Migrant Care Workers in the Italian Care Model

1
Migrant Care Workers in the Italian Care Model

• Dr. Barbara Da Roit
• Department of Interdisciplinary Social Science,
  Utrecht University
• B.daRoit_at_uu.nl
• Expert Seminar at the European Academy of Regions
• Domestic Support and CareBetween Quality
  Requirements and Costs
• Frankfurt, 20-21 October 2008

2
Structure of the presentation

• Brief background on long-term care in Italy
• Care workers in home care
• How do migrant care workers fit in the system?
• Diffusion, profile and conditions
• Policies
• Debates, attempts, problems and perspectives

3
Background elements on long-term-care in Italy

• Traditionally a family matter
• Unpaid daughters and wives
• Legal obligations
• National policies
• No explicit long-term-care policy
• National care allowance (mid 1980s)
• Initially meant for adult disabled, not older
  people
• Flat rate (450 euro/month) not means tested
• Very high dependency required
• Paid both in institutions and at home
• Low institutionalization rate (circa 2 of 65)
• Limited development (with regional differences)
• Partial public funding (regional health care
  funds)
• Very expensive for final users
• Home care services
• Two separate systems of services
• health care (Regions and local health
  authorities)
• Municipalities (social care)
• Diverse regional and local situations, but scarce
  supply

4
Domiciliary care for older peoplein Italy

• 4 separated (sometimes overlapping) sources of
  support for older people
• Informal care
• The health care system
• The social care system
• The private care market
• Dimensions
• scale/diffusion
• type of support provided
• Care workers profile
• Working relations
• Working conditions
• Professional profile

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Scale
Authority responsible Diffusion Trend
Informal care - High Decreasing
Health care Local health authorities/Regions Low max 5 of people 65 Stable
Social care Municipalities/Associations of Municipalities Low max 3 of people 65 Stable
Private care - High8-10 of people 65 (estimates) Increasing
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Services provided
Type of support Intensity Duration
Informal care Organization all sorts of direct care Varying
Health care Rehabilitation post-hospital care medications bathing 1-2 times (X 1-2 hours) a week Short cycles
Social care Housekeeping meals personal hygiene and care 2-3 times (1-2 hours) a week Medium-long term
Private care all sorts of direct care Up to 24h/7d Varying
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Care workers profile
Gender Age Nationality
Informal care Woman (more and more men) 50s (daughters) Italian
Health care Woman (care assistants) Varying Italian, but increasingly of migrant origin (care assistants)
Social care Woman varying Italian, but increasingly of migrant origin (care assistants)
Private care Woman (few men) 40s-50s Migrant origin (Eastern Europe South America)
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Working relations
Employer Living arrangement Contract
Informal care - (often) living next door -
Health care Not-for-profit organizations contracted by local (health) authorities Independent Employee of not-for profit organization atypical contracts
Social care Not-for-profit organizations contracted by local (health) authorities Independent Employee of not-for profit organization atypical contracts
Private care Older person/spouse/child(ren) (often) cohabiting Domestic worker
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Working conditions
Wage Social contribution Undeclared labour Costs for users
Informal care - (sometimes informal compensation) - - -
Health care 10-12 euro/hour (net) care assistants Lower than regular employees Present - (Sometimes co-payment)
Social care 10-12 euro/hour (net) care assistants Lower than regular employees Present - (Sometimes co-payment)
Private care 800-900 euro/month for live-in arrangement (net) The lowest in the system Widespread
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Professional profile
Profile Training
Informal care - -
Health care According to Regional (health) care regulations According to Regional (health) care regulations (circa 1000 hours)
Social care According to Regional social care regulations According to Regional (health) care regulations (usually 600-800 hours)
Private care Not defined None Local experiments (50-150 hours)
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The attitude of politics and society towards
migrant care workers

• Generalized acceptance of undeclared labour (not
  only in care)
• Definition of migrant carers as a category of
  deserving migrants
• Volunteer organizations in the area of migration
• Migration legislation
• Public opinion

12
Policy initiatives

• Two separate lines of intervention
• At the national level
• (mainly) migration issue
• At the local level
• (mainly) social care issue

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Policy initiatives at the national level

• The migration issue
• Mass regularization of migrant care workers
  (directly employed by families)
• Quotas of migrant care workers
• The care market approach
• Tax incentives for people with disability
  employing carers
• Problems and perspectives
• Stop-and-go approach (Inability to regulate
  migration flows)
• Low, unknown, non-effective tax incentives
• The missing debate on long-term care
• Scan provision of long-term care services is not
  an issue
• The national care allowance is one of the most
  important incentives in buying undocumented/undecl
  ared migrant labour
• Current arrangements (migrant carers) are likely
  to influence the direction of the debate

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Policy initiatives at the local level

• At the local level
• Training
• Registers of care workers
• (Public) agencies for matching demand and supply
  of care
• Care allowance conditioned to the emergence of
  undeclared labour
• Problems and perspectives
• Initiatives are territorially dispersed
• Low take-up
• Low incentives for families
• Low incentives for migrant carers
• Expectations better working conditions in
  exchange of professionalisation

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Elements of conclusion

• The long-term care issue has not (yet) been faced
  by policies
• The definition of the problem occurs when the
  care migrant model is well established
• Regulation difficulties
• Between-policy-area tensions
• National-regional-local tension
• Consequences of regulation for public and private
  costs