Long term care in Europe: An introduction

Abstract

Long Term Care (LTC) has started to become an issue in modern social protection. It means support for those who are not able to independently perform activities of daily living (ADLs). Whereas this support has, even after the introduction of social security in most developed states during the first half of the last century, remained mainly a task of families and social institutions for a long time, more and more states have, over the past decades, started to introduce social benefits for those dependent on care. This is, first, due to the fact that the situation of many persons in need for support calls for professional assistance. Second, there are fewer and fewer persons who might be able to provide non-professional care, such as relatives and neighbours, and fewer reliable social networks are formed that would suffice in order to cover the social needs of dependent persons. The most relevant factor for the growing involvement of public authorities is, third, the demographic development. The populations of most developed states are growing older than ever due to a rising life expectancy. This is a well-known and widely acknowledged development which does not need further explanation at this point. It may, on the one hand, be regarded as good news as it leads to an expansion of our life spans. Yet, medical evidence seems to back the assumption that the growing life expectancy also has, on the other hand, a negative side. Gerontologists tend to differentiate between ‘younger’ and ‘older’ elderlies. Wherever the borderline actually has to be drawn, ‘older elderlies’ run a relatively high risk of becoming dependent on support, and this risk seems to increase with biological age. Taking into account population ageing, it is most presumable that our future societies will consist of a higher percentage of dependent persons than today. A second demographic process has to be taken into account. In many developed countries, the fertility rate is below what demographers call the reproductivity rate. Of course, there are considerable differences between the Member States of the European Union in this respect. But those with a low fertility rate will encounter the problem that the number of persons prepared to provide non-professional care will consistently decrease. At least, more efforts have to be taken in order to stabilise the respective basis for non-professional LTC-which is already weakened as changes in society and labour market participation affect both the attitude towards non-professional care as well as the capacities for making time for such caregiving.