Findings

Overview of current situation

The first deliverable for the research field ‘Social support and long-term care’ is a overview report (PDF, 1.9MB). The countries of Europe are ageing, yet at a different pace and with huge differences in political, cultural, social and economic framework conditions. This is particularly true, when it comes to address the needs of older people who are suffering from chronic and often multiple diseases, with physical, mental and/or cognitive impairments. Although this group of the population is steadily rising, services, facilities and related policies with respect to their social and health support are only slowly developing.

Indeed, neither the rhetoric of active ageing nor the current discourse on social innovation are considering the area of social support and long- term care as a major source for new ideas and positive change in the social construction of old age. This report sets out to correct this image and fulfils two main tasks:

  1. The different approaches to fund, organise and regulate long‐term care regimes across Europe are described, compared and analysed.

  2. Opportunities for and on‐going practice of social innovation are identified and analysed in the context of different national realities.

Economic and fiscal issues of informal vs formal care

The second deliverable is an examination of the economic incentives and fiscal implications of informal versus formal care (PDF, 364KB). The report considers the private economic incentives and the fiscal consequences related to informal and formal long-term care. It focuses on the cases where providing informal care implies less market work. In such cases, informal care reduces both private wage income and government tax revenue compared to formal care. On the other hand, the cost of formal care may be borne largely by the state. A detailed quantitative analysis of the Finnish case is provided.

The private economic incentives and fiscal consequences related to the wage level of the potential informal care provider and the income of the care receiver are described; we find that they vary greatly across individuals. It seems likely, however, that in most cases the fiscal cost of informal care is smaller than that of formal care. On the other hand, the private economic incentives often favour formal care over informal care. Finally the report also gives a brief description of the situation in selected other EU countries; because of different social security systems, it is clear that the fiscal implications of informal care vary a lot across countries.

Key drivers of social innovation in social support and long-term care

The third deliverable is a report on the potential for innovation within the long-term care and social support sectors (PDF, 3.5MB). There is a clear need for change and innovation in long-term care policy and practice in Europe arising from a combination of factors, including but not limited to the rising share of the population occupied by older persons, a diminishing pool of available informal carers, and constraints on public sector financing. This raises concerns that current service options and coverage are inadequate in meeting the demand for high quality care in many countries.

While the convergence of these realities poses a distinct challenge for policymakers and providers, it can also be viewed as an opportunity to innovate, to change the status quo for the better by improving and expanding long-term care services, financing and delivery. In this context, long-term care and social support are notably appropriate areas to search for ‘social innovation’, needs and potentials for change.

Objectives

Following a detailed investigation of the issues above and examples of good practice in selected EU member states (the first deliverable, downloadable above) the present report sets out to focus more specifically on drivers and potentials of social innovation in emerging long-term care systems with the following two main objectives:

  1. To identify the principal drivers of and barriers to social innovation in the areas of long-term care provision and social support at the meso- and macro-levels.

  2. To propose recommendations for policymakers on how to effectively harness the opportunities offered by social innovation.

A two-part approach was used in order to make use of both theoretical and practice-based sources of information. First, a literature review was carried out in order to provide an overview of country-specific, regional and international sources contributing to the discourse on the key factors, drivers and barriers in social innovation in long-term care. Second, each of the 18 innovative initiatives identified in the course of a previous task within the MoPAct project were analysed individually to determine the drivers of and barriers to its development.

In the course of a collaborative workshop, work package 8 partners grouped these barriers and drivers into key themes/factors. The key factors were validated in the course of two focus groups per country and altogether 20 expert interviews in the second stage of the study. Individual findings of project partners were synthesised (by countries) and formed the basis of the present overview report.

Key findings

Foremost among the challenges facing the respective LTC systems is the persistent fragmentation of services in most of the countries investigated, from financing structures dictated at the national level down to delivery of care at the municipal level. The need for national policies to integrate LTC systems and coordinate services between the many stakeholders involved was repeated again and again by focus group participants and experts. In addition, access to services particularly in rural regions was a commonly identified concern.

Other major challenges concerned the state of the LTC work force. At the societal level, a call for a shift in the way we perceive ageing and in the way we collectively debate and engage with issues concerning older people resonated in multiple focus group discussions. Finally, participants in several focus groups cited the need for a user-centred, demand-driven approach to LTC. This extends to the financing mechanisms used to channel funds to service providers and to beneficiaries, as well as to design and bundling of the services themselves.

There is a wide range of social innovation potential that needs to be unleashed:

  • Empowering users and carers has been clearly highlighted as it would contribute to the sustainability of LTC, social cohesion, equal opportunities and economic development in general. Keywords: social solidarity, reconciliation of care and employment, acknowledgement of skills acquired by caring and new types of social relationships beyond family-ties.

  • Shifting the ‘ageing’ paradigm and reinventing the concept of ageing based on learning from experience would offer opportunities for intergenerational exchange and bottom-up processes to transform social relations between generations.

  • Expanding formal LTC services per se may not be a sign of social innovation unless it implies to reconsider the traditional way of delivering services and to allow for bottom-up processes (co-design and co-creation, user-oriented ICT deployment) to strengthen new types of organisations and appropriate funding mechanisms.

  • New local care networks are promising, but might be in conflict with the general expectation of equal opportunities, equal access and universal standards. While the bottom-up process driven by local stakeholders in LTC remains crucial, it needs to be underpinned by legal and financial incentives that allow relevant organisations to develop structures and processes appropriate to satisfy local needs.

  • Improving working conditions and employment for a genuine ‘LTC workforce’ is needed to recruit and retain professionals for this sector that faces difficulties to attract appropriately trained staff. Potentials for social innovation consist in reframing existing hierarchies by new types of relations between professionals, organisations and sectors.

  • Integration and coordination of care ranging from improved relations between informal and formal services to new types of cooperation between health and social care facilities (and policies) would transform social practice with the potential to render services more user-centred and sustainable.

  • Financing and governance would need to focus on improving financial incentives, or at least: to remove financial disincentives for cooperation and social innovation that may transform local delivery of LTC services in a ‘caring society’. New types of relationships between the health and social care sectors, the avoidance of fee-for-service payments and the development of integrated budgets that follow the user are needed to prepare the basis for further social innovation in LTC.

  • Small-scale social innovations need to be developed with a constant view on their sustainability so that successful initiatives are given the possibility to spread or to even become mainstream practice. Making the social business case from the very beginning of publicly funded pilot projects should become common practice.

Policy Brief

MoPAct Policy Brief 7 – Potentials for active ageing by social innovation in long-term care and social support (PDF, 3.8MB)