The four European Welfare State models

The Welfare State is a concept that refers to the entire set of state-directed interventions aimed at guaranteeing minimum services to the population through a social protection system.

Its recent origins are located in Europe, specifically in Bismarck’s Germany at the end of the 19th century, in which the foundations of the modern welfare system would be created based on the principle of contributory, which forced workers to finance the social welfare system.

The four pillars of the Welfare State

Health care, originally based on a universal and free system, and in which formulas have been appearing for which the citizen partially contributes to financing these services.

Social security, whose main item is contributory retirement pensions, but which also offers coverage for other contingencies, such as widowhood, orphanhood or situations of disability.

Education, universal and compulsory up to certain levels and subsidized at secondary or higher levels.

Social services, dedicated to providing assistance in situations where contributory benefits have not been achieved or in aid such as dependency.

European models of Welfare State

Depending on various variables, such as the degree of social protection or the distribution of weight in the provision of services between the public and private sectors, we find four different models of Welfare State in Europe.

Nordic Model (Denmark, Norway, Sweden, Iceland, Finland)

It is the model in which social protection is higher. Benefits are financed via contributions and the State is the main provider of services, with high quality standards.

They usually base the provision of their services on the principle of citizenship, which means more generalized access to them.

Continental model (Germany, Austria, France, Belgium, Holland, Luxembourg)

Based on the contributory principle, where employees and companies pay compulsory contributions to create a social security plan.

It also offers non-contributory benefits and subsidies, some of them not subject to any type of actions or commitments for reintegration into the labor market.

Anglo-Saxon model (United Kingdom, Ireland)

Social protection, both at the level of contributory benefits and social assistance, is much more limited. They tend to cover basic needs, delegating complete coverage of their needs to the responsibility of individuals.

The criteria for granting aid and subsidies are less lax and are subject to active employability actions.

Mediterranean model (Spain, Greece, Italy, Portugal)

It is halfway between the Anglo-Saxon model and the continental model at the level of aid and the role of the State in the provision of services.

It is based on cultural peculiarities such as the presence of the family in the lives of individuals, which covers certain needs that in other models are covered by the State, such as caring for children or the elderly.

Eight gifts that grandmothers would like to receive

Company. Although it may seem very obvious, if there is one thing that all grandmothers like, young and old, active or less active, it is the company of their loved ones.

Flowers. It’s a good way of expressing what they mean to us. It is always nice to enter a house that smells of flowers as it brings energy and vitality.

Personalised gifts. A frame with a photo or drawing of the family’s youngest members will always be well received by grandma and even more so if they can be placed in a visible place in the house.

Gifts to make life easier. Of course, we are referring to an automatic opener, a talking alarm clock, a reach tool to grab things or even a remote home monitoring device, something that over the yea Smartphone or mobile phone for the elderlyrs can be really useful.

Smartphone or mobile phone for the elderly. This gift not only keeps them in constant contact with their relatives but also allows them to view photographs, take pictures or, for the more tech-savvy, consume audiovisual content or read.

A subscription. Platforms such as Spotify, Apple Music, Netflix and HBO are not just for the young. They can be a great alternative to give to grandmothers who are music and film buffs. There are also subscriptions to literary platforms.

Ballroom dancing classes. Dancing is, along with swimming, one of the most complete and beneficial sports, both physically and psychologically.

A trip. Many older people have dreamed all their lives of taking the trips they could not take when they were young. This can be a good opportunity to make their dreams come true. Sometimes it is not necessary to take a plane and go far away, by train or car you can get to many places and perhaps it is also easier if you need to make stops along the way.

What functions does a healthcare worker perform?

Now we are going to delve into the functions of the socio-sanitary technician. As we have pointed out in the previous post, these workers focus on caring for people in a situation of dependency who require help in their day-to-day life.

We can distinguish 4 main functions:

Educational: refers to activities related to the promotion of autonomous personal and independent life habits.

Assistance: Refers to activities related to the supervision of hygiene habits, food control, assistance techniques… As well as the promotion of movement and action in the event of possible falls, assistance in the physiological needs of the patient, etc.

Socializing: refers to activities aimed at promoting social relations with the people around them. The maintenance of contact, and the relationship with the closest people and friends, has a very positive effect on the health and mood of the person.

Rehabilitation: this function focuses mainly on help and support in the functional aspects and recovery of the possible faculties that the person has lost or has deteriorated significantly. That is to say, tasks as important such as the recognition of people, orientation, location in time, place and memory.

In addition to the above

• Detail the patient’s needs, both psychosocial and healthcare.

• Organization of the Individualized Care Plan. Thus, inciting the cooperation of the patient’s own family.

• Implement food, hygiene and clothing tasks.

• Organize economic management.

• Carry out home maintenance and cleaning tasks.

• Relative interference with the physical condition through the employers arranged and with mobilizations or transfers.

• Prevention measures solving emergency situations.

• Psychosocial support.

• Conservation of autonomy, advice and support.

• Control and monitoring of activities and management of calls in cases of teleassistance.

In short, social and health technicians carry out a fundamental task in the management of dependent people, as well as care work for hospitalized patients. Above all, they carry out hygiene and patient transfer tasks, in addition to being a support for the work carried out by nursing.

Social-health care: what it is and what function it has.

Social-health care, which is increasingly important given the large elderly population that exists, is one of the professions of the moment.

Social-health care, what is it?

It is, among other aspects, the set of social and health care for those people who are in some way in a certain degree of dependency.

The main objective is to improve the quality of life of the most vulnerable people, such as the elderly, the disabled or the chronically or mentally ill.

The elderly population is increasing more and more, given the increase in life expectancy and the low birth rate. According to statistical analyses, by 2050, 30% of the population will be people over 65 years of age. It is for this reason that society needs professionals who work in this sector, and with this, according to the same study, employment in the social and health sector has increased by more than 35% since 2008.

It should be noted that it does not purely care work, since the professionals in socio-health care also seek the rehabilitation of the patient, their socialization, and the necessary support to continue with their vital development without the limitations they face being an obstacle.

What does a healthcare professional do?

Within the care offered by a social-health care professional, we find day-to-day tasks such as feeding, hygiene and cleaning the dependent person and their environment. They provide them with basic health care and the supply of the corresponding medication and basic cures.

Another of the functions of the socio-health care professional, which is one of the most common, is to carry out the corresponding transfers, such as medical visits or accompanying walks abroad. They also offer psychosocial support.

As we have indicated, it is of great importance to integrate these people into society by improving communication with patients, helping them with their education and facilitating their entry into the labor market, so that they can perform certain jobs.

What professional opportunities does social and health care have?

Among other professional opportunities we highlight the following:

• Home help assistant: This is the person who takes care of a dependent person in their own home, meeting the person’s day-to-day needs, improving their autonomy and relationship with the environment.

• Home Help Assistant in sheltered flats in the European Union: The skills are the same as the home help assistant, but in sheltered flats.

• Personal Home Care Assistant in private homes in the territory of the European Union.

• Socio-sanitary assistant in private centers and public centers: This is the person who intervenes in the performance of social-health care in public and private residential admission centers, providing social and health services to the different people in a situation of dependency who are in it.

• Professional caregiver of dependent people in occupational centers, clinics, day care centers and early care centers.

• Geriatric Assistants in residences for the elderly and dependents: They are those who attend and care for the elderly in their basic needs. Its functions are determined in the 7th State Collective Framework Agreement for care services for dependent persons.

• Therapist in care centers.

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.