Care as public good or market commodity: Regulation of
home-based care work in Slovenia
Majda Hrženjak, Peace Institute, Ljubljana
Majda.hrzenjak@guest.arnes.si
(Work in process, please do not quote)
Paper presented at the international conference 'Developing and Implementing
Policies for a Better Future at Work' International Labour Office
Geneva, Switzerland, 8-10 July 2015.
1
Abstract
In Slovenia a steep demographic decline stimulates demand for home-based elder carers and
situation is aggravated by the absence of public long-term care policies. The other expansive
grey economy care market refers to cleaning of private households in dual-earner middle class
families with children given the high full-time and permanent labour market participation of
women and gender unequal share of unpaid work at home in Slovenia. This work is
predominantly taken up by local women who are either long-term unemployed or working
poor employed in labour-intensive, poorly paid jobs such as cleaning, service, nursing,
assembly-line work and retail clerking and to a less extent by female migrants coming mostly
from the so-called 'third countries' of former Yugoslavia.
While many European states have over the past decade developed specific policies to actively
promote the development of the formal market of home-based care services through the
introduction of cash-for-care schemes, vouchers or different socio-fiscal measures in order to
diminish grey economy, create formal employments and support work and family balance,
Slovenia did not take that route. Instead of investing public money in supporting the demand
side and developing private markets of care, Slovenia, though reluctantly and ambivalently,
continues to support public and mixed system of home-based care. Based on comparison of
evaluation studies of subsidizing schemes for home-based care in selected European countries
and in Slovenia the paper discusses pros and cons of policy framing of home-based care
services as public good or as market commodity from the perspective of quality of
employments for care workers.
0. Introduction
Regardless of the form of welfare system the extent of paid reproductive work in
private households is in increase across Europe in last decades (Angermann and Werner,
2013), which can be denoted as processes of re-familisation and re-privatisation of care work.
On the side of demand, reasons for this need to be searched for in increased care needs
associated with population ageing, in changes of post-modern family, increased inclusion of
women into labour market and absence of effective integration policies of reproductive and
productive work that would relieve women of the burden of the »second and triple shift«. On
the side of supply, main reasons lie in increased structural unemployment as well as local and
global inequalities and associated feminisation of migrations.
The increase of paid care work in private households along with re-marginalisation and
privatisation of the field of care means a revival of ‘old’ exclusions from social citizenship
tied to participation in formal labour market for those who perform this work. In Europe,
these are increasingly migrant women and local unemployed or poor women for whom the
informal care work markets represent a survival strategy. Work of informal paid care workers
in private households is namely illegal, criminalised, it does not ensure social security
deriving from the length of service and retirement benefits, it increases the risk of old age
poverty and economic dependency on partner and it reinforces the persistent pattern of
feminisation and privatisation of care work. Globalisation of care work we witnessed in
Europe in past decades revealed reproductive dependency of European societies on (global)
structural inequalities based on gender, ethnicity/race and class. These inequalities are
2
strengthened with European migration and employment regimes producing insecure
citizenship and labour statuses (Hrženjak, 2014).
As Morel (2013) pointed, the increase of paid care work in private households is not merely a
consequence of »natural« growth of supply and demand, but is structured with specific social
and employment policies that influence demand and supply. On the EU level as well as on the
level of individual countries the role of the state in assuming responsibility for social
reproduction is re-structured through the shift from state-provided and institutional based care
towards subsidised, informal and private care, like cash-for-care subsidies enabling users to
ensure the service on the market (Ungerson and Yeandle, 2007). Parallel to this, specific
policies are implemented – which actively promote demand, prevailingly in the field of child
care, elderly care and household work, with motivation to create new jobs, reduce grey
economy and meet the new reproductive needs of contemporary societies, especially the
needs of work-life balance – through diverse schemes of public subsidies (voucher schemes,
tax remission and incentives to encourage purchase) (Morel 2013, Farvaque 2012). Structural
changes of welfare systems aiming to limit public expenses for social reproduction introduce
shifts of responsibility for meeting reproductive needs of the population from their
socialization to privatised market solutions. The underlying argument of this paper is that
while the state by establishing public social care services and framing care as a public good of
special social interest maintains the quality of services and working conditions, the
introduction of market mechanisms that are based on assumption that autonomous individuals
freely choose care work solutions on the market shoves this work right back to the private
sphere of family and turns care services into market consumer goods with harmful
consequences for care workers and users.
Problems of care deficit and growing precarity in care sector are addressed by current
transnational and national strategies which attempt to solve them on intersections of social
and employment policies. The purpose of this paper is to analyse selected national strategies
that promote regulation of paid work in private households from the perspective of labour
market (de)segmentation and position of care as public or private good. In the first part, paid
care work in private households is analysed in the context of studies on processes of
fragmentation, flexibilisation and precarisation of contemporary labour market and will show
that such work, according to numerous criteria, is placed among non-standard, flexible and
precarious forms of work. In second part, it will be analysed how strategies of the European
Commission (EC) respond to the situation by promoting regulation of this field and, in third
part, how these strategies are implemented in selected EU countries. In the fourth part the
public system of social care for the elderly in Slovenia will be presented. We do not intend to
present this system as an example of ‘good practice’; the aim is to contrast two different
models of responding to the demands for quality of employments of care workers and care
needs of aging Europe: a public system of social care based on the concept of care as a public
good and a model of publicly supported demand side based on the concept of care as a market
commodity.
1. European Commission’s recommendations for regulation of care work in
private households
Definitions of paid care work in households differ from country to country (numerous
countries do not even have a definition) and include a wide range of tasks: from care activities
such as child care, care for the sick, elderly assistance, handicapped assistance and long-term
3
care to housekeeping tasks such as cleaning, meal preparation, shopping, tidying, gardening;
some countries include also remedial classes, home repairs and ICT support. EC defines this
work as ‘personal and household services (PHS), encompassing a broad range of activities
that contribute to well-being at home of families and individuals’ (EC, 2012) and it includes
all of the above mentioned activities. In spite of the broadness of this definition, however,
studies show that most of this work pertains to housekeeping and care for dependent family
members (Tomei, 2011). The observation of European Women’s Lobby to the EC’s definition
of PHS underlines that care cannot be cited in the same way as the other activities because of
its central and vital role in sustaining societies and economy and that there is a need to value
the central importance of care (EWL 2012). Broadness and national diversity of definitions,
along with the fact that such work often does not have its own category in the statistics but it
is rather a part of wider categories, prevent a formation of precise quantitative evaluation of
the extent of this work. According to estimation of the EC1, PHS sector formally employed
7.5 million persons in the European Union in 2011 (EC, 2012). As the majority of these
services are carried out within the realm of grey economy (for instance, in Spain and Italy it is
estimated that the extent of grey economy in this field is 70%, in Germany as much as 90%
(Farvaque, 2012)) it is possible to assume that the number of persons working in PHS sector
is substantially higher. All this shows that this work, despite its numerous manpower, does
not have a clear status in contemporary labour legislation and is de facto excluded from
formal regulations and mechanisms of their implementation.
While ILO (ILO 2010) promotes protection of care workers, the motives of EC lie in
promotion of PHS sector as a track for creation new jobs through development of low-skilled
employments in service sector and simultaneous re-structuring of public sector of social
services. EC is promoting development of this field for over 20 years now. Promotion of PHS
sector was identified in several documents2 with motives such as: ‘improvement of work-life
balance’ with ‘externalisation of daily household chores and child and elderly care’, through
which it would ‘strengthen gender equality’ and ‘support production potentials of highskilled’, at the same time it would create ‘new quality jobs for under-qualified’ and ‘restrict
grey economy’ (EC, 1993, 2012). It provides provisions for growth of micro businesses and
self-employments in formal economy (EC, 2012).
Promotion of PHS development was first observed in 1993 in the document White Paper
‘Growth, competitiveness, employment’ focusing on the problem of unemployment which
was, already at that time, estimated as high level, especially for the low-skilled. As Morel
(2013) showed, this same document identifies potential fields for creation of new jobs for
low-skilled in ‘local services’ for children, elderly, handicapped, long-term care and
housekeeping chores. These fields are defined as the fields of ‘new social needs’ occurring
because of intense employment of women who are thus no longer available to perform unpaid
care. The document mentions also Europe’s challenges with population ageing, which put an
enormous pressure on public social services and costs. Further on, the document noted
1
Estimation observed NACE code measuring: 97, 'activities of households as employers of domestic
personnel'; 88 'social work activities without accommodation'; 96 'other personal service activities'; 82
'other business support services' and 78 'activities linked to employment'.
2
See: White Paper 'Growth, competitiveness, employment' (1993), White Paper 'European social
policy – A way forward for the Union' (1994), The European Employment Strategy: recent progress
and prospects for the future (1995) and 'Commission staff working document on exploiting the
employment potential of the personal and household services' (2012).
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market’s inability to adequately respond to new social needs due to the obstacle of high costs
of care work on the demand side and reluctance to take on jobs which are being perceived as
degrading on the supply side. Therefore, as concluded by the EC in White paper ‘the
development of this sector is left to either grey economy or it is publicly financed which is
expensive’ (p. 19). Document called upon member states to develop incentives to promote
demand: ‘incentives such as income tax deductibility, or the local issuing of ‘vouchers’
instead of providing the social services normally provided by employers and local authorities’
(p. 19). The state would get its input returned through collecting more social security
contributions, decreased number of unemployment allowances and externalities such as,
work-life balance and productivity growth of the high-skilled (EC, 2012).
2. Selected national implementations
Across Europe it is possible to identify different models of regulation ((Kvist et al., 2012).
France, Belgium and Austria have implemented a voucher system. France, being a pioneer in
the field with introduction of regulation even before the EC recommendations in 1987,
subsidizes direct employment of care worker from the side of household with exemption from
social security charges and additional tax deduction for hiring a nanny. Low-skilled and older
unemployed women and migrant women specifically were targeted for these jobs. 2 million
people are employed in this sector out of which 91% are women; 21% migrant women and
only 3.8% native women work in the field in France (Morel, 2013). Evaluations critically
emphasize that approximately 70% of employed work part-time, most of them small amount
of hours (on average 12 hours a week) while French social security system provides only for
limited social security for the short part-time employed. Their wage is very low and 85% of
employments are direct worker – household employments, which establishes isolation and
unprotected situation for workers. Evaluations also point to the fact that care work that was
performed by high-skilled workers in public sector is now being de-professionalised with this
regulation (ibid.).
In Belgium, a voucher system was implemented in 1994 with the aim of creating
employments for long-term unemployed. Through voucher the state subsidizes the wage of
the worker; additional tax deduction for the purchase of vouchers was introduced in 2004.
Evaluations showed that out of 149,827 employed in this sector 97% were women. Only 12%
were full-time employed, 64% worked part-time and 24% worked very short part-time jobs
(Morel, 2013). Critics emphasize that with such subsidies public means are transferred to
wealthier strata that are on the side of users and not to, for instance, the worker or the
employer who would also assume responsibility for ensuring quality employments (Supiot,
2001).
Nordic countries, Denmark, Finland and Sweden have introduced a model of tax deductions.
Danish scheme, which lowered costs of work for 50% with subsidies, was implemented in
1994 and was aiming to restrict grey economy, to create employments for migrant and lowskilled women, and to improve well-being of families with children and of the elderly. In
2004, the scheme was suspended, with the exception of elderly users, because it demonstrated
that public subsidies actually went in favour of the wealthier strata (Kvist at al., 2012). With
new scheme, introduced in 2013, they subsidize one third of renovation work costs and
housekeeping assistance in private households.
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In 1997, Finland started a trial scheme with similar aims, and in 2001 the scheme was
implemented on national level; with tax exemptions they lowered the costs of work for 45%
for care workers that were employed in public or market agencies, and for 15% in case of
direct employment from the household. Beside care work scheme included also renovation
and repair works. They have established that the scheme is used mainly by older, 75+ people,
entrepreneurs, property owners, two-parent families and the high-skilled, and that 48% of
users belong to upper class. In 2007, Sweden introduced 50% tax deduction for employment
of care worker in private household, however, that is only for tax registered service providers.
In evaluation it was noted that 40% of service providers are self-employed (Kvist et al.,
2012).
In the 1990s Germany introduced a tax exemption for families with two children younger than
10 years for full-time employment of a domestic worker. In 1997 they withdrew the condition
of two children and later on dropped also the condition of full-time employment of a worker.
To create new employments and reduce grey economy they introduced Hartz reform in 2002,
with regulation of mini jobs which are not allowed to exceed a certain amount of monthly
income. Such jobs are completely exempt of paying social security charges from the side of
the worker as well as the employer; however, these workers also do not enjoy unemployment
insurance and health and retirement benefits. One of the categories of mini jobs pertains
directly on employment of care workers in private households for which the household gets a
10% tax deduction from the costs of the care worker. This means that the core of the reform is
financial subsidy aimed at demand, while all the conditions for households employing care
workers are removed. At the same time the state introduces a scheme according to which
households get 20% tax deduction for the costs of hiring a worker who is employed with an
agency (Jaehrling, 2004).
Different analyses of these schemes (Supiot, 2001, Jaehrling, 2004, Farvaque, 2012, Morel,
2013) pointed that all national schemes have in common the subsidizing of demand. Morel
(2013) argues that, through schemes of demand subsidizing state structures the market and
determines contract relations on the market which has implications for the market as well as
for social services. Evaluation studies show that in this way - especially in cases where these
schemes enables households to become direct employers - the state backs out of its
responsibility to control working conditions, regulation of work with collective agreements,
protection of workers from termination, securing the institute of minimal wage, defining
educational criteria for work performers, enabling trade union representation etc. Subsidizing
demand is thus reflected as an active de-regulation of labour market for specific social groups,
such as low-skilled, long-term unemployed, migrants and women, which leads to creation of
inequality for high- and low-skilled work on labour market (Morel 2013). This way state also
limits its own mandate to secure quality standards of care services, it allows inequalities in
geographical accessibility of care services which are a part of socio-economic inequalities.
One of the important critiques is that the logic of demand subsidizing redistributes public
means in favour of wealthier users instead of establishing public, accessible to all, care
capacities and recognition of the field of care as an activity of special social interest (Supiot,
2001). As emphasized by Morel (2013), this logic of regulation reflects specific social
choices: enhancement of income inequalities, promotion of social structure based on
distinction between productive and unproductive work, low-skilled and high-skilled work,
institutionalisation of growing dualism of the labour market and legitimisation of inequalities
in access to care services. Tomei (2011) adds that all these schemes perpetuate the image of
care work as poorly paid, low-skilled, flexible, women’s and migrant’s work, and thus as
work field of no quality.
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3. Paid domestic and care services in private households in Slovenia
Similar to the rest of Europe, in Slovenia households also encounter care deficit with strategy
of paid home based care. Empirical research3 showed that paid help in private households was
used by 5% or 34,251 households in 20094, out of those 81% were used for housekeeping and
cleaning, 23% for elderly care and 10% for child care.5 Only a small minority of households
(7%) used regular market cleaning and care services because they are expensive and thus
accessible only to the wealthier. 22% of services were ensured by the public system of homebased care that enables services only to users that are older than 65 and the chronically ill. A
high proportion of 71% of services were being performed in the field of grey economy. As
most of this work is performed in the field of grey economy and is sanctioned for workers as
well as for users it is probable that phenomenon is more wide-spread, yet pushed into the
invisible due to criminalisation.
These data reflect the impact of public care policies on shaping the informal care markets with
respect to who undertakes informal paid care work, under what conditions and within what
power relations. In Slovenia, in the field of childcare which is characterized by a solid,
qualitative public institutional care facilities and reasonable parental social rights 6, one can
observe a low demand for child care services, absence of migrants and exploitative power
relations in informal care market. In elder care characterized by a mix of public/private care
services in which responsibility for care is allocated to the family and is publicly supported
by cash- for-care allowances assimilated migrants and women living under the poverty
threshold step in and working conditions become much more oppressive and undefined. In the
area of household maintenance, i.e. cleaning which is completely lacking socialization and is
entirely individualised, global care chains in its most oppressive form step in (Hrženjak 2012).
Data show that the share of care and domestic work services provided by the grey market
considerably surpasses the share of public and commercial services in elder care and cleaning.
In Slovenia, paid home based care work outside grey economy can be provided in several
legal forms: through a market agency, via self-employment, social policies of care for
handicapped stipulate a status of family carer and of personal assistant. In this regard I will
3
In 2009, Public Opinion and Mass Communication Research Centre (CJMMK) at the Faculty of
Social Sciences conducted a phone survey on a statistically representative sample of 2,677 households.
Survey has, beside demographic questions and questions about attitude of household toward paid
household assistance, asked also whether households use such assistance, what form, for which
service, to what extent, why, how much they pay, what is ethnicity, age and employment status
structure of the employed, how did they find the worker and what their relationship is like. The survey
was conducted within research project Informal Paid Reproductive Work: Trends in Slovenia and the
EU (2007-2009), financed by Slovenian Research Agency (J6-0958).
4
According to 2002 Census there were 685,023 households in Slovenia.
5
Due to combining of some of the services (especially elderly care and cleaning) the total sum of
percentage shares is over 100.
6
The socialist legacy which has provided a quality, subsidized and accessible network of public
kindergartens, three months of maternity leave and nine months of parental leave which are covered to
a 100% of wage is still in place. Parents are entitled to share the parental leave. There is a possibility
for parents to work part-time until the child’s sixth birthday, and there are tax deductions for children
as well as a means-tested child allowance. In 2003, Slovenia extended parental rights by introducing
paternal leave, in order to encourage a more just distribution of care work between parents. With all
these measures the state encourages women’s economic independency as they return to work in 11
months after birth giving.
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focus on the following two forms: a newer regulation of personal supplemental work or the
Slovenian version of ‘mini jobs’, which in a modified way follows European
recommendations of introducing vouchers as a mean to reduce the grey economy; and public
system of social elderly care which, as I maintain, represents an alternative to marketization
and privatisation of care. First I am going to present both of the above, and then contrast the
public social care system in Slovenia with above presented market-directed trends of home
based care work regulations from the perspective of ensuring ‘decent work for domestic
workers’.
3.1. New regulation of personal supplementary work
In 2014, state intervened with new Prevention of Undeclared Work and Employment Act
which stipulates tightened sanctions and prosecution mechanisms for workers and households
that are solving their existential and care needs in such manner on one hand, while on the
other it introduces vouchers for personal supplementary work (PSW) and thus stipulates
implementation of social security for these workers and clearer relationship between a
household and a worker. PSW beside numerous other occasional non-care related jobs
includes also ‘household assistance and similar work’, such as ‘occasional help in household
and help with maintenance of apartment, house, weekend house and similar’, ‘occasional
child care and elderly care, care for sick and handicapped at home’.7 As explained by the
documents of the Ministry of Labour, Family, Social Affairs and Equal Opportunities8, new
regulation follows the principle of ‘every work counts’ which means that each work, also the
PSW which was an exception until now, has to contribute for retirement and health insurance
charges. From 2015 on, a monthly voucher worth 9 Euro (7 Euro for retirement, 2 Euro for
health insurance) will be paid by the households. Limitation defining that 6-month income
from PSW must not exceed 2 average monthly salaries and limited social security rights
deriving from this form of work set PSW along the line of German model of mini job.
In Slovenia, regulation of paid care work in private households, especially current changes of
the institute of PSW that can implicitly be understood also as partial regulation of this field,
point to an important difference from prevailing regulations in Europe. While other European
national schemes assume that the user of service pays subsidized price of service which thus
reaches the level of the price on the grey market – the state subsidizes the difference between
the two prices which usually represents the cost of social security charges for the work –,
Slovenia takes the opposite rout: care workers within PSW scheme are indeed exempt from
paying social security charges from PSW, however, these charges are put on the user of the
service. From the point of view of social services such regulation does not address care needs
of households with establishing accessible and alternative yet regulated mechanisms, but
rather legitimizes privatised market-based solutions within the framework of PSW where the
state is not responsible neither for the equal access and quality of the services nor for the
protection of workers. An important difference in comparison to the above presented
strategies lays in the fact that these privatised market solutions used mostly by well-situated
social groups mainly for cleaning are not subsidized with public means and therefore
represent a cost to the user. However, by adding to the taxation and introducing although
simplified yet still administrative procedures for the users (and workers) of care services the
7
Rules on forms of work deemed as additional personal work and on the procedure to notify such
works.
8
Proposal of the Prevention of Undeclared Work and Employment Act.
8
state can indirectly decrease demand for care services in the framework of PSW and can
consequentially, due to stricter sanctions, shove care work even deeper into the invisible
sphere of grey economy.
From the point of view of labour market regulation, the state aims at reduction of grey
economy, ‘equalisation of all forms of work’ in terms of taxation, and partial enabling of
limited extent of social rights deriving from this work. However, because it does not subsidize
these services but rather additionally burdens them for consumers, the state also misses the
opportunity to create new jobs in the field of care services in private households where a great
demand is being present. Namely, Slovenian example of public system of social care
demonstrates that subsidizing of care work in private households does not necessarily lead to
creation of precarious jobs and redistribution of public means to the wealthy.
3.2.
Alternative: a public system of social care
In Slovenia, home based social care intended mainly for the elder population and their quality
of living in the shelter of their own home started to develop intensively after 1992 through
centres for social work and elderly homes. While some sort of social care system was already
well developed in some countries, such as Holland, Belgium, Denmark, Ireland, Sweden,
United Kingdom, and some countries, such as Austria, Greece, Spain and Italy, had the
system in early stage of development, for Slovenia this was a social innovation. Due to
economical motives (this form of elderly care was less expensive than building new elderly
homes) and at the same time due to pluralisation of social care services the initiator of this
social innovation was the state.
Ten years later in 2000, the service was professionalised through setting the standards of
knowledge and skills for the occupation of social carer and in 2002 first public agencies for
social care were established in some municipalities. In the beginning the service was free of
charge, but with professionalization it became chargeable yet subsidized by the state, mostly
through municipalities. Service is a responsibility of municipality which is obliged to ensure a
network of public services via a contract with a public institution or by awarding of a
concession. Public system of social care therefore implies municipality’s responsibility for
organisation, accessibility and quality of home based care services, and according to
legislation municipality is also obliged to cover at least 50% of the service costs (most
municipalities co-financing reaches beyond that; for instance in the capital Ljubljana the
subsidy reaches 80%). The cost of the service is additionally reduced by the state subsidy as a
part of active employment policy measures – the state in part covers the costs of labour force
providing these services. In 2013 the average price paid by the user of home based care
service was 5.12 Euros per hour. Whereas for the organizer of the home based care service or
an employer the whole cost amounted on average 16.91 Euros per hour. Thus the user actually
paid on average one third of the full cost of the service. However, the system lacks a
consistency in the pricing – municipalities' costs per user can vary substantially (between 0.00
to 9.69 Euros per hour) (Nagode 2014).
Home based social care is professionally managed process and organised form of practical
assistance which includes cooperation of a manager and coordinator of service, service
performer, user, key or responsible family members and volunteers. An important difference
between public system of social care and market model of consumption promotion that is
being introduced in numerous EU countries lays in the fact that the condition for acquisition
of public means depends on identification of actual care needs. Programme performance starts
upon a request of a user or their statutory representative and includes: (1) establishment of
9
entitlement to the service, preparation and conclusion of an agreement on extent, duration and
form of service, organisation of key environment members and execution of introductory
meetings between service performer and service user or their family, and (2) direct service
performance at the home of the user in accordance to the agreed content and within the agreed
scope. Individual is entitled to 4 hours of care per day or up to 20 hours per week (Smolej at
al 2008). Direct service is performed at the home of the user by a social carer with at least
primary education and completed additional social care training which includes 120 hours of
theoretical and practical training. Normative regulation of the programme performance is set
at maximum 5 users per one social carer.
Service includes: (1) household assistance (delivery or preparation of meals, washing dishes,
basic cleaning of living spaces and trash removal, making bed and basic up keeping of
sleeping space); (2) assistance with personal hygiene (help with dressing and undressing, help
with washing, feeding, executing basic human needs, up keeping and care of personal
orthopaedic aids); (3) help with maintaining social contacts (establishment of social network
with the environment, with volunteers and family members, accompanying user in running
urgent errands, informing institutions of the state and needs of the user as well as preparation
of the user for institutional care) (ibid.). In 2013 most of the users (87%) were receiving
household assistance, 73% were being helped with maintaining social contacts and 58% were
assisted with basic daily routines (Nagode 2014).
Each year Social Protection Institute of the Republic of Slovenia working under the Ministry
of Labour, Family, Social Affairs and Equal Opportunities publishes an evaluation of the
programme of social care across all municipalities. Evaluation encompasses the number of
service users, number of services, number of hours put into service per individual user, price
of the hour per user and per municipality, employment situation of care workers and sick
leave absence and an estimation of needs according to service form. From the perspective of
employment quality within the system of social care evaluation reports show a growth of the
proportion of standard employments since 2011. In 2008 there were 61.3% regular full time
employments; in 2011 90.3% and in 2013 even 93.9%. Similarly, share of care workers
employed for indefinite time is in increase – among regularly employed social care workers
73.6% were employed for indefinite time in 2011; the percentage grew to 86.5% in 2012 and
to 88.7% in 2013. For contrast should be added that Slovenian labour market is characterized
by high rate of atypical permanent employments.
In 2013 5% were working through community work placements and only 0.8% within other
contractual relationships (self-employed, PSW, contractual work). In 2013 social care worker
worked on average 102 hours per month (ibid.); their full-time employment includes also
transport between users, a lunch break, holidays and sick leave.
In 2013, Faculty of Social Sciences with partners conducted an integrated research on quality
of home based social care in Slovenia which among other things encompassed also a
quantitative questionnaire for social care workers. The research showed that social care
workers are women of middle age (the average age is 44 years), with secondary professional
and occupational education and additional training for the social care work (verified training
programme for social care worker or National Vocational Qualification). In evaluation of their
own employment, social care workers emphasized following aggravating factors: physically
demanding work, extreme posture, manual handling (of over 20 kg), physical and
psychological fatigue, stress situations and time pressure in traffic. 40 % of them were
dissatisfied with their salary; they were also dissatisfied with a lack of possibilities for
promotion and career development. They have expressed a need for additional training on
dementia. Social care workers emphasized also positive aspects of their work, such as being
10
satisfied with relationships they develop with their service users and their relatives, their
independence and freedom at work, and they assessed their work as important (Hlebec et al.
2014).
Since 2011 a Trade Union of Social Care Workers of Slovenia9 is in existence with the aim to
promote a decent pay, healthy work environment and positive valuation of social care work in
society.
4. Discussion
As already mentioned in the introduction, the purpose of this rough presentation of public
system of social care is not in emphasizing Slovenian model of elderly care as a case of good
practice. Quite the opposite, numerous researches show that Slovenia is lagging behind in
relieving family as traditional elderly care source as well as in modernisation of elderly care,
and this is even truer with home based care as a more recent form of care (Mandič 2012).
However, this occasion does not allow us to go any further into an analysis of system’s
deficiencies. We can merely mention, that deficiencies pertain mainly to insufficient scope of
the system with regard to the demand, to inequality in access to services among
municipalities, diverse service pricing per user across municipalities which depends on
municipalities’ capabilities for co-financing of services, and to time range of assistance
received by a service user (Hlebec 2010).
The purpose of this presentation is thus to contrast the two different concepts and models of
home based care subsidizing, where the Slovenian model follows the logic of municipalities
being responsible to ensure service through public institutions or concessions, as opposed to
just cash-for-care logic, and that public means are directed towards service providers who
entered a contract relationship with a municipality through which they assume responsibility
for organisation and quality of services, professional standards and quality of employment
itself. The above presented models and recommendations of EC on the other hand follow the
logic of consumption promotion, meaning that the state or municipalities do not ensure the
service but instead direct public means towards the service users non-selectively, i.e. without
assessing the entitlement to public means on the basis of actual care needs and without taking
public responsibility for the quality of employments and services. Both models have in
common the spending of public means for service subsidizing, but they differ in many other
points: in definition of care, in the aim of such public means spending, in who/what is
subsidized, in whether subsidizing is targeted or non-selective, in who takes responsibility for
quality of service offered and working conditions of those providing the service etc.
What are the consequences of these two logics of financing of home-based care for care
workers and users?
Definition of services: in public system of social care care services have a special meaning as
a support for independent living, social inclusion and cohesiveness and do not follow the
broad definition of PHS sector. Care services have status of public good not of market
commodity. The scope of subsidized work is therefore narrower in public social care system
than in consumption promotion model.
9
http://ssos.si/Pridruzite_se_nam.html
11
Service users: consequently, in public system of social care public means are directed into
lowering the price of the service and thus used selectively on the basis of assessing care
needs. Economically vulnerable social groups are entitled to further payment reductions.
Public means for care work are thus directed to those social groups who are in greatest need.
In consumption promotion model service subsidizing is not selective and consequently public
means are often spent for life style services for well situated social groups while actual care
needs of the population remain unaffected.
Organisational form, monitoring and responsibility for quality and accessibility of
services and employments: in public system of social care responsibility for organisation of
home based care and its accessibility, quality and quality of employments is assumed by
municipality and the state who also conducts annual evaluation of the system; in consumption
promotion model responsibility is dispersed, untraceable and left to the logic of the market
that is also in charge of the accessibility of the service.
Care workers’ working conditions: in public sector of social care prevailing form of
employment is standard employment (full-time employment contract for indefinite time).
Salary of social care worker, although according to care workers insufficient, is not allowed to
be lower than minimal wage and has to include payment of all social contributions including
health and retirement insurance as well as insurance for unemployment. Working time
includes the time needed for transport between service users and a 30 minute lunch break.
Care workers are organized into a trade union and included in collective agreement; they are
covered by the Employment Relationships Act as all the other employees. On the contrary the
consumption promotion model, as shown in evaluation studies, increases the number of
atypical employments (especially self-employment) with precarious contracts and involuntary
shortened working time (which often reaches also extremely short working periods of 12
hours, for instance). Time for transport between service users is not incorporated in working
time. Consequentially, salaries for such work do not reach minimal wage and include only
partial payment of social contributions and insurances. Care workers are isolated,
individualized and often not covered by a collective agreement or organised into trade unions
in this model.
Professionalization: in public system of social care work care work is professionalized –
employed care workers are obliged to have a vocational qualification for social care worker,
while in consumption promotion model systems of professionalization and standardisation of
work are not established.
Public costs: often we hear the argument that public systems of social care are expensive and
that privatisation and marketization brings relief for public funds, something that should be of
utmost importance from the perspective of population ageing in EU. However, Morel (2013)
showed that public means invested in promotion of consumption, i.e. for voucher schemes
and schemes for tax reductions, are the opposite of modest: 6.6 billion in France, 1.6 billion in
Belgium, 1.15 billion in Germany, 475 million in Finland. In Slovenia, municipalities have
invested 14,506,194.12 Euros in subsidies for home based assistance in 2013. Beside that they
have put additional 649,946.05 Euros in lowering of costs for some of the service users. State
subsidies (means for active employment policies) amounted to 376,796.60 Euros in 2013.
Thus all together it came to 15.5 million Euros (Nagode 2014).10
10
Due to different sizes of countries these numbers are not comparable, but do provide for a rough
picture of the situation.
12
The field of social care work by all means has the potential for creation of new employments.
However, at the same time care work is a field of inherent hierarchies and inequalities
according to gender, class, race/ethnicity, age etc., and therefore regulative models have to be
even more sensible and sound. How to create attractive employments and ‘open’
employments in care sector up to a wider circle of social groups (not only for migrant women,
but also to local youth and older people; not only to women, but also to men etc.) should have
been a priority to policy makers. In past decades the tendency in resolving the care deficit was
directed into growing marketization and privatisation of services instead of thorough reforms
and upgrades of existing public systems. Privatisation of care, however, does imply several
core problems, such as absence of control over quality and accessibility of services and the
quality of working conditions of social care workers. The effects that different types of public
financing of care services have on created jobs, professionalization and reputation of this
work, standards of services and equal access to services have to be monitored. Current
evaluations show that the model of consumption promotion and consequent privatisation and
marketization of care services lead to precarisation of this work with promotion of selfemployment, part-time work and labour regulation with limited access to employment based
social rights. And on the side of the service user it leads to unequal access to service and
undefined quality standards. Key argument presented here maintains that existing systems of
public social care and the status of care work as a public good could be a good role model for
establishment of conditions for ‘decent work for domestic workers’. For this purpose existing
models should amplify their scope and upgrade in the sense to become more tailored
according to individual needs and include more different target groups (not only elderly, but
also for instance families with small children and both parents full-time employed etc.), and
thus provide for a broader range of services.
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