European long term care responsibility and inequality

under

pressure:

implications

for

stability,

Long-term care in Europe for the elderly, and persons with intellectual and physical disabilities and persons with psychiatric care needs is under pressure, as a consequence of ageing and rising costs and demographic changes: rising caring needs are coupled with decreased supply of both formal and informal care, as a consequence of geographical mobility and increased labor market participation of women. Pressures on long term care are hoped to be somewhat relieved by marketization and technological innovation, but nowhere are they expected to completely take off the pressure. States and municipalities mainly count on cost reduction, by waves of budget cuts and restrictions in entitlements for care provisions, and thus expect informal carers to intensify their contributions. The recent economic crisis only augments the pressure on long term care, also in European countries with a less developed welfare state, where governments have sometimes just started to take on more responsibilities for long-term care. All these developments blur the boundaries between formal and informal care, and reshuffle responsibilities for long-term care and raise urgent questions concerning the future of long term care in Europe. In the first day of this conference, we focus on three shifts concerning the pressure on long term care in particular: shifts in: 1. Stability and quality of care arrangements: How do these changes affect the stability and quality of care provision? How do they affect the assurance for vulnerable groups that they will be looked after and cared for over time? How vulnerable are various care arrangements and how does the pressure on them influence this vulnerability? 2. Delegation of responsibility And what do the changes indicated above imply for the allocation of responsibility? To what extent are the responsibilities for attending to the long-term care needs of dependent persons shifting between the public, the market, civil society and individual citizens or families? What do the often used terms personal responsibility or community care mean in practice? 3. Social (in)equality What are the implications of the pressure on long term care for social (in)equality? A shift from public to private responsibilities may increase inequalities among citizens, as skills and social and economic resources to take care of themselves and their close-ones than others are unequally divided. The conference will address these issues on a European level, on the basis of data we gathered on nine European countries: Germany, Greece, Italy, Norway, the U.K., Sweden, Portugal, Poland and the Netherlands, concerning the changes that have taken place over the past four decades. However, the conference will not be restricted to these countries, but will cover pressures on long term care in Europe more broadly.

European long term care in diverse populations: challenges for care providers, policy makers and researchers. The pattern of chronic diseases including disabilities - varies hugely internationally, and this is now reflected in Europes multiethnic populations. This is creating challenges for long term health care in Europe. Human rights legislation and health policies in Europe are mandating equity of services i.e. equal needs across different groups in the population should be met equally well. This raises the question whether the diversity in the population with respect to ethnic background, but also with respect to age, social economic status, gender and sexual orientation, should be translated into long term care arrangements in order to match the different needs within the population. In the second day of this conference we will focus on the following questions: 1) Is diversity within the European population translated into diversity in needs of long term care arrangements? Scientific research into variations in needs of long term care related to diversity within the population is largely limited to small scale - qualitative research. The studies indicate that the diversity within a population indeed translates into diversity in needs for long term care to at least some extent. The state of the art of the research will be presented and discussed, with special focus on the meaning of the scientific knowledge for care providers and policy makers. 2) To what extent are differences in needs translated into long term care arrangements across Europe? All across Europe examples exist of long term care arrangements that take into account diversity in needs of the population. Mostly religion is taken into account (e.g. elderly homes for Jewish people), but also age, ethnicity (e.g. elderly homes for Hindustanic people) and sexual orientation (e.g. elderly homes for homosexuals) has been accounted for. Examples across Europe will be presented and experiences with diversity in long term care arrangements discussed. Special attention will be given to the extent differentiation in long term care arrangements is needed (what can be universal, what should be specific). 3) To what extent leads differentiated long term care to increased (perceived) quality of life? The presumption is that differentiation in long term care arrangements according to different needs within the population will increase (perceived) quality of life of the target populations. In fact, increased (perceived) quality of life is the legitimacy for differentiation in care arrangements. The present scientific knowledge will be presented and discussed with special focus on the meaning for care providers and policy makers.