Introduction The previous steps have:
4.2 Examples of good practice
¾ Awareness of employers
A good example for raising awareness that there is an actual problem of reconciling work and care can be seen in the work of the British government’s Department for Education and Employment which launched the “Employers for Work-Life Balance Initiative” which aims at encouraging organisations to make a commitment to support carers in the workforce. Similar is the “Work-Life Balance Campaign” which aims at raising employers’ awareness of the business benefits of introducing policies which help employees obtain a better balance between work and family life, also embracing family care.
Going even further, the British Government set up the “Work-Life Balance Challenge Fund (WLB- CF)” which provides financial aid to employers to help them develop work-life balance policies and practices. “Evidence from a 20-month independent evaluation of the first three rounds of the WLB-CF indicates that the vast majority of employers have positively benefited from participation in the Fund. The findings indicate that the WLB-CF has enabled employers to introduce significant changes in their employment practices so as to create greater awareness of, and develop policies to support, work-life balance.”148
¾ Facilities for respite care
In Sweden, a three-year Action Plan from 1999-2001 (Anhörig 300) provided funding for local governments to develop an infrastructure of services targeting family carers. Municipalities were stimulated to expand non-financial support for informal carers e.g. by setting up caregiver resource centres that offer training, counselling, support groups, respite care and other programmes. As a result, the number of support programmes available has steadily increased.149
Respite care was already available, but the variety increased. Practices such as day care and replacement of informal care givers at home is now available in more municipalities. Practices of counselling, training and contact points also have become significantly more popular than before. “The evaluation by the Swedish National Board of Health and Welfare concludes that municipalities have continued the efforts to develop the range of non-financial support for informal care givers, but it is difficult to know whether these support services reach the people who need them most and there is a continued need for developing their quality. Developing the appropriate form of help is a challenge, and surprisingly often informal care givers said “no thanks” to offers of support.”
¾ Flexible work arrangements
In Austria, according to the Labour Contract Law Amendment of 1997, employees who have temporary care obligations can claim part-time work. After finishing the care work a return to the formers working time should be possible.150
In Germany, in 2001 the general right to work part time was introduced for employees working in companies with 15 and more employees. This allows a bigger choice in what to do with ones time. It is planned to introduce on 1st of July 2008 a right to six months care leave with job return guarantee. In the Netherlands, the 1998 Act to Finance Career Interruptions permits employees to take leave for at least half of their regular working hours for between 2 and 6 months (can be extended by local labour agreements to 18 months). The person taking leave receives a payment of €11 an hour, up to a maximum of €436 for leave of 38 hours or more a week. Additional periods of leave can be taken so long as there is at least a year between them.
“In the United Kingdom - from April 2007 - the Work and Families Act 2006 gave certain carers the right to request flexible working such as changing hours or working from home. This act extended the right – which came into force in April 2003 – of parents of children under six, or 18 if the child is disabled, to ask for flexible working. Employees who have worked for their employer for at least 26 weeks can apply to make a permanent change to their terms and conditions. Only one request is allowed in a year. Employers can refuse a request, but must give good reasons. Employees can appeal. Parents of disabled children have had the right to request flexible working for the past three years. Research shows that four in five requests are granted. The right to request flexible working could make the difference between a carer quitting or remaining at work. Currently, 2.65 million carers could take advantage of this new right, but millions more will benefit in the years ahead.
The act defines a carer as “someone who cares for, or expects to care for, a husband, wife or partner, a relative such as a child, uncle, sister, parent-in-law, son-in-law or grandparent, or someone who falls into neither category but lives at the same address as the carer”. People who care, say, for an elderly neighbour, fall outside the remit of the act. Evidence shows that most employers are open to requests from those not eligible under the new law.
In addition, under the Employment Relations Act 1999, employees gained the right to “reasonable time off” to deal with any unexpected situations that arise in relation to their caring or parental roles. At the discretion of the employer, time off can be paid.” 151
¾ The choice of carer
In the Netherlands, persons assessed and eligible for non-institutional care, can ask for care in cash (“personal budget for care”, PGB) or care offered in kind. In 2001, there were five different schemes (allowance for help and care at home, intellectual deficiency, mental health, intensive care at home and physical disability). The reform of 1 April 2003 replaced all schemes by one, the personalised budget new style. In 2006, there were 90.000 beneficiaries152. About 70% of new beneficiaries in 2005 had a “somatic” deficiency.
A person who is entitled to care under the Exceptional Medical Expenses Act can opt not to take care in kind, but to receive a personal care budget. In principle, anyone who requires care under the Act for more than three months can qualify for such a budget. The budget is a sum of money awarded to the client to enable him/her to purchase care independently. However, the budgets are available only for certain functional forms of care, such as nursing, general care and guidance; they are not available for treatment or institutional accommodation. The minimum disability level required to be eligible is the
150 Barkholdt C. and Lasch V., (2004).
151http://www.carersuk.org/Employersforcarers/Thebusinesscase/Carersandthelaw
152 Rapport Uitvoeringsverslag PGB nieuwe stijl; juli 2005 – juli 2006; Publicatienummer 244; CVZ, 2006,
existence of care functions restrictions. Eligible people cover all ages (beneficiaries of the Exceptional Medical Expenses Act).
The beneficiary can choose to pay his own caregiver. He may pay their own relatives for the care or they can buy customised professional services.
“A study of the outcome of the Personal Budget scheme in the Netherlands, which found that while care quality is roughly the same as when persons needing care are referred administratively to a designated agency, persons receiving care through a personal budget feel less dependent because they have more control over when care is provided and notably by whom.”153
In Germany, the Long term care insurance benefits can be received in the form of a cash payment (at a lower value); or in the form of professional home care services (worth nearly twice as much); or as a combination of the two. The level of the cash benefit option depends on the level of ‘care dependency’.
The cash benefit option is only payable if the care insurance recipient is able to secure adequate home care from relatives, friends or neighbours. The cash benefit is awarded directly to the person needing care, who may then pass it on to a family carer.
Despite its significantly lower value, the cash option has proved much more popular than ‘in kind’ services.
Once an older person’s entitlement to care insurance has been established, a number of other benefits can be received which are of potential benefit to family carers. These are154:
- Respite, holiday or stand-in care: Informal carers providing home care can take up to 4 weeks holiday a year, during which the Long term care insurance will pay for substitute professional home care services. The same entitlement is available if the usual carer is ill.
- Insurance cover: Care insurance pays the retirement pension and accident insurance contributions of informal carers who are employed for less than 30 hours a week and provide unpaid home care for at least 14 hours a week. Informal carers are also automatically covered by the statutory accident insurance scheme while they are providing unpaid home care.
- Direct support for carers: Care insurance beneficiaries who have chosen the cash option have a home visit from a nurse employed by the care insurance fund every 3-6 months, depending on the level of care dependency. This is partly to monitor the quality of care being received and partly to provide advice and support for carers. The Long term care insurance funds are also required to offer free nursing care courses for informal carers; Carers are also entitled to retraining opportunities if they want to return to paid employment after a period of care- giving.
¾ Insurance cover
In Germany, care insurance pays the retirement pension and accident insurance contributions of informal carers who are employed for less than 30 hours a week and provide unpaid home care for at least 14 hours a week. Informal carers are also automatically covered by the statutory accident insurance scheme while they are providing unpaid home care.
Similar measures and pension accruals apply in Finland (see below).
In Austria, since 2006, in addition to social insurance statutory protection for carers who are relatives, a preferential personal insurance for periods of care for close relatives was created; according to this, people who are caring for a close male or female relative with a right to a long term care benefit,
153 Lundsgaard (2005) (Jens Lundsgaard (2005): Consumer Direction and Choice in Long-Term Care for Older Persons,
placing considerable demands on their capacity for work in the home environment, may be self- insured in the pension insurance scheme under favourable terms. Only one person may be self-insured for each case requiring care. Care in a home environment is not interrupted if the person requiring care has a temporary stay as an in-patient. In the cases of this newly created preferential self-insurance in the pension insurance scheme for periods of care by close relatives, the Federal Government, as is the case for the existing opportunity of preferential further insurance in a pension insurance scheme, assumes the fictitious employer contribution. Through this new opportunity for self-insurance, statutory social insurance protection is also created for those relatives who are carers and who have either not yet been amongst the insured or for whom taking up the benefits which existed to date for carer relatives was not an issue because they did not fulfil the statutory requirements.
¾ Support for informal care
In Finland, the municipality can give support for informal care for relatives who look after an older person, a person with disabilities or a long-term ill person. The Act on Support for Informal Care came into effect at the beginning of 2006. Support for informal care is a statutory social service. The municipality is responsible for organising the support within the limits of its resources. Support for informal care encompasses necessary services for the client, a compensation for the informal carer as well as leave and support services for the carer. The municipality and the person providing care draw up a care agreement (which is a commission agreement between the municipality and the care giver, not an employment contract) that includes a plan on care and services. In 2006 the minimum caregivers allowance is EUR 300 a month. There is no upper limit on the allowance, which is taxable. The caregiver who has made an agreement with the municipality is entitled to employment pension accrual with certain limitations. The municipality also covers the caregiver's accident insurance. People receiving support for informal care are entitled to two free days a month during a period when the nature of the care they have provided has been very demanding. During this statutory free time, the municipality is responsible for providing care to the elderly recipient. The municipalities may organize supplementary holidays for the caregiver and free time for recreational activities of less than 24 hours155.
4.3 Conclusions
Innovative practices focus notably on:
- a consensual approach (sensitisation of employers),
- extension of local support services to carers and the dependent person, - part-time work and flexible work hours,
- allowances and personal budgets which formalise informal caring,
- insurance and pension credits to avoid long-term negative impacts on the carer, and - Support to carers.
Generally, the different measures aim to improve the quality of services provided to dependent people and improve the work life balance of carers.