COMMISSION STAFF WORKING DOCUMENT Summary of consultation activities Accompanying the document Commission Communication 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, labour market, long-term care, pre-school education, service occupation, social facilities, work-life balance

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 7.9.2022  SWD(2022) 440 final  COMMISSION STAFF WORKING DOCUMENT Summary of consultation activities Accompanying the document Commission Communication on the European care strategy {COM(2022) 440 final}  
 
 
Contents 

1. 

INTRODUCTION 

2. MAIN ELEMENTS OF THE STAKEHOLDERS’ CONSULTATIONS 
2.1 
2.2 
2.3 

Call for evidence on Have your Say website 
Targeted consultations 
Inter-institutional process 

3.  CHALLENGES AND OPPORTUNITIES FOR THE EUROPEAN CARE 
STRATEGY – MAIN FINDINGS FROM THE CONSULTATIONS 
3.1 
3.2 
3.3 
3.4 
3.5 
3.6 
3.7 
3.8 
3.9 
3.10 
3.11 
3.12 
3.13 

On the European Care Strategy in general 
Gender dimension in care 
Socio-economic and territorial inequalities 
Social protection and affordability of care services 
Access and availability of care services 
Quality of care services 
Care workers 
Informal carers 
Potential of digitalisation and innovation for the care sector 
Financing of care services 
Governance and implementation 
Active and healthy ageing and prevention policies 
The impact of the COVID-19 pandemic 

2 

3 
3 
4 
5 

7 
7 
9 
10 
10 
12 
12 
13 
15 
16 
17 
18 
20 
21 

ANNEX 1: LIST OF STAKEHOLDERS WHO SUBMITTED FEEDBACK ON THE 
EUROPEAN CARE STRATEGYTHROUGH RESPONSES TO THE CALL FOR 
EVIDENCE 

22 

 
 
 
 
 
 
1. 

INTRODUCTION 

The 2022 Commission Work Programme announced a European care strategy to address both 
carers and care receivers, from childcare to long-term care. The strategy sets a framework for 
policy reforms to guide the development of sustainable long-term care that ensures better and 
more affordable access to quality services for all. It also helps close the gender employment 
gap  and  contributes  to  gender  equality,  including  by  revising  the  Barcelona  targets  on 
childcare. Finally, it sets out ways to improve the working conditions in the care sector. The 
Strategy  thus  supports  the  implementation  of  several  principles  of  the  European  Pillar  of 
Social  Rights.  The  package  comprises  three  elements:  (i)  a  Chapeau  Communication  on  a 
European Care Strategy, (ii) a proposal for a Council Recommendation on the revision of the 
Barcelona  targets  on  early  childhood  education  and  care,  and  (iii)  a  proposal  for  a  Council 
Recommendation on access to affordable high-quality long-term care. 

The  European  care  strategy  aims  to  respond  to  calls  for  a  strategic  and  comprehensive 
approach to care, including by the Member States, the European Parliament,  the Committee 
of the Regions, the European Economic and Social Committee, social partners, civil society, 
care providers and other stakeholders.  

The  initiative  builds  on  the  input  gathered  via  three  public  consultations,  notably  on  the 
European  Pillar  of  Social  Rights  action  plan1,  the  Green  paper  on  ageing2,  and  the  Gender 
equality strategy3.  

As  concerns  the  consultation  on  the  European  Pillar  of  Social  Rights  action  plan,  there 
were  calls  for  comprehensive  EU  action  on  long-term  care  to  address  common  challenges, 
including  via  minimum  standards,  quality  guidelines,  and  monitoring  mechanisms.  The 
importance  of  enhanced  mutual  learning  and  exchanges  of  best  practice  was  emphasized. 
Specific  feedback  was  received  inter  alia  on  the  attractiveness  of  the  care  sector,  working 
conditions, importance of social dialogue, occupational health and safety, prevention, person-
centred care, community-based care, and support for informal carers. There was furthermore 
a  call  for  a  Care  Package  including  a  revision  of  the  Barcelona  targets.  Accessible  and 
affordable  quality  long-term  care  and  childcare  services  is  considered  crucial  for  closing 
gender gaps.  

Respondents  to  the  consultation  launched  by  the  Green  Paper  on  Ageing  highlighted  the 
need  for  an  integrated  approach  to  long-term  care  that  is  accessible,  affordable  and  of  high 
quality,  that  is  centred  around  the  care  recipient’s  needs  and  aims  at  supporting  individual 
independence  as  long  as  possible.  The  right  to  live  in  dignity  was  stressed,  with  NGOs  in 
particular calling for Member States to increase levels of public spending on  long-term care 
and  expand  the  provision  of  formal  long-term  care  services.  Additional  feedback  was 

1 The Commission received 1 041 unique written contributions. 67.5% of submissions came from individual citizens. Many 
citizens took the opportunity to describe their personal situation, notably persons with disabilities and women with care 
responsibilities: SWD(2021) 46_EN_autre_document_travail_service_part1_v8 (2).pdf 
2 The public consultation gathered a total of 473 replies. 133 submissions came from individual citizens. Long-term care was 
discussed  in  the  context  of  older  people’s  autonomy  and  ensuring  their  at-home  care,  which  opens  new  employment 
opportunities  and  skills  needs.  Moreover,  the  need  to  recognise  pension  rights  of  informal  carers  was  highlighted.  See: 
GREEN PAPER ON AGEING: Factual summary report of the public consultation: 090166e5de9b0583.pdf 
3 The consultation was available online from 8 March until 31 May 2019. It received 1335 replies; 73% of the replies came 
from EU citizens (970 replies). Respondents were asked in particular about which specific goals they would prioritise for EU 
action  to  increase  women’s  participation  in  the  labour  market.    https://ec.europa.eu/info/law/better-regulation/have-
your-say/initiatives/12114-Gender-equality-strategy-2020-2024/public-consultation_en 

2 

 
 
                                                           
received inter alia on the importance of social protection coverage for  long-term care risks, 
the importance of increased provision of home and community-based care to enable ‘ageing-
in-place’,  the  need  to  tackle  long-term  care  staff  shortages,  the  role  of  cities  and  local 
authorities in  long-term  care  provision,  the role of technology  and prevention as drivers for 
cost-effectiveness and the need to reconcile adequate and affordable long-term care coverage 
with cost-effectiveness and financial sustainability.  

Respondents  to  the  public  consultation  on  the  Gender  equality  strategy  ranked  making 
childcare  and  other  dependents’  care  more  available,  accessible,  affordable  and  of  high 
quality  and  giving  support  to  informal  carers  as  key  priorities  for  EU  action  to  increase 
women’s participation in the labour market. Next to this, they highlighted the importance of 
equal sharing of caring activities between parents, as well as improving the conditions of part-
time  work,  flexible  working  arrangements  and  family  leaves  to  make  them  valid  career 
options  for  both  women  and  men.  Furthermore,  there  was  support  for  actions  aimed  at 
improving  childcare  provision  targeting  in  particular  under-served  groups  (e.g.  indigenous, 
low-income,  single  parents,  rural  areas,  etc.).  Enhanced  access  of  parents  to  affordable, 
accessible and quality early childhood education and care services was considered essential to 
encourage female labour market participation including for women with disabilities.  

The  Staff  Working  Document  describes  the  key  elements  of  the  stakeholders  consultations, 
which  complemented  the  above-mentioned  public  consultations  (section  2),  as  well  as  the 
main findings (section 3). 

2. MAIN ELEMENTS OF THE STAKEHOLDERS’ CONSULTATIONS 

2.1 

Call for evidence on the Have your Say website 

On 1 March 2022 the European Commission published a Call for Evidence on the European 
Care  Strategy  and  the  accompanying  proposals  for  Council  Recommendations,  inviting 
stakeholders  to  provide  their  input.  The  Commission  received  feedback  both  through  the 
dedicated website and direct submissions from stakeholders. 

Stakeholders  and  citizens  could  submit  their  feedback  on  the  European  care  strategy  via  a 
dedicated web page. The Commission received 123 contributions, with 64 submissions (52%) 
coming  from  NGOs.  Public  authorities  accounted  for  8%  of  total  submissions,  business 
associations for 8%, EU citizens for 7% and trade unions for 5%. Further contributions came 
from business organisations (5%), research institutions (1%) and other (15 %).  

3 

 
 
 
Distribution of contributions per type of stakeholder (N=123) 

The  most  recurrent  topics  raised  during  the  consultations  were  access  to  and  availability  of 
care services, social protection and affordability of care services, quality of care services, care 
workers  and  informal  carers,  socio-economic  and  territorial  inequalities,  gender  dimension, 
active  and  healthy  ageing  and  prevention  policies,  financing  of  care  services,  governance/ 
coordination  aspects,  potential  of  digitalisation  and  innovation  for  the  care  sector,  and  the 
COVID-19 pandemic and its impact. 

2.2 

Targeted consultations 

In  addition  to  the  Call  for  Evidence,  the  Commission  invited  stakeholders  to  provide  input 
through targeted consultations which included: 

  an  exploratory  debate  with  the  High  Level  Group  on  Gender  Mainstreaming  (28 

January); 

  exploratory debates with the Member States’ representatives in the Social Protection 

Committee (17 March) and Employment Committee (1 April); 
  a strategic dialogue with civil society organisations (11 March); 
  a  joint  hearing  of  the  Committees  of  the  European  Parliament  on  Employment  and 

Social Affairs and Women’s Rights and Gender Equality (24 March); 

  and a dedicated hearing with EU-level social partners (7 April). 

4 

 
 
 
 
2.3 

Inter-institutional process 

The  Commission  received  contributions  or  held  exchanges  of  views  with  the  European 
Parliament,  the  Council,  the  European  Economic  and  Social  Committee  (EESC)  and  the 
Committee of the Regions (CoR). 

The  European  Parliament,  in  its  Resolution  of  17  December  20204,  called  on  the 
Commission to present a plan to  ensure the mental health, dignity and wellbeing of people, 
including the elderly, and in its Resolution of 7 July 20215, underlined the importance of fully 
protecting  the  right  to  care  and  support  for  older  people  and  emphasised  the  key  role  of 
adequately funded social protection schemes in making care affordable and truly accessible. It 
called on the Member States to ensure equal access to health and care services, including at 
home, as well as residential or community-based long-term care and palliative care, without 
discrimination  on  any  grounds,  and  on  the  Commission  to  put  forward  a  ‘care  deal  for 
Europe’. 

During the joint hearing of the Committees of the European Parliament on Employment and 
Social Affairs and Women’s Rights and Gender Equality on the European care strategy of 24 
March  2022  all  political  groups  welcomed  the  European  care  strategy.  Key  challenges  and 
avenues  for  actions  included  the  underfunding  and  understaffing  of  the  care  sector,  low 
unionisation in the sector; the need to better recognise job creation and innovation potential 
and  improve  working  conditions  and  education  and  training  opportunities  as  a  way  to 
ensuring  qualified  staff  and  professionalization.  There  were  further  calls  for  more  public 
investments  to  expand  services  in  order  to  offer  a  choice  to  those  in  need  of  care  and  their 
families, and more focus on independent living. The strong gender dimension of care policies 
and the burden placed in informal carers were highlighted as well as the need to have in place 
supporting measures and to expand formal  long-term care services to establish the principle 
of  freedom  of  choice.  Issues  such  as  quality  of  care,  working  conditions,  including  for 
migrant workers, the need to monitor progress as well as take into account the Member States 
competences in this policy area were also highlighted. In its most recent own initiative report 
‘Towards  a  Common  European  action  on  care’6,  the  European  Parliament  called  for  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 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. 

The  Council  invited  the  Member  States  and  the  Commission  to  improve  the  availability  of 
high-quality long-term care and the sustainability and adequacy of social protection systems7, 
use digitalisation to make health, social and long-term care services easily accessible and user 

4 European Parliament resolution of 17 December 2020 on a strong social Europe for Just Transitions (2020/2084(INI)) 
5 European Parliament resolution of 7 July 2021 on an old continent growing older – possibilities and challenges related to 
ageing policy post-2020 (2020/2008(INI)) 
6 European Parliament resolution of 5 July 2022 towards a common European action on care (2021/2253(INI)) 
7 Council Conclusions on ‘Demographic Challenges – the Way Ahead’ 2020/C 205/03 of 19 June 2020 

5 

 
 
                                                           
friendly8, and develop services that provide person-centred and integrated care, including for 
persons with disabilities9. 

The EESC welcomed the Commission's initiative to establish a new European Care Strategy 
and called for its swift implementation.10 It urged the Commission and the Member States to 
develop in the short term the principles relating to care for older people within the framework 
of the European Pillar of Social Rights Action Plan. In a previous instance, EESC highlighted 
the precarious situation of live-in carers, who are often migrant or mobile women, and set out 
a number of recommendations to improve it, including via regularisation of their situation and 
supporting their professionalisation11. Most recently, in its draft opinion  Health Workforce 
and Care Strategy for the future of Europe SOC/720, which is scheduled for adoption in 
September  2022,  the  EESC  stressed  the  need  for  a  transformative  approach  to  care,  going 
beyond minimum standards and providing for a quality eco-system for care, which should be 
affordable,  and  available.  Addressing  workforce-related  challenges  was  also  identified  as  a 
key priority. 

The  CoR  adopted  in  July  2021  an  opinion  on  the  Future  plan  for  care  workers  and  care 
services  –  local  and  regional  opportunities  in  the  context  of  a  European  challenge12,  which 
stresses the need for a European quality framework for LTC services and for a comprehensive 
data collection and analysis. 

8  Council  Conclusions  on  Human  Rights,  Participation  and  Well-Being  of  Older  Persons  in  the  Era  of  Digitalisation  of  9 
September 2020  
9 Council Conclusions on Mainstreaming Ageing in Public Policies of 12 March 2021 
10 Own-initiative opinion “Towards a New Care Model for the Elderly: learning from the Covid-19 pandemic” (SOC/687) 
11 Own-initiative opinion on “The rights of live-in care workers” (SOC/535) from 2016 and a follow-up report “The future of 
live-in care work in Europe” from 2020. 
12 Own-initiative opinion “Future plan for care workers and care services – local and regional opportunities in the context of 
a European challenge” (COR/05862) from 2021 

6 

 
 
 
 
                                                           
3.  CHALLENGES  AND  OPPORTUNITIES  FOR  THE  EUROPEAN  CARE  STRATEGY  –  MAIN 

FINDINGS FROM THE CONSULTATIONS 

This  chapter  gives  an  overview  of  the  contributions  received  during  the  consultations 
conducted  in  preparation  of  the  European  care  strategy  through  responses  to  the  Call  for 
Evidence,  targeted  consultations  and  inter-institutional  processes.  It  is  structured  around 
overarching topics, which were recurrent throughout the consultation.  

3.1  On the European care strategy in general 

Overall  feedback  indicates  that,  while  care  systems  across  the  Union  face  common 
challenges and structural weaknesses, they have a key role in enhancing social fairness, 
gender inequalities and are as such a social investment.  Member States are responsible for 
designing and delivering long-term care and there are significant differences in the way they 
organise  and  fund  care  systems.  However,  there  are  common  challenges  and  structural 
weaknesses13,  which  were  especially  highlighted  by  the  COVID-19  pandemic.  Such 
challenges  include  availability,  access,  affordability,  quality,  workforce  shortages  and 
working conditions, and insufficient support for informal carers. At the same time, investment 
in care is a social investment, with multiple returns for individuals, societies and economies. 
Strong  care  systems  reduce  inequalities,  enhance  social  fairness  and  intergenerational 
solidarity.  High  quality  early  childhood  education  and  care  facilitates  children’s  personal 
development and social integration and later on their social and labour market outcomes, thus 
breaking the intergenerational cycle of poverty. Accessible, affordable and high-quality long-
term care helps persons in need of care maintain autonomy and live in dignity for as long as 
possible,  while  also  protecting  human  rights  and  preventing  poverty  and  social  exclusion. 
Adequate care systems foster gender equality, by reducing gender gaps in employment, pay 
and pensions. Care has a great economic potential. New opportunities arise in the silver and 
care  economy,  resulting  from  the  growing  demand  for  care  services.  In  addition  to 
contributing to gender equality, addressing care needs also leads to job creation and supports 
strong local communities. 

A right-based approach to care is often called for. Some civil society organisations (SSE, 
Social Platform, Eurodiaconia, ESN) call for a comprehensive European Care Guarantee 
that approaches care as a right which people have throughout their lives, ensuring access to 
quality  and  affordable  social  care  for  everyone  whenever  it  is  needed,  and  particularly  for 
persons in vulnerable situations. Next to high quality services, a Care Guarantee would also 
help  to  enable  framework  conditions  for  social  care  services  across  Europe  and  equally 
support  upward  convergence  amongst  Member  States’  care  strategies  (SSE).  As  part  of  the 
Care Guarantee, Member States could adopt care schemes allowing workers wishing to leave 
their job to provide informal care for relatives to receive poverty-proof wages. This would be 
in combination with adequate education and training opportunities for the carers (SSE). 

13  Council,  Endorsement  –  Key  conclusions  on  2021  long-term  care  report  of  the  Social  Protection  Committee  and  the 
European Commission. https://data.consilium.europa.eu/doc/document/ST-9144-2021-INIT/en/pdf 

7 

 
 
 
                                                           
 
Other  civil  society organizations (NCPE, EWL)  are calling  for  a  Care Deal  for Europe to 
complement the European Green Deal, since they consider caring for the planet and caring for 
each other as part of the same continuum. A Care Deal for Europe would include investment 
in  care  provision,  work-life  balance  policies  and  the  re-evaluation  of  the  care  sector, 
particularly  with  regard  to  training  provision,  working  conditions  and  pay  (NCPE).  Trade 
unions stressed that the right to care should be universal, accessible to all no matter where 
they  live,  with  some  additional  support  to  vulnerable  groups,  and  they  called  for  an 
integrated  and  lifelong  approach  to  care,  asking  also  to  cover  healthcare  and  decent 
incomes (EPSU, ETUC).  

A person-centred approach to care is strongly encouraged. Concretely, it should be based 
on  human  rights,  dignity,  inclusiveness,  non-discrimination  and  solidarity.  It  is  imperative 
that more efforts be directed towards fostering home and community-based care provision 
(Eurohealthnet, SSE, ESN, AGE). Choice is regarded as a fundamental element of the right to 
long-term care (AGE). Therefore, a continuum of long-term care services would enable each 
person to have the greatest freedom of choice, depending on his or her specific circumstances 
(Santa casa, HU in SPC). To have a fundamental rights-based approach with a rights of the 
child perspective, improving access  to  quality and affordable childcare is necessary (ERGO 
network). 

An  inclusive  and  holistic  approach  is  also  deemed  crucial.  Strengthening  the  rights  of 
people  in  need  of  care  and  of  their  caregivers  to  participate  in  decision-making  both  at 
political  and  individual  level  is  conducive  to  this  (BAGSO).  Caregivers  and  care  recipients 
from  varied  backgrounds  have  to  be  involved  (ERGO),  including  individuals  and 
organisations  representing  people  from  different  ethnical  and  socio-economic  backgrounds, 
persons  living  with  (rare)  diseases  and  disabilities  (ERGO,  ViiV,  EURORDIS,  Inclusion 
Europe).  Tackling  discrimination  and  stigma  is  considered  necessary,  for  instance  through 
tailored  education  programmes,  since  health  and  social  workers  who  are  well  trained  and 
appropriately skilled are champions for addressing discrimination in health and social settings 
(ViiV). There is also a need for a holistic approach that brings healthcare professionals and 
formal  and  informal  carers  into  closer  partnership  (CCI  Europe).  The  Care  strategy  should 
aim to increase both awareness and use of evidence-based palliative care across Europe (CCI 
Europe, BAGSO).  

A  resilient  ecosystem  for  care  services  is  expected  to  contribute  to  quality,  affordable, 
available,  and  accessible  care  infrastructures  in  all  Member  States  (Social  Platform).  It 
has to be ensured that care is an integral part of a sustainable economic model (NCPE). The 
public discourse should be reoriented towards the value of care instead of focusing solely on 
its  costs  (Incare).  Moreover,  some  respondents  highlighted  that  people  who  do  not  have  an 
EU  nationality  but  live  in  the  EU  should  be  fully  considered  in  the  European  care  strategy 
(LaStrada et al). Synergies have to be ensured and nurtured with other Union initiatives (e.g. 
the EU Pillar of Social Rights action plan; the European strategy for the rights of persons with 
disabilities;  the  Gender  equality  strategy;  the  Work-life  Balance  Directive;  the  Council 
Recommendation on the European Child Guarantee; etc.). 

8 

 
 
Unlocking  the  job  creation  potential  of  the  care  sector  is  of  particular  importance 
(Social  Platform,  Red  Cross).  Member  of  the  European  Parliament  stressed  the  current 
underfunding  and  understaffing  of  the  care  sector  and  its  high  job  creation  and  innovation 
potential. International organisations such as the International Labour Organisation (ILO) and 
the  World  Health  Organisation  (WHO)  pointed  to  the  need  for  transformative  care  policies 
ensuring  decent  work  for  care  workers  and  quality  care  for  those  in  receiving  it,  including 
through integrated and person-centred approaches. 

3.2  Gender dimension in care 

Women  form  the  majority  of  the  workforce  in  all  sectors  related  to  care  -  health, 
education, and long-term care and they carry the lion share of informal care work, too (EWL, 
FES/FEPS,  EFPIA).  Care  work  is  often  undervalued  and  underpaid,  bringing  along 
lifelong consequences (EWL, CAI). This has an impact on women’s economic independence, 
access to social rights and particularly pensions, as the high gender pension gap attests (40% 
EU average) (EWL). Older women are also more in need of long-term care, but at the same 
time more exposed to poverty risks. For example, women are disproportionately impacted by 
Alzheimer’s disease (EFPIA). Given that the majority of informal carers are women, women 
are exposed to a considerable risk of economic hardship and poor health outcomes (EFPIA). 
Moreover,  there  is  a  need  to  attract  a  more  gender-balanced  workforce  into  the  care  sector 
(COFACE). 

Investments,  decent  wages  and  training  are  part  of  the  solution.  There  are  various 
suggestions  on  ways  to  address  the  above-described  issues.  First,  it  is  essential  to  develop 
sustained investment in public services and social infrastructure, so that there is a lesser need 
for informal care provision (NWC). Second, it is crucial to gradually increase salaries in the 
care  sector  in  order  to  reflect  their  high  value  for  the  society  (CZ  Ministry  of  Labour  and 
Social  Affairs).  Simultaneously,  efforts  are  needed  to  combat  gender  stereotypes  in  care  as 
well as within the household and the family, so that more men can be attracted to work in the 
care sector (NCPE, CZ Ministry of Labour and Social Affairs). Guidance on national tax and 
benefits  systems  as  well  as  on  fiscal  and  pension  policies  for  carers  was  called  for  (NCPE, 
LaStrada et al, EWL). Next, increased public funding should be dedicated to the training and 
education  of  informal  carers  and  formal  care  workforce  (FES  and  FEPS).  There  is  a 
correlation between better funding and the availability of qualified staff (AT in SPC). Migrant 
carers,  gender  and  racial  stereotypes,  discrimination  and  violence  should  also  be  addressed 
accordingly (LaStrada et al, EWL).  

is  an  obstacle  for  women’s 

Lack  of  care 
labour  market  participation  and 
entrepreneurship. Employers’ organisations highlighted that such lack of care services does 
not  only  concern  childcare  (Inclusion  Europe),  but  also  afterschool  care  and  care  for  sick 
children  (BusinessEurope,  SMEunited)  and  pointed  to  the  need  to  have  more  ambitious 
childcare targets, to include another target regarding after-school services (BusinessEurope). 
There  is  a  particular  challenge  for  single  parents,  most  of  whom  are  women  (ES  in  SPC). 
Finally,  it  is  important  also  to  provide  incentives  for  businesses  to  put  in  place  support 
measures for workers with family responsibilities (CONFINDUSTRIA). 

9 

 
 
 
 
3.3 

Socio-economic and territorial inequalities 

Families  and  individuals  in  remote  or  rural  areas  often  face  more  difficulties  in  the 
access  to  care  services  (Federation  of  Catholic  Family  Associations  in  Europe,  City  of 
Ghent). The European care strategy is expected to play a role in addressing socio-economic 
and territorial inequalities. It is expected to create a level-playing field to ensure a balanced 
provision of accessible, affordable and high-quality care services across regions and countries 
(CESI,  REIF)  for  all  groups  of  the  population  that  are  in  need  of  care  (DSV).  A  decisive 
factor  is  the  presence  in  the  territories  of  services  capable  of  meeting  the  needs  of  resident 
populations  and,  in  particular,  of  workers  (CONFINDUSTRIA).  This  is  also  crucial  for 
allowing  women  to  participate  in  the  labour  market  and  social  life  (CONFINDUSTRIA). 
Community-based  services  could  be  helpful  to  achieve  this,  including  social  economy 
initiatives, to create local jobs and respond to community needs where they arise (ERGO).  

Territorial  inequalities  in  access  could  be  tackled  through  monitoring,  strengthened 
administrative capacity and enhanced use of ICT. Digital solutions implemented in long-
term  care and healthcare service, as well as digital  assistance systems  and care  applications 
can  reduce  inequalities  in  access  to  care  (DSV).  Additionally,  it  is  useful  to  establish  close 
and  constant  monitoring  activities  at  regional  level  and  to  strengthen  the  administrative 
capacity  (CONFINDUSTRIA).  Investments  in  care  should  meet  the  regional  needs  (DE  in 
SPC).  Expansion  of  mobile  home-patient  care  also  has  a  positive  role 
to  play 
(Kinderpalliativteam). Furthermore, it is of paramount importance to make sure that people in 
need  of  care  (and  not  only)  have  proper  access  to  health  services,  independently  of  socio-
economic status (Platform for better oral health in Europe, CCI Europe).  

There is a need for a special focus on increasing participation of vulnerable children in 
early childhood education and care (FYFPC). Families in vulnerable situations need to be 
informed and be consulted in the development of early childhood education and care services 
(COFACE/ FYFPC). High-income families with a highly educated mother use childcare more 
often  than  families  with  a  lower  socio-economic  status  (City  of  Ghent).  There  is  a  need  to 
provide diversity education and awareness about Roma language, culture and history in order 
to  increase  participation  of  Roma  children  in  early  childhood  education  and  care  (ERGO). 
Moreover, there is a need for inclusive enrolment systems the participation of children from 
disadvantaged backgrounds to ensure a social mix (EUROCITIES). The reformed EU Roma 
Strategic  Framework  for  equality,  inclusion  and  participation  for  2021-2030  promotes 
empowerment of Roma young people and children to overcome socio-economic gaps. In this 
sense,  it  is  important  to  pursue  efforts  to  reach  the  proposed  target  to  cut  the  gap  in 
participation in early childhood education and care by at least half. 

3.4 

Social protection and affordability of care services 

Social  protection  coverage  for  long-term  care  is  mixed  and  in  general  limited,  while 
affordability  of  childcare  continues  to  be  a  barrier  to  access.  Loss  of  autonomy,  its 
management and occupational aspects affect all ages through disability, illness or aging and 
are addressed through support in different care settings. This solution can be expensive and it 
is often not well covered by public funds being financed by insurances (AEIP). Hence, loss of 

10 

 
 
 
autonomy  is  an  increasingly  prevalent  risk  considered  within  social  protection  systems 
(ESIP). It is highlighted that there should be a social protection approach to care (AGE), with 
financial barriers for persons  with  disabilities being tackled (Inclusion Europe). Parents  and 
caregivers of children with cancer, in particular, should be entitled to an extraordinary leave 
tailored to the intense period of cancer treatments (with an employment guarantee) with early 
and  ongoing  assessment  of  their  mental  health  needs  (CCI  Europe).  Furthermore,  Member 
States should ensure effective and free access to high quality ECEC for all children, including 
migrant children (LaStrada et al) as well as a universal non-discriminatory approach to child 
benefits, regardless of migration or residence status (NCPE). Special attention is needed for 
families in vulnerable situations who should be informed and consulted in the development of 
early childhood education and care services and extra efforts should be made to reach out and 
provide early childhood education and care services adapted to those families in an inclusive, 
accessible and non-stigmatising way (EASPD).  

Strengthening public provision of care is seen as key to implementing the right to care. 
Member States should improve affordability of care services for low-income individuals and 
families,  including  migrants  (LaStrada  et  al).  Member  States  should  invest,  including  by 
making  use  of  EU  funds,  in  the  provision  of  public  services  and  subsidised,  well-regulated 
private service provision (LaStrada et al). Caution should be exercised to avoid promoting the 
commercialisation of care (EPSU). Furthermore, the social protection systems should evolve 
to  be  fully  individualised  to  reflect  the  diversity  of  today’s  lives  and  to  promote  an  equal 
division of paid work and care (CAI). 

Care-friendly  and  gender-responsive  social  protection  systems  are  needed.  This  would 
entail promoting social protection systems based on a “universal  carer model” and ensuring 
that social benefits recognise and compensate the cost of care and avoid reproducing gender 
inequalities.  It  also  means  ensuring  that  social  protection  is  extended  to  workers  in  the 
informal  economy  and  care  credits  are  implemented  as  part  of  social  protection  systems 
(ILO). Civil society organisations echoed this call. It is important to introduce ‘care credits’” 
to the benefit of both women and men and to fairly take these credits into account in pension 
entitlements (LaStrada et al, NCPE, MMM). Career break entitlement (e.g. the Belgian ‘time-
credit’ system) (MMM)  should ensure income compensation during longer periods of leave 
for care duties (NCPE). Moreover, unpaid care work should be considered as essential work 
giving access to social rights (e.g. access to social security, education and training) (MMM). 
The overall goal should be building robust public social protection systems for those needing 
care and those working in the sector (LaStrada et al, EPSU). Incentives could be provided to 
companies that voluntarily provide to their workers in-company care services, supplementary 
healthcare, etc. (CONFINDUSTRIA). 

Flexible  working  arrangements  by  choice,  adequate  care  leaves  and  access  to  quality 
and  affordable  services  are  needed  in  order  to  increase  the  participation  of  childcare 
(EASPD). A good coordination between family leaves, childcare and provision of other types 
of support is necessary in this regard. Financial barriers should be removed by offering places 
based  on  income-related  rates  to  increase  access  to  childcare  (City  of  Ghent).  Moreover, 
strengthening the provision of publicly funded care services is called for (NCPE). 

Robust  social  protection  has  a  positive  impact  on  access  to  and  affordability  of  high-
quality care services. Trade unions stressed that long-term care needs should be covered by 

11 

 
 
social  protection  and  all  workers  (including  platform  workers)  need  to  contribute  to  social 
security  (EPSU),  while  the  employers  cautioned  that  there  is  already  a  lot  of  investment  in 
social  protection,  so  a  balanced  approach  is  needed  which  look  into  possible  savings  and 
reallocation of existing social protection resources (BusinessEurope). SGI Europe called for 
more public investments in care services. 

3.5 

Access and availability of care services 

More availability and integration of home care and community-based care services and 
person-centred  approaches  facilitate  access  to  care.  The  European  care  strategy  is 
expected to ensure that all people living in the EU have access to quality care services on the 
basis  of  need,  regardless  of  their  migration,  legal  or  residence  status  (La  Strada  et  al,  Red 
Cross). This entails early childhood education and care for children as well as long-term care 
for persons in need of all ages, including persons with disabilities, cancer, rare diseases, etc. 
(SIOP  Europe, ENIL, MMM).  Person-centred and user-led, care services should be flexible 
and  inclusive  in  order  to  allow  for  adaptation  to  the  individual  needs  and  choice  (VÖWG, 
Vienna  Social  Fund,  ENIL).  Independent  living  and  social  inclusion  should  be  promoted 
(ENIL).  This  necessitates  more  availability  and  integration  of  home  care  and  community-
based care services (Eurocarers, Red Cross, European Disability Forum), allowing people in 
need of care to exercise their freedom of choice and stay (longer) in their own home if wished 
so  (Caritas  Europe),  as  well  as  community-based  palliative  care  and  alternatives  to 
institutional care (VÖWG, ENIL, European Disability Forum). 

Care  services  need  to  be  developed  and  expanded  according  to  the  needs  of  the 
population (Vienna Social Fund). More options over their live choices have to be provided 
also  to  informal  carers  (EASPD).  High-quality  and  inclusive  early  childhood  education  and 
care  is  essential  to  support  the  inclusion  of  all  children  into  society  (ESIP)  and  therefore 
should be available to all families through a range of strategies, including a shared definition 
of high-quality early childhood education and care and targeted measures towards identifying 
which children are from disadvantages families (EASPD).  

Care services are a public good. Employers stressed that the state should have a very strong 
role  in  providing  care  services,  while  also  acknowledging  that  privatisation  of  care  is 
increasing  (BusinessEurope)  and  trade  unions  pointing  to  risks  of  low  quality  and  profit-
driven  approach  (FERPA).  Employers  called  for  a  level  playing  field  between  private  and 
public  provision,  with  similar  standards  applied  across  the  board.  They  also  mentioned  the 
important  role  of  public-private  partnerships  and  responsibilities  devolved  to  regional  and 
local governments (BusinessEurope). 

3.6  Quality of care services 

Ambitious quality standards on care are needed. The European care strategy is expected to 
facilitate  the  development  and  promotion  of  ambitious  common  quality  standards  on  early 

12 

 
 
 
 
childhood  education  and  care  and  long-term  care  services,  rooted  in  a  human  rights-based 
approach,  with  a  strong  focus  on  social  justice,  non-discrimination  and  equality  (Social 
Platform,  EWL,  Eurocarers,  EFSI,  MMM).  Quality  standards  of  care  services  and  quality 
control should be implemented, especially in childcare (Caritas Europe). 

Effectiveness,  safety  and  people-centredness  are  key  ingredients  of  quality  care 
(Eurocarers).  Improved  cleaning  and  enhanced  infection  prevention  and  control  are  also 
integral  elements  of  high-quality  care,  since  they  can  help  save  lives.  In  early  childhood 
education and care, staff shortages and the lack of resources for space remain big hurdles that 
need to be tackled to improve the quality of care services (Eurocities and the Municipality of 
Milan).  

Quality  monitoring  and  assurance  systems  should  be  further  developed.  This  should 
involve  care  service  users,  care  workers  and  informal  carers  in  the  process  (LaStrada  et  al, 
Eurocarers).  Special  attention  should  be  given  not  only  to  the  quality  of  care  activities 
(technical quality), but also to the way the care is provided (functional quality) and the effect 
of the quality of  care on the  quality of life (EAN). A  common definition on quality  would 
to  address  discrepancies  between  Member  States  (EASPD).  Regulatory 
also  help 
arrangements  such  as  certification  could  ensure  that  the  care  provided  meets  safety  and 
quality criteria (MGEN).  

Integrated  care  is  viewed  as  a  tool  to  ensure  quality  and  responsiveness  of  care  to 
individual  needs.  This  includes  different  needs  of  older  persons,  persons  with  disabilities, 
persons with mental health problems and cancer patients (Generalitat de Catalunya, TBCT). 
High-quality services also mean that caregivers have strong relationships with the people they 
support  and  can  adapt  the  services  to  the  beneficiaries’  preferences  (Red  Cross).  Hence, 
mechanisms for quality assurance that are based on continuous quality improvement need to 
be  promoted  and  strengthened  (Red  Cross).  Not-for-profit  provision  of  care  should  be 
prioritised,  ensuring  a  focus  on  quality  care  and  care  work,  not  on  profits  and  private 
marketisation (Caritas Europe).  

Training  and  education  of  caregivers,  including  informal  carers,  contribute  to 
enhancing the quality of care provided. This  could  also  be  achieved  by integrating  home 
care  programmes  into  professional  healthcare  training  (Caritas  Europe).  In  addition  to  this, 
early childhood education and care staff should be properly trained and equipped in order to 
facilitate  inclusion,  gender  equality  and  end  segregation  of  Roma  children  (EASPD  and 
ERGO).  Furthermore,  certified  child  minders  would  improve  the  quality  standards  of  early 
childhood education and care (COFACE). 

Quality not only ensures the dignity of persons receiving care, but also increases trust in 
care  services.  Employers  stressed  the  importance  of  an  outcomes-based  approach  to 
investment  (e.g. by integrating quality  criteria in  public procurement) and called for quality 
regulation to apply in the same way to public and private actors (BusinessEurope). 

13 

 
 
 
3.7 

Care workers 

Transformative  care  policies  are  needed.  A  decent  work  approach  to  the  care  economy 
should be incorporated in the European Care Strategy which is grounded in the ILO’s Decent 
Work Agenda, the UN’s Agenda 2030 and its Sustainable Development Goals. The elements 
of ILO’s 5R Framework for Decent Care Work are (i) recognize, reduce and redistribute 
unpaid care work; (ii)  reward paid care work, by promoting more and decent work for care 
workers;  and  (iii)  guaranteeing  care  workers’  representation,  social  dialogue  and  collective 
bargaining rights. Such transformative care policies can  yield positive health, economic and 
gender equality outcomes (ILO). 

There is an urgent need to improve the working conditions of the care workforce (EWL, 
FES/FEPS,).  Member  States  (e.g.  DE,  FR)  are  aware  of  workforce  shortages  and  some  are 
developing  strategies  to  attract  more  workers,  including  men,  to  the  care  sector.  Raising 
wages  as  well  as  pay  transparency  (for  combatting  the  gender  pay  gap)  will  play  a  role  in 
making the sector more attractive (NCPE, EWL, VÖWG). The situation of the formal carers 
is a determinant of the quality of care (REIF). Measures to improve their working conditions, 
training, health and safety at work will contribute to staff attraction and staff retention (CESI, 
EPSU). All  employment regulations,  including the ‘Working Time Directive’ and proposed 
Directive  on  adequate  minimum  wages  should  be  correctly  and  fully  implemented  for  the 
benefit  of  all  care  workers,  including  domestic  workers  (LaStrada  et  al).  Labour  standards 
should be guaranteed to  all workers in  the sector, regardless  of their migration or residence 
status,  work  arrangements  (live-in,  live-out,  single  or  multiple  employers),  employment 
relationship  (placement  agencies,  provider  organisations,  contract  with  the  end-users  or 
domestic  workers  operating  as  self-employed)  (LaStrada  et  al).  It  is  equally  important  to 
provide information  and effective  complaint mechanisms that enable workers to  know their 
rights,  file  a  complaint  and  access  remedies  without  any  immigration  enforcement 
consequences  (LaStrada  et  al).  Moreover,  better  work-life  balance  is  key  (EASPD). 
Enhancing  occupational  health  and  safety  (e.g.  personal  protective  equipment,  proper  risk 
assessments)  is  also  key  for  improving  working  conditions  in  the  care  sector  (EPSU).  The 
PHS  workers  as  a  part  of  the  care  workforce  should  receive  policy  attention  (EFSI). 
Moreover, safe staffing ratios should be ensured both in  early childhood education and care 
and long-term care (SOS Children’s Villages).  

Migrant  workers  deserve  more  policy  attention.  There  is  a  need  for  schemes  for 
regularisation of migrant workers currently performing care jobs with irregular or precarious 
status (La Strada et al). The recognition of mobile EU  and non-EU migrant care workers in 
factual  employment  relationships  for  the  purpose  of  labour  rights  and  social  protection 
(LaStrada et al) should be facilitated. In addition, domestic, home and community-based care 
work  should  be  eligible  under  general  work  permit  schemes  for  admission  for  people  from 
outside of the EU, as the permits should be renewable for a reasonable period (e.g. two years) 
(LaStrada  et  al).  Work  permits  for  foreign  graduates  should  also  be  facilitated 
(Wirtschaftskammer  Österreich).  Migrant  workers  should  have  the  right  to  bring  family 
members (LaStrada et al). 

Regulating European cross-border placement agencies for care workers and ensuring the 
application of all relevant legal provisions and decent work standards is important to prevent 
abuse  (FES/FEPS).  Yet,  some  respondents  suggest  that  welfare  measures  that  promote 

14 

 
 
domestic care work and other precarious care schemes should be avoided (FES/FEPS). Live-
in carers in many countries operate in the “grey” economy, which deprives them from social 
and legal protection (SSE). Moreover, heavy reliance on staff from other countries is noted to 
be  an  unsustainable  option,  since  carers  might  return  to  their  home  countries  at  some  point 
(SSE). On the other hand, if they do not return, the long-term negative effects of migration of 
care  workers  from  less  developed  regions  to  more  developed  ones,  might  create  a  situation 
where the access to care services of the aging population from these less developed regions is 
gravely  affected  by  the  severe  staff  shortages  (Harghita  County  Council).  The  imbalances 
between the destination countries and countries of origin of care workers within the EU, and 
the needs of the workers themselves are to be taken into account (FES and FEPS). 

training  and  professional  development 

Retaining  and  attracting  trained  and  qualified  staff  is  increasingly  challenging.  (SSE, 
DSV).  New  recruitment  and  training  strategies  need  to  be  developed  (SSE).  Skill  gaps  and 
needs,  good  practices,  and  successful  initiatives  should  be  identified  (SSE,  Eurodiaconia). 
Member States highlighted the need for the professionalisation of the care sector, the role of 
training and qualifications (DE and EE in SPC) and the prospects of care as a potential career 
path  for  young  people  (FR  in  EMCO).  Care  workers  should  have  access  to  customised 
(NCPE).  Recognition  and 
professional 
certification  of  social,  technical,  linguistic  and  transcultural  competencies  and  skills 
acquired, including for informal carers (LaStrada et al) should be facilitated. Upskilling and 
reskilling is also of paramount importance (CECOP, SSE, Eurodiaconia, LaStrada et al). It is 
critical to create a modern, positive, professional and career-based image of the sector (EAN). 
Especially for the revalorisation of the work in  early childhood education and care, training 
and  reskilling  the  workforce  and  work  on  the  gender  aspect  is  important  (COFACE).  Staff 
should  be  offered  opportunities  to  boost  their  inclusive  skills  and  to  access  trainings  on 
discrimination  and  unconscious  bias  (COFACE).  Attracting  young  workforce  could  be 
facilitated  by  campaigns  among  the  youth  (Harghita  County  Council).  This  could  be 
reinforced  also  through  developing  jobs  and  professions  in  the  care  sector  that  have  much 
broader  skill  sets  than  those  that  currently  exist  (LaStrada  et  al).  Increasing  the  variety  of 
training  paths  and  expanding  tasks,  financial  support  and  incentives  during  training  is  also 
recommended  (Wirtschaftskammer  Österreich).  Member  States  should  provide  publicly 
subsidised opportunities for all carers, including migrant informal carers and care workers, to 
participate in vocational education and training and gain qualifications. (LaStrada et al). 

Social  dialogue  at  European  and  national  level  and  building  the  capacity  of  social 
partners at national  level  to  engage in collective bargaining are of utmost importance. 
Employers  stress  the  role  of  the  social  dialogue  and  recalled  the  calls  they  made  for  two 
advisory committees on employment and social policies (BusinessEurope). Trade unions refer 
to  the  upcoming  social  dialogue  initiative,  including  for  sectoral  social  dialogue;  they 
proposed  to  invite  Member  States  to  have  a  designated  contact  point  for  expanding 
unionisation  in  the  care  sector  at  national  level  (UNICARE).  Trade  unions  mentioned  the 
importance of adequate staffing levels to ensure quality and person-centred delivery (EPSU) 
and  stressed  that  migrant  workers,  domestic  workers  and  people  in  the  personal  household 
services should benefit of the same social and labour rights as workers in the mainstream care 
sector  (EFFAT).  Finally,  trade  unions  call  for  the  ratification  of  the  ILO  Convention  on 
domestic  workers  by  the  Member  States  and  for  a  revision  of  the  OSHA  framework  to 
include domestic workers (EFFAT). 

15 

 
 
3.8 

Informal carers 

The social value of informal carers’ work is largely unrecognised across Europe and the 
world. However, the European care strategy can play an important role to address this. Apart 
from  being  fair  and  justified,  adequately  recognising  and  supporting  informal  carers  will 
address care quality, safety and sustainability (IFIC).  

Access to information, training, counselling and access to complementary care services 
should be put in place (LaStrada et al, Incare). Particular attention should be paid to defining 
a  legal  status  for  informal  carers,  facilitating  access  to  rights  such  as  employment  rights, 
social  protection,  respite  care,  financial  support,  pension  credits,  and  flexible  working 
arrangements (Red Cross, Eurocarers, AIM, ESN). Moreover, it is crucial to ensure relief for 
informal  carers,  including  targeted  relief  services  (e.g.  respite  care,  holiday  care)  and  the 
extension of existing services (e.g. longer opening hours of day centres, provision of mobile 
services  also  during  the  night)  (VÖWG,  Vienna  Social  Fund).  Besides,  more  flexibility  is 
called  for  in  the  exercise  of  carers’  rights  in  cross-border  situations  (AIM).  Member  States 
should also develop measures to provide specific support to informal carers of migrant origin 
(LaStrada  et  al).  Parents  and  caregivers  should  be  able  to  enjoy  a  proper  work-life  balance 
and  they  should  have  flexibility  to  spend  adequate  quality  time  with  their  children  (ERGO 
and COFACE).  

Better recognition of the role of informal carers, including families is needed (Federation 
of Catholic Family Associations in Europe). Recognition of their status and improvement of 
their  situation  (with  a  right  to  respite  and  simplified  procedures  for  access  to  rights,  for 
example)  are  key  to  the  success  of  any  initiative  in  this  area  (REIF,  AIM,  EASPD).  Other 
policy measures may include increasing the non-taxable income threshold for carers as well 
as  increasing  the  ceiling  on  the  number  of  hours  in  paid  work  outside  the  home  (CAI). 
Informal care should be  recognised through the introduction of care credits  to  offset  breaks 
from  employment  taken  to  provide  informal  care  to  family  members  and  periods  of  formal 
care  leavers  (MMM).  The  importance  of  incorporating  targeted  labour  market  integration 
measures and promotion of career opportunities for informal carers providing the main part of 
family  care  has  been  stressed  (VÖWG).  Some  respondents  insist  on  recognising  and 
validating  the  skills  acquired  while  doing  unpaid  family  care  work  (MMM).  Health 
prevention  for  informal  carers  should  be  provided  through  mental  health  support,  targeted 
information, and better communication channels with formal carers (ESIP, DSV, Red Cross, 
AIM). 

3.9 

Potential of digitalisation and innovation for the care sector 

Digitalisation offers substantial opportunities in several aspects in the delivery of long-
term  care,  both  for  care  recipients  and  carers  (EAN,  REIF).  For  example,  investing  in 
more  effective  information  systems  would  simplify  administrative  procedures  and  speed  up 
communication between service providers and service recipients. With telemedicine being on 
the rise, it is suggested that it will become the standard of care for some visits, check-ups and 

16 

 
 
 
 
consultations,  especially  chronic  conditions  and  long-term  diseases  (Europa  Donna). 
Moreover, digitalisation could enhance the accessibility of care services, especially in remote 
and rural areas (REIF, ESIP). This could benefit the feasibility of home care as a long-term 
care  option  (ESIP).  Yet,  it  is  crucial  to  maintain  the  complementarity  between  digital  and 
physical provision of care (REIF, Social Platform). 

For  carers,  digitalisation  has  the  potential  to  improve  their  working conditions  (Social 
Platform,  EAN,  ESN).  Employing  assistive  technology  and  applications  can  increase  care 
recipient’s  independence  and  reduce  the  intensity  or  time  of  care  needed  (EAN),  which 
addresses the challenge of staff shortages. Further, digitalisation can make the care jobs more 
flexible, allowing  for  a  certain degree of  remote working  (ESN). With the establishment of 
more  and  better  digital  communication  tools,  care  professionals  can  much  more  easily 
collaborate with and support each other (AIM).  

Digital  inequalities  and  digital  divide  should  be  taken  into  account  and  tackled  (ESIP, 
Social  Platform,  AIM,  ERGO).  Due  to  a  lack  of  digital  skills,  a  lack  of  IT  infrastructure, 
lower  income  or  by  choice,  some  persons  in  need  of  care  cannot  make  use  of  digital  tools 
(ESIP).  

Solutions could also build on EU-funded social innovation projects in long-term care as 
well  as  the  guidelines  on  integrated  care  by  the  WHO  and  other  stakeholders 
(Eurocarers). However, current legislation and regulations of services on the internal market 
as  well  as  unclear  classification  of  health  and  social  services  hamper  the  development  of 
adequate  social  services  in  innovative  care  concept  (EAN).  Additionally,  the  blur  between 
health  and  social  care  and  more  commercial  services  with  a  social  objective  is  reported  to 
lead to an unnecessary financial and bureaucratic burden for care providers, hindering them to 
develop  their  full  potential  (EAN).  Therefore,  special  attention  should  be  paid  to  VAT, 
taxation and regulation in the care sector. 

Innovation  in  care  has  a  great  potential  and  should  be  more  heavily  promoted.  This 
could take place for example through targeted calls within the Horizon Europe Programme or 
the  European  Competence  Centres  for  Social  Innovation  (EaSI).  Financial  instruments  and 
investment  (e.g.  InvestEU)  should  be  utilised  by  the  Care  strategy  to  boost  investment  into 
the social sector (SSE, CAP). Additionally, EU funds should become more accessible to care 
organisations  and  care  service  providers  –  either  through  raising  awareness  about  the 
available  opportunities  for  EU  funding  or  through  reforming  EU  funding  programmes  in  a 
way that social care providers could also qualify to utilise them (EAN). 

3.10  Financing of care services 

Public  funding  and  investment  for  the  development  of  the  care  economy  should  be 
viewed  as  an  investment  in  the  future,  not  merely  as  a  cost  (Social  Platform,  EWL, 
Eurodiaconia,  EPSU).  Public  funding  of  care  services  is  being  strongly  encouraged  (SSE, 
Social Platform, EWL, Eurodiaconia, EPSU, VÖWG, Vienna Social Fund), reflecting the call 
for  a  person-centred  approach  to  care,  as  opposed  to  a  market-centred  approach  (EPSU). 
Sustainable  public  funding  is  deemed  crucial  to  guarantee  the  quality,  continuity, 
accessibility, availability, and affordability of social care services for people in need of care 

17 

 
 
 
(SSE,  AT  in  SPC).  Such  guarantees  are  reported  to  have  proven  unreliable  through  the 
current funding levels, as well as through competition-driven funding instruments (i.e. public 
procurement)  and  long-term  care  insurance  (CECOP,  SSE,  VÖWG,  Vienna  Social  Fund). 
Member States should be supported to implement the European Child Guarantee to increase 
public  investment  for  children  (PICUM).  A  voluntary  handbook  on  financing  models  was 
proposed (EE in SPC). 

EU funds and instruments can support national investments and reforms in LTC (EWL, 
Eurodiaconia,  European  Disability  Forum).  Examples  include:  reforming  the  fiscal  rules  of 
the  Stability  and  Growth  Pact  to  give  more  flexibility  to  Member  States  to  invest  in  care 
services  and  care  workers  (Eurodiaconia);  making  relevant  funds  from  the  Multiannual 
Financial Framework (MFF) and Next Generation EU accessible to not-for-profit care service 
providers (Social Platform); investing EU funds in  personal  assistance and in-home support 
schemes (European Disability Forum). The need to use the Recovery and Resilience Facility 
(RRF) for care was echoed by trade unions (ETUC, UNICARE). It is suggested that funding 
be  conditional  on  providers  abiding  by  safe  staffing  ratios  and  good  working  conditions, 
(EPSU, Eurodiaconia). Profit made through care provision should be directly reinvested into 
the sector (Eurodiaconia, VYV). CECOP highlighted the role that the social economy which 
already  reinvest  profits  to  ensure  long-term  dimension  and  uninterrupted  functioning  of  the 
service.  Besides,  recovery  funds  should  be  invested  in  robust  care  infrastructure  (NCPE). 
Financing  by  means  of  tax  resources  within  Member  States  remains  key,  though  (Vienna 
Social Fund). Proper tax incentives could potentially also boost the influx of private finance 
into the care sector (CAP, Insurance Europe). The use of the ESF+ and the Child Guarantee 
national  action  plans  to  improve  access,  affordability  and  quality  of  care  services  for 
vulnerable  and  disadvantaged  people  and  families,  including  mobile  EU  and  non-EU 
migrants (PICUM). 

EU funding should be conditional upon compliance with worker’s rights and collective 
bargaining.  The  award  of  public  funds  such  as  the  ESF+  and  the  national  recovery  and 
resilience facility should be made conditional on the respect of workers’ rights and collective 
bargaining.  In  cases  where  the  provision  of  long-term  care  services  is  awarded  via  public 
procurement  contracts,  contracts  should  only  be  awarded  to  economic  operators  or 
subcontractors who fully respect workers’ right to collective bargaining (UNI Europa). 

It  is  important  to  develop  approaches  to  care  that  decrease  the  pressure  on  health 
systems  (Insurance  Europe).  These  might  include:  promoting  prevention  and  healthy 
lifestyles  (Insurance  Europe);  making  meaningful  use  of  digital  solutions  (VÖWG,  Vienna 
Social  Fund,  Insurance  Europe);  developing  payment  and  reimbursement  systems  based  on 
pathways rather than individual and disease specific interventions, aiming to make health and 
social systems more sustainable (EFN). Supporting Member States in making insurance cover 
more  accessible  and  affordable  (Insurance  Europe)  is  important.  Insurers  could  be  keen  to 
explore with authorities the possibility to expand their range of activities, particularly services 
that  encourage  prevention,  awareness  and  adaptation  –  areas,  in  which  insurers  have 
experience and which are vital to keep healthcare costs affordable (Insurance Europe). 

18 

 
 
 
3.11  Governance and implementation  

The European care strategy is expected to position care as a prominent priority at EU 
and national levels (SSE, Eurocarers). On an EU level a permanent group in the form of an 
institutionalised platform or a steering group is recommended to be created (AEIP, AIM), or a 
European Care Platform that would work on a similar basis to the Disability Platform (SSE, 
Eurodiaconia). On the national level, Member States are encouraged to develop clear national 
action plans (SSE).  

Measurable  indicators,  concrete  objectives,  and  mechanisms  for  follow-up,  including 
timeframes and indicators play an important role in the effective implementation of the 
Strategy  (EAN,  ESN,  Eurocarers,  Incare,  REIF).  Development  of  a  coordinated  and 
harmonised  data  infrastructure  and  tools  for  EU-wide  comparable  data  on  long-term  care 
across Europe, including EU indicators, quality audits, quality integrated statistics as well as 
data on attitudes, preferences and expectations on long-term care are called for (Incare, AGE, 
AEIP,  Red  Cross).  It  is  also  key  to  social  partners  to  set  indicators  for  policy  monitoring 
(ETUC, NEXEM). As social protection and long-term care systems differ across countries, it 
is  deemed  important  that  the  proposal  for  a  Council  Recommendation  on  long-term  care 
focuses on the overarching objectives  at EU level (SME United). Consistent monitoring for 
participation  to  early  childhood  education  and  care  should  be  ensured.  Disaggregated  data 
should monitor children including children with disabilities’ participation in  early childhood 
education and care and this analysis should be transformed into policy measures (EASPD). 

Due regard should be given to the administrative burden at national level. Some Member 
States  (SPC)  shared  concerns  regarding  the  potentially  increased  administrative  burden  and 
highlighted the importance of consistency and synergies with related policy initiatives at EU 
and  international  level.  During  the  exploratory  debates  with  SPC  and  EMCO,  several 
Member  States  (e.g.  EE,  HU)  pointed  out  that  the  initiative  should  be  developed  in  full 
respect  of  national  competencies  and  the  principles  of  subsidiarity  and  proportionality,  also 
taking into account the different national circumstances and set-up of the care systems. 

EU level  support for mutual learning among Member States is  appreciated to support 
implementation  efforts.  This  may  include  measures  to  ensure  decent  work  conditions  for 
care  workers  in  private  homes  through  defining  and  enabling  labour  inspections  in  private 
homes  as  well  as  providing  opportunities  in  a  safe  environment  for  workers  to  speak  with 
relevant  authorities  (LaStrada  et  al).  Member  States  (SPC  and  EMCO)  also  agreed  on  the 
need  to  improve  the  evidence  base  and  supported  a  continued  exchange  of  good  practices. 
Facilitating dialogue and exchange of best practices among Member States as well as between 
service providers and national authorities is also viewed as an integral part of the European 
care strategy (Red Cross, CAP, ViiV).  

In  the  development,  monitoring  and  evaluation  of  care  policy-making,  it  is  crucial  to 
involve  representatives  of  care  workers,  as  well  as  of  care  recipients  (LaStrada  et  al). 
Moreover,  it  is  important  that  persons  in  need  of  care  with  statutory  care  insurance  are 
guaranteed the right to freedom of movement through adopting a reform on the Regulations 
on the coordination of social security systems (DSV). 

There are strong call for the European care strategy to take an integrated approach to 
care  (EPSU,  EMSP,  Eurocarers,  IFIC,  ViiV,  EURORDIS,  AEIP,  ESN,  Platform  for  better 

19 

 
 
oral health in Europe, European Hospital and Healthcare Federation, Santa casa). Facilitation 
of  effective  communication  as  well  as  collaboration  between  health  and  social  care 
professionals  (EMSP,  EURORDIS,  Platform  for  better  oral  health  in  Europe)  is  needed. 
Synergies should be  established between health  and community services,  including peer-to-
peer support (ViiV). It is recommended that not only a patient’s medical profile is taken into 
account  for  long-term  care  services,  but  also  his/her  family,  economic  and  environmental 
context (AEIP). Development of integrated home and community-based care services is also 
essential,  since  the  lack  of  such  integration  increases  reliance  on  informal  care  as  a  default 
option  (Eurocarers).  Therefore,  investment  in  community-based  care  is  going  to  not  only 
increase the quality of care, but also enhance care options and make care jobs more attractive 
(Eurocarers). Besides, it is emphasised hat local actors play a key role in the  long-term care 
delivery,  which  is  why  their  recognition  and  stable  financing  for  innovative  long-term  care 
providers  is  very  important.  An  effective  integration  of  healthcare  and  long-term  care  (and 
within these sectors) has a positive impact on care quality (SE in SPC). 

The European Semester is considered to be the right framework to monitor progress in 
addressing challenges in the care sector. Social Partners encourage Member States to use 
the  RRF  (ETUC,  UNICARE)  for  care  and  highlighted  that  the  European  Commission  can 
also  support  preparations  for  LTC  reforms  through  funding  for  technical  assistance 
(BusinessEurope). 

3.12  Active and healthy ageing and prevention policies 

Investing in prevention saves lives and reduces costs. In order to tackle increasing demand 
for LTC brought by the ageing of the population, fostering health promotion, prevention and 
health  literacy  across  the  lifespan  is  key  (ESIP,  Eurohealthnet,  MGEN,  BAGSO).  The 
European  Care  Strategy  is  expected  to  support  Member  States  in  developing  and 
implementing guidelines for prevention and empowerment (EFN). Prevention campaigns and 
health  promotion  should  also  reach  people  with  disabilities,  including  those  in  institutions, 
and  be  accessible  to  avoid  further  costs  (Inclusion  Europe).  Screening,  early  detection  and 
prevention, data registries and electronic health records, as well as health systems reforms are 
viewed  as  an  important  part  of  the  solution  (EFPIA).  Health  promotion  and  disease 
prevention  activities  should  address  the  causes  (biological,  psychological  and  social  aging), 
and  not  the  consequences  of  illness  (Red  Cross).  This  helps  to  reduce,  delay  or  prevent 
reliance  on  care  (Vienna  Social  Fund,  VÖWG).  In  particular,  eye  health  checks  should  be 
seriously taken into account in public policy – not only due to the obvious difficulties caused 
by sight loss, but also since issues such as diabetes, hypertension and neurological conditions 
(e.g.  multiple  sclerosis  or  brain  tumours)  can  be  detected  through  visual  inspection  and 
without an invasive procedure (ECOO).  

Rehabilitation  and  social  inclusion  of  older  people  in  community  life  are  key  success 
factors for active and healthy ageing. Remobilisation measures ensure that people with care 
needs  can  stay  in  their  usual  environment  for  as  long  as  possible  (DSV,  IT  in  SPC)). 
the 
Furthermore,  activating  communities 
neighbourhood and even residents of nursing homes and care homes in community activities 
helps  to  keep  people  socially  involved  and  to  make  them  feel  useful,  also  contributing  to 

include  older  vulnerable  people  from 

to 

20 

 
 
 
reducing  loneliness  (EAN).  Provided  that  older  persons  desire  to  work,  self-employment 
could  also  have  a  favourable  effect  on  their  perception  of  feeling  useful  and  independent 
(VÖWG). For cancer patients and survivors, having the ability to work has been reported to 
restore  a  sense  of  normality  and  wellbeing,  contributing  to  financial  stability  too  (TBCT). 
Therefore, the work dimension could be considered in the development and implementation 
of long-term care programmes (TBCT). These actions need to be complemented by improved 
health literacy and adherence to treatment of the population, as this will contribute to better 
health outcomes and more efficient use of health resources (EFPIA). A holistic approach to 
ageing for improving the quality of life at all stages, strengthening healthy and active ageing 
policies, and promoting lifelong learning needed to stay at the centre of policy attention (Red 
Cross). 

3.13  The impact of the COVID-19 pandemic 

Enhancing the resilience of care systems is crucial. The COVID-19 pandemic has exposed 
the  care  systems  across  the  Union  to  be  largely  unprepared  for  care  emergencies.  Better 
preparedness  for future crises should be ensured (AIM, EPSU). Guidance for professions at 
risk should be proposed on how to ensure proper working conditions (AIM). Such a guidance 
should  be  developed  in  collaboration  with  networks  of  care  professionals  and  implemented 
with  the  help  of  financial  and  technical  support  to  Member  States  (AIM).  Furthermore, 
Member  States  should  ensure  that  their  health  and  care  systems  are  more  resilient  through 
reinforcement of medical workforce and equipment, the implementation of concrete measures 
for the provision of care and enhancing capabilities for virtual health and care administration 
(EURORDIS).  Public  funding  for  long-term  care  should  be  regarded  as  an  investment  in 
community  health  and  welfare  (EPSU).  Monitoring  of  LTC  policies  at  Union  level,  for 
instance through a uniform system of surveillance for long-term care that monitors pandemic 
outbreaks  in  long-term  care  across  the  EU  Member  States  (EPSU),  may  be  helpful.  Long-
term care should also be included in the stress-tests set out in EU regulation on serious cross-
border threats (EPSU). 

21 

 
 
 
 
 
ANNEX  1:  LIST  OF  STAKEHOLDERS  WHO  SUBMITTED  FEEDBACK  ON  THE  EUROPEAN  CARE 
STRATEGY THROUGH RESPONSES TO THE CALL FOR EVIDENCE 

Organisation 
AGE Platform Europe 
Air Liquide 
Alzheimer Europe 
Assindatcolf - Associazione Sindacale Nazionale dei datori di lavoro 
domestico 
Association Internationale de la Mutualité (AIM) 
Association of 200 big cities in Europe 
BAGSO - Bundesarbeitsgemeinschaft der Seniorenorganisationen 
Barcelona City Council 
Beleidsdomein Welzijn, Volksgezondheid en Gezin 
Berufsverband Kinderkrankenpflege / Arbeitsgruppe Politik 
Care Alliance Ireland 
Caritas Europa 
CECOP - European Confederation of Workers' Cooperatives, Social 
Cooperatives and Social and Participative Enterprises 
Česká asociace pojišťoven 
Childhood Cancer International - Europe (CCI-E, CCI Europe) 
Childhood Cancer International - Europe (CCI-E, CCI Europe) 
Childhood Cancer International - Europe (CCI-E, CCI Europe) 
Citoyenne Francaise (et non citoyenne européenne) 
City of Ghent 
COFACE Families Europe 
COFACE Families Europe 
COFACE Families Europe 
Confindustria 
Department of Social Rights (Government of Catalonia) 
DSV (Deutsche Sozialversicherung Europavertretung) 
EASPD (European Association of Service Providers for Persons with 
Disabilities) 
EASPD (European Association of Service Providers for Persons with 
Disabilities) 
EFFE (European Federation for Family Employment & Home Care) 
EFN (European Federation of Nurses Associations) 
EFPIA (European Federation of Pharmaceutical Industries and 
Associations) 
Essity 
Eurocarers 
Eurochild 
Eurocities 
Eurodiaconia 
Eurodiaconia 

Country 
Belgium 
France 
Luxembourg 
Italy 

Belgium 
Romania 
Germany 
Spain 
Belgium 
Austria 
Ireland 
Belgium 
Belgium 

Czech Republic 
Austria 
Austria 
Austria 
France 
Belgium 
Belgium 
Belgium 
Belgium 
Italy 
Spain 
Germany 
Belgium 

Belgium 

Belgium 
Belgium 
Belgium 

Sweden 
Belgium 
Belgium 
Belgium 
Belgium 
Belgium 

22 

 
 
 
Eurodiaconia 
EuroHealthNet 
EUROPA DONNA - The European Breast Cancer Coalition 
European Ageing Network (EAN) 
European Anti Poverty Network Nederland 
European Anti Poverty Network Nederland 
European Association of Paritarian Institutions (AEIP) 
European Association of Service providers for Persons with Disabilities 
(EASPD) 
European Confederation of Independent Trade Unions (CESI) 
European Council of Optometry and Optics (ECOO) 
European Disability Forum 
European Federation for Services to Individuals (EFSI) 
European Hospital and Healthcare Federation 
European Multiple Sclerosis Platform 
European Network on Independent Living (ENIL) 
Member of the European Parliament 
European Roma Grassroots Organisations (ERGO) Network 
European Roma Grassroots Organisations (ERGO) Network 
European Roma Grassroots Organisations (ERGO) Network 
European Social Insurance Platform (ESIP) 
European Social Network (ESN) 
European Women's Lobby (EWL) 
EURORDIS 
FairWork 
Federation Française des Entreprises de crèches 
Federation of Catholic Family Associations in Europe 
Federation of European Social Employers (FESE) 
First Years First Priority Campaign 
Fonds Soziales Wien 
Friedrich-Ebert-Stiftung (FES) and Foundation for European 
Progressive Studies (FEPS) 
Groupe MGEN 
Groupe VYV 
Harghita County Council 
Harghita County Council 
HIV Outcomes 
Huddinge kommun 
InCARE project consortium (10 partner organizations) 
Inclusion Europe 
Inclusion Europe 
Inclusion Europe 
Insurance Europe 
International Foundation for Integrated Care 
Kinderpalliativteam 
La Strada International 

Belgium 
Belgium 
Italy 
Belgium 
Netherlands 
Netherlands 
Belgium 
Belgium 

Belgium 
Switzerland 
Belgium 
Belgium 
Belgium 
Belgium 
Belgium 
Finland 
Belgium 
Belgium 
Belgium 
Belgium 
Germany 
Belgium 
Belgium 
Netherlands 
France 
Belgium 
Belgium 
Belgium 
Austria 
Belgium 

France 
France 
Romania 
Romania 
Belgium 
Sweden 
Romania 
Belgium 
Belgium 
Belgium 
Belgium 
Netherlands 
Austria 
Netherlands 

23 

 
 
Belgium 

Belgium 
Belgium 
France 
Portugal 
Belgium 

Spain 
Spain 
Belgium 
Belgium 
Belgium 
Slovenia 
Czech Republic 
Italy 
Malta 
Ireland 
Belgium 

Madrid City Council 
Madrid City Council /Ayuntamiento de Madrid 
Make Mothers Matter (MMM) 
Make Mothers Matter (MMM) 
Make Mothers Matter (MMM) 
Mestna občina Ljubljana 
Ministry of Labour and Social Affairs 
Municipality of Milan_ Education Department 
National Commission for the Promotion of Equality (NCPE) 
National Women's Council of Ireland 
PICUM- Platform for International Cooperation on Undocumented 
Migrants 
Platform for Better Oral Health in Europe 
Red Cross EU office 
REIF - Protection sociale française 
Santa Casa da Misericórdia de Lisboa 
Save the Children EU Office, on behalf of the EU Alliance for Investing 
in Children 
Save the Children EU, on behalf of the EU Alliance for Investing in 
Children 
Hungary 
Senior Corporate Silver Spoon, Environment & Nature Association. 
Hungary 
Senior Corporate Silver Spoon, Environment & Nature Association. 
Belgium 
Social Platform 
Belgium 
Social Services Europe 
Belgium 
SOS Children Villages International 
Spain 
Suara Serveis SCCL 
Sweden 
Sveriges Kommuner och Regioner (SKR) 
Belgium 
The European Federation of Public Service Unions (EPSU) 
The European Federation of Public Service Unions (EPSU) 
Belgium 
The European Society for Paediatric Oncology - SIOP Europe (SIOPE)  Belgium 
The European Society for Paediatric Oncology - SIOP Europe (SIOPE)  Belgium 
Finland 
The Finnish Union of Practical Nurses 
Finland 
The Finnish Union of Practical Nurses 
Belgium 
Transforming Breast Cancer Together (TBCT) 
Ireland 
University College Cork 
United Kingdom 
ViiV Healthcare 
Austria 
VÖWG - Verband der öffentlichen Wirtschaft und Gemeinwirtschaft 
Österreichs 
Wirtschaftskammer Österreich 
Citizen 
Citizen 
Citizen 
Citizen 
Citizen 
Citizen 
Citizen 
Citizen 

Austria 
Slovakia 
Austria 
Netherlands 
Slovakia 
France 
Czech Republic 
Czech Republic 
Slovakia 

24 

 
 
Some organisations provided up to three contributions (on the Communication and the two 
proposals for Recommendations) 

25