Rethinking structures in 24-hour care

The overload is inherent in the system. In the three welfare states Germany, Austria and Switzerland, in-home care in an ageing society is more and more frequently provided by paid external care workers. The “live-in model” of 24-hour care involves agencies that recruit migrant carers who live within the client’s home on a weekly basis. However, this model results in a contradiction between good quality of care and good working conditions for the care worker. How could this issue be resolved? Brigitte Aulenbacher of the Johannes Kepler University in Linz, Helma Lutz of the Goethe-Universität in Frankfurt am Main (Germany) and Karin Schwiter of the University of Zürich (CH) have explored this question in a research project that received international funding from the Austrian Science Fund FWF, as well as from the German DFG and the Swiss SNF.

The team have pooled their expertise in order to shed light on this agency-mediated live-in care, which has so far not been researched in detail. “As soon as the idea arose, we had intensive exchanges and then applied for a joint project with joint leadership that covers three countries,” explains Brigitte Aulenbacher, the principal investigator for Austria. All three welfare states consider the live-in model to be an accepted method of closing the care gap. One of the driving forces of the method is the placement of care workers via agencies. “In Germany and Switzerland, the Austrian solution of having care workers who are self-employed rather than in an employment relation with the agencies is often considered a model solution. Our results show, however, that no system can simply be transferred to another location,” Aulenbacher notes.

Supposed negotiating power of the self-employed

In Austria, more than 900 agencies and roughly 60,000 self-employed personal care workers are organised under the umbrella of the Austrian Economic Chamber. While the care workers have social security coverage, they work at rates that are essentially dictated by the pricing policy of the agencies. In Switzerland, the care workers are in an employment relation, a situation that is often claimed to be “unfeasible” and “unaffordable” in Austria. It has to be noted that the state funding in this field is different, since unlike Austria, the Swiss state offers no “care allowance” to individuals in need of care. In Germany, on the other hand, the focus is on care workers who are employed in their country of origin (usually Poland) and sent to work in Germany by their employer. Current media coverage on 24-hour care during the pandemic has highlighted problems that the system presents in Austria (the keyword here: “corridor trains from Romania”).

Another case that made the headlines in Austria concerned repressive action taken against a Romanian care worker who set up a Facebook group for networking with colleagues, in which working conditions and the profitable business of agencies in terms of certificates, trainings, transport services and so on became an issue. “In the field, we quickly had to learn that any black-and-white thinking was counterproductive,” is Aulenbacher’s comment on this situation. At first the researchers conducted systematic analyses of the agency websites and interviewed stakeholders in ministries, chambers, trade unions and NGOs about requirements and demands placed on this care arrangement. They also conducted parallel interviews with experts at management level in the agencies in order to understand their strategies and operational principles.

Three agencies in Austria permitted researchers to observe their work at first hand at different levels of detail, according to the ethnographic principle of “follow the people and follow the things”. One agency provided insights into internal processes and activities, while another agency established contacts for the team with people involved in the respective households, where they talked about requirements and demands in terms of good care and good work, as well as about conflicts and contradictions. The third agency took the research team along, so that Brigitte Aulenbacher and the two team members Michael Leiblfinger and Veronika Prieler were able to speak with all the people involved in different constellations.

Ambivalent function of agencies

The agencies promise “good care for those who need it” and address this mainly to the care recipients and their family members. The company structures differ greatly, as the ongoing analyses show. In Austria, agencies also offer standardised packages covering a wide range of depth of care: from companionship to household help, or light medical care on the basis of orders from doctors’ or certified nursing services. In Austria, the agencies are obliged by law to do an initial needs assessment followed by recruitment of the care workers they consider appropriate and then matching them with the client.

Especially large well-established companies and NPOs offering a wide range of care services that also engage in lobbying are pushing for quality certificates (introduced by the state in 2019), professionalisation and binding standards. Others do not feel responsible for individual working conditions and try to keep costs down. – There are clients for all of these agencies, because the gap is huge and so is the burden on families. “Agencies can have a strong protective function wherever clients behave in an extremely exploitative way, but then there are those who themselves exploit the care workers,” notes Brigitte Aulenbacher.

The inherent contradiction is still there: the live-in model is based on care workers commuting between countries because they have no prospects in their home country. Given current pay rates, personal care workers can only live in the same household, where they are permanently available and where the recipients of care may include people with difficult diagnoses: “Living at your work place and having to adapt perfectly to someone else’s private house rules while doing a highly demanding job does not contribute to good working conditions,” emphasises Aulenbacher.

How to improve things?

Brigitte Aulenbacher is aware of the fact that her findings lack universal validity, because the team only had access to agencies willing to submit to the investigation. To counterbalance this aspect, the team also investigated the perspectives of organisations representing the care workers and of family members. A field visit with one of the Austrian trade unions gave the researchers important ideas for questions relating to the countries that send care workers abroad. More or less all those involved are aware of the exploitation, concrete suggestions for improving the situation are proffered, and agencies often seek to distinguish themselves from the “black sheep”.

The conclusion of sociologist Brigitte Aulenbacher: “The entire care mix needs to be tackled! When people in need of care live at home this must not be at the expense of female relatives or the living and working situation of predominantly migrant women.” To improve the situation Aulenbacher considers it necessary to rethink care infrastructures in a local context and networks: “In the current system, there is little free choice,” says Aulenbacher, and goes on to explain: “Neither the family nor the care workers choose this situation of their own free will, and two strangers living together at close quarters is a difficult setup. Even if you adjust the quality level, you still perpetuate the existing problematic model.” Aulenbacher sees an alternative in more mobile services, more community care workers, or living arrangements with several care workers and care recipients close to home. The latter is currently being tested in model trials in Germany, and it seems to mitigate isolation and exploitation.

Personal details

Brigitte Aulenbacher studied sociology at the University of the Saarland and the University of Bielefeld. In 2004 she acquired professorial qualifications for sociology in the Faculty of Humanities and Social Sciences at the University of Hannover. In 2008 she was appointed professor at the Johannes Kepler Universität Linz, where she now heads the Department for the Theory of Society and Social Analysis at the Institute of Sociology, Faculty of Social and Economic Sciences. Her focus lies on social theory, analysis of capitalism, care, labour and gender studies.

Project website: http://decent-care-work.net

Publications

Gute Sorge ohne gute Arbeit? Live-in-Care in Deutschland, Österreich und der Schweiz, Edited by Aulenbacher, Brigitte; Lutz, Helma und Schwiter, Karin; Beltz Juventa, April 2021

Aulenbacher, Brigitte et al.: Facing Covid-19: Live-in-Care in Central Europe, in: Global Dialogue - the Magazine of the International Sociological Association,GD10.3, 2020

Aulenbacher, Brigitte; Leiblfinger, Michael; Prieler, Veronika: The promise of decent care and the problem of poor working conditions: Double movements around live-in care in Austria, in: sozialpolitik.ch, Universität Fribourg 2/2020

Michael Leiblfinger, Veronika Prieler, Karin Schwiter et al.: Impact of COVID-19 Policy Responses on Live-In Care Workers in Austria, Germany, and Switzerland, in: Journal of Long-Term Care, 2020