  who  exercise  these  rights  must  not  be  treated  unfavourably  or 
discriminated against in the workplace. Workers with care 
responsibilities need to be aware of the new rights granted 
by the Directive and employers need to be encouraged to put 
in place work-life balance friendly policies also in light of 
the uptake of new (tele)working arrangements triggered by 
the COVID-19 circumstances. 

Access  to  adequate  support  services  and  measures  for 
informal  carers  such  as  counselling,  psychological 
support or respite care is often scarce and uneven. Many 
informal carers do not receive proper training in caring for a 
dependent,  sometimes  resulting 
in  feelings  of  over-
burdening  or  even  mental  health  issues  (e.g.  burnout). 
Especially for older informal carers, caring responsibilities 
can be challenging and affect their own healthy living. There 
is  scope  to  foster  good  practice  in  supporting  informal 
carers,  for  instance  by  tapping  into  the  expertise  of  the 
World Health Organization. Policies to formalise informal 
care,  for  example  by  service  contracts  with  public 
authorities, can benefit informal carers and their dependents 
and help recognise and value better care giving.  

European Commission - Joint Research Centre, 
Impact on female employment of revising the 
Barcelona targets for childcare (GENDERMOD), 
September 2022. 

The Commission will: 

-  monitor  the  take-up  of  the  new  rights  covered  by  the  Work-Life  Balance  Directive, 
including  through  the  monitoring  framework  drawn  up  by  the  Employment  and  Social 
Protection  Committees  on  the  uptake  of  family  leave  and  flexible  working  time 
arrangements by women and men with care responsibilities; 

-  launch  an  awareness  raising  campaign  on  the  new  rights  granted  by  the  Work-Life 
Balance Directive; 

- cover the unequal sharing of unpaid care work in its upcoming communication campaign 
on combating gender stereotypes; 

- work with EQUINET to identify measures to tackle possible unfavourable treatment in 
Member States of workers who take family leave, including through cooperation between 
equality bodies and other actors; 

- support schemes that promote family-friendly practices in companies, encourage the take-
up of the new rights by both women and men and promote the role of men in care and family 
responsibilities under the Citizens, Equality, Rights and Values Programme; 

- facilitate better  use and outreach of WHO tools and training  materials  on the support 
measures available to informal carers. 

21 Directive (EU) 2019/1158, OJ 2019, L 188 

17 

 
 
 
                                                           
The Commission calls on the Member States to: 

-  combat  gender  stereotypes  and  promote  a  more  equal  sharing  of  care  responsibilities 
between women and men; 

-  design  support  measures  for  informal  carers,  e.g.  counselling,  psychological  support, 
respite  care  and/or  adequate  financial  support,  which  does  not  deter  labour  market 
participation, together with policies to formalise informal care. 

4. INVESTING IN CARE 

Public  spending  on  care  varies  considerably  between  Member  States.  This  reflects 
different approaches to organisation, quality and valuing of care work and, in the case of long-
term care, varying weight given to formal and informal care provision.  

Long-term  care  is  expected  to  be  the  fastest-rising  ageing-related  public  expenditure  item, 
projected to increase to 2.5% of GDP by 2050, with marked variations across Member States22.  

Public support for the care sector is a social investment which, in parallel with action on 
sustainable financing, brings multiple returns for individuals, society and the economy. 
Increasing investment in care has a positive impact on children’s development and the well-
being  and  dignity  of  care  recipients,  contributes  to  social  fairness  and  gender  equality  and 
promotes women’s participation in the labour market and job creation. Recent research23 shows 
that investment in care can generate additional tax and social security contributions from jobs 
created as well as from increased labour market participation of women. Overall, tax revenue 
from increased earnings and employment would rise, reducing the total funding requirement 
of care policy measures from 3 per cent of GDP (before taxes) to a net 2 per cent of GDP (after 
taxes)24. The ILO estimates that the rate at which Member States can recoup investments in the 
care sector is on average around 55%, depending notably on the amount of investment needed, 
the labour demand in the Member State concerned and the level of taxation.  

22  European  Commission  and  Economic  Policy  Committee,  2021,  The  2021  Ageing  Report  –  Economic  and 
budgetary projections for the 27 EU Member States (2019-2070). 
23 International Labour Organisation (ILO) report – Care at work – Investing in care leave and services for a more 
gender equal world of work, 2022. 
24 International Labour Organization (ILO). 2022. ILO Care Policy Investment Simulator (Geneva, forthcoming). 

18 

 
 
 
 
 
 
                                                           
Unlocking the potential of early intervention and prevention measures can contribute to 
fiscal sustainability of public budgets. Health promotion, disease prevention, timely and good 
quality healthcare as well as healthy living policies have great potential to postpone or reduce 
the  need  for  health  care  and  long-term  care  while  enabling  ageing  at  home  for  as  long  as 
possible.  

Furthermore,  the  lack  of  investment  in  long-term  care  and 
prevention risks shifting the costs to pensions, social assistance and 
healthcare budgets. The Healthier Together initiative and Europe’s 
Beating Cancer Plan address the prevention, treatment and care of 
non-communicable diseases, to ensure that patients can live long, 
fulfilling lives and that challenges faced by families and carers are 
addressed.  

Fiscal  sustainability  of  care  services  can  be  improved  by 
ensuring  their  cost-effectiveness.  Cost-effectiveness  can  be 
improved  by  creating  a  coherent  and  integrated  governance 
framework, continuous monitoring and ensuring that the available 
resources  are  well-targeted  and,  for  long-term  care,  support  for 
independent  living  and  that  services  match  the  needs  of  the 
individual. Achieving this can benefit from mapping available infrastructure and services and 
establishing a gap analysis, while taking into account territorial inequalities and demographic 
challenges. Innovative, integrated care solutions and the ethical use of new technologies in care 
can also help improve the fiscal sustainability of long-term care and healthcare systems.  

Care providers need stable and sustainable financing mechanisms and  they need clear 
and  enabling  regulatory  environments.  Given  their  clear  social  function,  long-term  care 
services are a public good. When provided by public authorities and associations, long-term 
care  services  are  primarily  considered  social  services  of  general  interest.  Both  public  and 
private investments in long-term care should take place in a clear regulatory environment, with 
high quality standards, that takes into account the social value of care services and the need to 
uphold the fundamental rights of persons in need of care and fair working conditions and wages 
for  care  staff.  Stronger  support  for  regional  and  local  care  providers  can  create  jobs  and 
empower local communities.  

Social economy actors bring an added-value to the provision of high-quality care services 
due to their person-centred approach and the reinvestment of profits into their mission 
and local communities. As called for in the Social Economy Action Plan25, policy and legal 
frameworks  should  create  the  right  environment  for  the  social  economy  to  optimise  its 
contribution to care services. The systematic use of socially responsible public procurement 
could boost the potential of social economy to contribute to high-quality standards in care and 
to provide fair working conditions. The forthcoming report of the high-level group on the future 
of social protection and welfare states in the EU will provide further insights on sustainable 
financing and the role of social services in the welfare states.  

There  is  a  need  to  increase  public  and  private  investment  at  national  level,  and  EU 
funding can complement this. Member States can tap into EU funding opportunities such as 
the European Regional Development Fund (ERDF), the European Social Fund Plus (ESF+), 
including its Employment and Social Innovation strand, the European Agricultural Fund for 
Rural  Development,  the  Just  Transition  Fund,  the  Horizon  Europe  or  Digital  Europe 
programmes.  In  addition,  the  Recovery  and  Resilience  Facility  (RRF)  can  finance  eligible 

25 COM/2021/778 final. 

19 

 
 
                                                           
reforms and investments in the context of the recovery from the COVID-19 pandemic. The 
Technical  Support  Instrument  can  also  support  reforms  and  investment.  At  the  same  time, 
Member States should pursue policies conducive to the sustainable funding of care services 
that are coherent with the overall sustainability of public finances.  

In the programming period 2014-2020, the European Social Fund (ESF) has supported several 
actions related to long-term care ranging from the reskilling and upskilling of the workforce, 
expanding access and coverage, supporting integrated care services and independent living, to 
active and healthy ageing. ESF resources have also been allocated to regional and local level 
projects  to  enhance  childcare  provision,  to  address  the  gaps  experienced  by  disadvantaged 
children, to assist parents in accessing the labour market and to make efforts towards addressing 
disparities in employment between men and women. 

Programming for the period 2021-2027 is ongoing, and access to the ERDF and the ESF+ is 
conditional upon the existence of national or regional strategic policy frameworks for health 
and long-term care.   

The European Child Guarantee provides Member States with an opportunity to leverage ESF+ 
funding  to  strengthen  access  to  early  childhood  education  and  care.  It  can  also  be  used  to 
support the quality of provision in formal and informal settings, and to improve the inclusion 
of children with disabilities, children at risk of poverty or social exclusion, and children from 
marginalised communities.  

The  European  Agricultural  Fund  for  Rural  Development  (EAFRD),  based  on  the  relevant 
evidence and facts described in the Long-term Vision for Rural areas, also provides Member 
States with the possibility to support rural childcare and long-term care.  

While the main aim of the Just Transition Fund is to support investment to mitigate the impact 
of  the  climate  transition,  where  duly  justified,  territorial  just  transition  plans  may  contain 
activities in the areas of education and social inclusion including, investments in infrastructure 
for the purposes of training centres, child- and long-term care facilities as indicated in territorial 
just transition plans. 

The  Recovery  and  Resilience  Facility  (RRF)  provides  Member  States  with  significant 
opportunities to fund reforms and investments in social resilience. A large number of Member 
States26  mobilised  the  RRF  for  the  long-term  care  sector.  Examples  of  reforms  under  the 
Recovery  and  Resilience  Plans  (RRPs)  include  strengthening  long-term  care  system  and 
promoting a change in the model of support and long-term care, increasing human resources 
and infrastructure capacity for the provision of long-term care services, training, reskilling and 
upskilling of long-term  care professionals. Additional reforms  are also expected to improve 
long-term care provision by modernising or expanding social services, including community-
based services, and by supporting long-term fiscal sustainability of long-term care systems. Of 
the 25 plans adopted as of 20 July 2022 under the Recovery and Resilience Facility, 12 include 
reforms  and investments  in  the area of early  childhood education and care, totalling around 
EUR 7.9 billion27. Those investments are expected to increase participation rates, in particular 
among disadvantaged groups, hence reducing inequalities. These measures are also supported 
by reforms aiming to improve access, inclusiveness and quality of early childhood education 
and care.  

26 See SWD (2022) 441. 
27 AT, BE, CY, CZ, DE, EL, ES, HR, IT, LT, RO, SK.  

20 

 
 
 
                                                           
 The Commission calls on the Member States to: 

- ensure adequate and sustainable financing and investments in high-quality care systems, 
including by:   

- pursuing policies conducive to the sustainable funding of care services that are coherent 
with the overall sustainability of public finances;  

- promoting both public and private investments in care services, while ensuring a clear 
regulatory  environment that takes into account  the social value of  care services  and the 
need to uphold the fundamental rights of persons; 

-    using  existing  EU  funding  to  improve  equal  access  to  high-quality  long-term  care,  in 
particular community-based and home care;   

- using existing EU funding to ensure equal access to inclusive and quality early childhood 
education and care services, including at parents’ workplaces, for all children, in particular 
children at risk of poverty or social exclusion and for marginalised groups such as Roma, 
children  with  a  migrant  background,  children  with  disabilities,  and  children  deprived  of 
parental care. In this context, the Commission will continue to support Member States in 
guaranteeing free and effective access of children at risk of poverty or social exclusion to 
early childhood education and care, as outlined in the European Child Guarantee. 

5. IMPROVING THE EVIDENCE BASE AND MONITORING PROGRESS 

Reliable and comparable data are essential to monitor progress and for evidence-based 
policy  making.  This  includes  ensuring  a  sufficient  level  of  detail  in  the  reference  data  on 
participation in early childhood education and care, e.g. with a breakdown by specific groups 
or age categories. Further, strengthening the evidence base requires better data on the type and 
consequences  of  informal  care  provision,  i.e.  to  identify  gender  inequalities,  working  time 
arrangements and the uptake of family leave. 

Despite  some  progress  in  building  common  long-term  care  indicators  on  access  and 
financing,  statistics  on  long-term  care  are  still  underdeveloped.  They  lack  comparable 
administrative data e.g. on care expenditure and provision. Therefore, more work is needed to 
develop and harmonise data collection at EU level. In addition, taking a rigorous and systematic 
approach to projecting the evolving national needs for long-term care will help Member States 
plan ahead. Despite evidence of access to care being more difficult in rural and remote areas, 
data on territorial inequalities in long-term care provision is scarce; more evidence is needed 
on the main causes of these inequalities and on effective policy responses. 

The Commission will: 

-  work  to  improve  care-related  data  collection  and  analysis,  in  particular  by  increasing 
reporting on participation in early childhood education and care, in cooperation with Member 
States.  It  will  also  step  up  strategic  cooperation  with  international  organisations  such  as 
OECD and ILO, and exchanges with EU agencies, namely the European Institute for Gender 
Equality (EIGE) and Eurofound. Where feasible and relevant, data should be disaggregated 
by sex, age, disability and ethnic background;  

- with input from EACEA’s Eurydice network and EIGE, monitor progress and work to develop 
and analyse indicators tracking early childhood education and care. This work will build on 

21 

 
 
 
 
the  work  already  carried  out  in  response  to  the  Recommendations  on  Early  Childhood 
Education and Care and the Child Guarantee; 

- create a task force on long-term care statistics to improve the evidence base for long-term 
care. This work will aid the monitoring and development of EU common indicators on long-
term care, agreed by the Social Protection Committee; 

- develop detailed projections on the demand for health and long-term care services in the 
EU (building on long-term population projections available at national and regional levels), 
to aid resource planning; 

-  finance  research  via  a  call  for  proposals  under  the  Horizon  Europe  programme  on 
addressing territorial inequalities in care and research into the development of integrated 
care solutions, including digital tools and telecare; 

- support Member  States in sharing evidence on care provision in rural areas through the 
Rural Observatory set up under the Rural Action Plan28 and the common agricultural policy 
network. 

The Commission calls: 

- on Union agencies, such as EIGE, to collect data regularly, develop indicators and carry out 
analyses on the gender care gap, the gender pay gap, and the use of time in paid and unpaid 
work, individual and social activities by women and men with care responsibilities and on work 
arrangements throughout their working life; 

- on the Member States to collect data, broken down by gender, age and other aspects of time 
use (preferably via time use surveys carried out in the context of Harmonised European Time 
Use Surveys), on the uptake of family leave and on flexible working time arrangements. 

The  successful  implementation  of  the  European  care  strategy  requires  a  shared 
commitment of all stakeholders. In taking forward this strategy, the Commission will work 
in close partnership with other EU institutions and bodies, notably the European Parliament, 
the Council, the Committee of the Regions and the European Economic and Social Committee, 
Member States, social partners, social economy  actors, civil society organisations and other 
stakeholders. 

The Commission will: 

-  monitor  implementation  of  early  childhood  education  and  care  and  long-term  care 
policies,  assess  progress  towards  the  Barcelona  targets  in  the  context  of  the  European 
Semester  process,  and  consider  advancing  country-specific  recommendations  when 
appropriate; 

- expand the opportunities for all stakeholders to share their experience and learn from 
each other, through mutual learning programmes on all dimensions of care. 

The Commission calls on: 

- the Member States to create the conditions to enable care providers, including civil society 
organisations and social economy actors to play an active role in the design and delivery 
of high-quality care services and improving working conditions in the sector and support 
regional and local authorities’ efforts to invest in care services; 

28 COM (2021) 345 final. 

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-  the  Member  States  to  swiftly  agree  on  and  implement  the  proposed  Council 
recommendations on the revision of the Barcelona targets on early childhood education 
and care and on access to affordable and high-quality long-term care.  

6. CONCLUSION 

The way we value care should reflect the way we want children, older people, persons 
with disabilities and carers to be valued.  

This  strategy  is  a  cornerstone  of  the  EU’s  approach  to  social  policies  to  help  adapt  to 
demographic change, eliminate persistent gender and other inequalities, tap into the potential 
of the green and digital transitions, and increase resilience to significant external shocks. It is 
designed to benefit people in need of care at all ages by improving their access to affordable, 
accessible and high-quality care. It is about living in dignity, upholding human rights, leaving 
no one behind and providing opportunities for better life and career prospects, the backbone of 
our European way of life. 

Improving the care sector helps ensure that both women and men can participate in work and 
society on an equal footing, while caring for their loved ones. It aims to ensure that care workers 
benefit  from  better  working  conditions,  which  should  make  the  sector  more  resilient  and 
attractive and help create new jobs to meet the rise in demand.  

The Commission calls on the EU institutions, Member States, local and regional authorities, 
civil society, social partners, and other stakeholders to endorse this strategy and contribute to 
implementing it.  

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