010. February 2022

Home care in Europe: current structure and challenges for the future

Policies and legislation have been set, but they need to be fully implemented. Developing and expanding the home care sector in Europe will be difficult in times of tight financial constraints, and unconventional solutions will be increasingly necessary to bridge the gap between growing needs and limited budgets.

There are four working-age people in the European Union for every person over 65. By 2050, however, there will be only two. Therefore, the demand for long-term or continuing care will inevitably increase in the coming decades. This will lead to an increase in the demand for home care.

Despite the importance of this trend, there is a significant information gap on this topic in Europe. This volume attempts to fill some of these gaps by examining current European home care policy and strategies.

The evaluation of home care in Europe involves several issues, including the relationship between social services and health care delivery systems, the prevalent financing mechanisms, how providers are paid, the impact of government regulation, and the complex role of informal care providers.

The EURHOMAP (Mapping Professional Home Care in Europe) study, conducted between 2008 and 2010 by the Netherlands Institute for Health Services Research, in collaboration with several institutions and researchers in various countries and funded by the European Commission, seeks to assess various aspects of home care in 31 countries. The results are presented in the original report.

Based on several case studies, this report presents descriptive and comparable information on various aspects of the organisation, financing and delivery of home care across the continent. It is a document that will help frame the approaching debate on how best to serve older citizens in an ageing European population.

Comparative descriptive information has been drawn from this study, which is useful for all those involved in health care provision, planning, or financing. It addresses not only the existing formal structures but also the reality of home care, system failures and unmet needs.

Home care has a different meaning and intention depending on the country, from care accessible to those with no family members to systems covering the entire population. Consequently, there is great diversity in the characteristics of the system, such as the role of professionals in-home care, eligibility for services, financial conditions, regulatory mechanisms, etc. This study focuses on regulated systems, although existing informal provisions have also been considered.

After an introduction to home care and its environment, including social services and health systems and demographic developments, a review of the existing literature is given. It then describes the European countries’ choices to guide their home care policies, including the responsibilities assumed by governments in this area, the coherence and regulation of their vision, and how access to services and quality assurance is monitored. One of the contributions is the observation of differences in the management of the care process, including coordination between different typologies of services, competition between providers and the maintenance of the quality of services at the operational level.

Descriptions of the home care sector in each of the 31 countries studied are presented in a structured way in a separate volume also available online.

The role of government in home care is not self-evident. On the one hand, they are under pressure to anticipate the future. On the other hand, some countries’ health and social policy sectors show a tendency for governments to retreat, leaving more room for private initiative. However, in public opinion, the government has an unequivocal role in care provision. 90% or more of Europeans believe that home and institutional care should be taken over by public authorities (TNS Opinion & Social, 2007).

In addition to the expected increase in demand and increasing constraints in the home care sector, the availability of home care workers is expected to be a possible challenge. It is labour intensive, and the question is whether there are enough qualified staff in terms of the expected future ratio of active to the elderly population.

This shortage also applies to informal providers, such as family members or volunteers. In many countries, informal provision is becoming increasingly scarce due to mobility, urbanisation and the growing participation of women in the labour market. There are different positions of different governments on home-based care, namely what services are included and funded by each government, the different payment models for these services, the accessibility criteria for these same services, the main challenges of the current situation environmental and policy trends.

Governments with smaller budgets, and the growing role of the private sector, may lead to the need to find a new balance between regulation, efficiency and flexibility in service delivery. Even so, some of the principles should not be compromised. Frail and dependent people need to be protected against quality breakdowns and care beyond their financial reach. And in general, better client information and participation in care delivery must be encouraged.

To find solutions that can respond to these challenges, policymakers and care planners need to look beyond typical models and best practices for inspiration. The descriptions in this report are an entry point to ideas from other countries.