Between Migrant Care Work and New Occupational Welfare Tools: Changing Home Care Arrangements in Italy.

Georgia Casanova,Giovanni Lamura,Oliver Fisher,Mirko Di Rosa

doi:10.3390/ijerph17155511

Abstract

Austerity measures on services provision, introduced due to recent economic crises, have stimulated the search for innovative welfare solutions, including options that are not directly or entirely funded by public sources. In Italy, recent legislation has promoted the development of occupational welfare (OW) measures, aimed at strengthening the supply of services to support employees with informal (elder) care responsibilities. This paper aims to describe how the newly introduced OW schemes might innovate existing care arrangements, by identifying their impact on the different actors involved in home care provision (care recipients, family carers, home care service providers and migrant care workers), as well as at a macro level in terms of promoting social innovation. The international relevance of the Italian case comes from the fact that it is one of the more representative familistic care regimes, largely characterized by home care provided by informal carers and migrant care workers (MCW). The importance of Italian OW schemes is increasing, and in 2018 their presence in company-level bargaining agreements grew by more than 15%. A rapid review of the literature and expert interviews allowed us to describe the complex Italian OW schemes system, and to identify the positive implications of their application for the country’s long-term care (LTC) context, underlining what makes these measures a clear example of “social innovation” likely to have a future positive impact on home-based care in Italy.

Highlights

In the last decade, the international debate on home care provision for frail elders has repeatedly underlined the importance of recognizing the role of informal care within a partnership approach in care management, in order to achieve a more effective long-term care (LTC) system [1,2,3,4,5].The challenges posed by the recent international economic crisis that started in 2008 and the consequent austerity measures imposed, among other things, on public expenditure for care services and social protection policies, has stimulated the search for alternative welfare solutions, including options that are not directly or entirely funded by public sources [6,7]
The basic idea is to integrate the public expenditure for the Italian LTC system, which in 2017 reached only 0.7% of GDP, i.e., one of the lowest among Organisation for Economic
occupational welfare (OW) agreements would include home care schemes, and at least 50% would be using them [58]. This scenario seems realistic, taking into consideration that, in 2018, almost 400 thousand workers required daily job leaves for family care purposes, and that the requests have increased by 30% in a few years. These results show at the same time, that in order to make sure that OW schemes in home care can go beyond the level of a sort of “start-up” experience, robust and thought-through communication and information actions are needed to make them a more significant component of the Italian LTC

Summary

Introduction

The international debate on home care provision for frail elders has repeatedly underlined the importance of recognizing the role of informal care within a partnership approach in care management, in order to achieve a more effective long-term care (LTC) system [1,2,3,4,5].The challenges posed by the recent international economic crisis that started in 2008 and the consequent austerity measures imposed, among other things, on public expenditure for care services and social protection policies, has stimulated the search for alternative welfare solutions, including options that are not directly or entirely funded by public sources [6,7]. A not always explicit corollary of this approach is that citizens are today called upon to be increasingly responsible for managing their care arrangements, de facto to rely more heavily on care provided by relatives, friends, and neighbours [8,9,10]. This lies, on the one hand, on the continued demographic trends leading to an increase in the percentage of elders on the whole population, as in 2018 almost 20% of the European population was aged 65 or older, with an overall increase of more than 2 percentage points from 10. Public Health 2020, 17, 5511; doi:10.3390/ijerph17155511 www.mdpi.com/journal/ijerph

Methods

Results

Discussion

Conclusion