Report on the ‘Uber-isation’ of care services

New forms of work have already established themselves in various service sectors (see article Oct 2019).

In a recent report, the European Economic and Social Committee’s (EESC) Workers’ Group looked at the growing trend of platform work in the field of long-term home care. The report looks at the working conditions of platform work and its applicability to the field of long-term care with regard to its unique requirements.

Challenges faces long-term care in the EU

The upward trend of an ageing population in the EU means there is an increasing need for care services. Member States organise and finance their national long-term care independently. This results in a very mixed picture of formal entitlements to care services. In all Member States there is a growing trend towards prioritising home care over institutionalised care.

The growth in home care is a result of excess demand for long-term care services, the shortage of long-term care facilities and a general lack of public funding.

In addition, a large proportion of care activities are provided by family members or by other persons of trust. The reasons for this can be systemic, financial or cultural.

Platform work and long-term care

In the EU, the number of platforms mediating long-term care services is increasing. Examples of these platforms include ‘Pflegix’ and ‘Pflegetier’ in Germany, ‘Curafides’ in Austria and ‘Home Care Direct’ in Ireland. These and other providers want to take advantage of the challenges currently facing the long-term care sector and the trend towards home care. The EESC’s report examines the framework conditions of the platform business model in long-term care from the perspective of clients (those requiring care or their relatives), workers (carers facilitated by the platform) and the platforms.

Clients

Unlike most other platform services, when it comes to long-term care platforms, family members, friends and relatives are often involved in the process in addition to the person in need of care (care seeker). This means that the care seeker is not necessarily the client. Furthermore, the individual care needs of clients vary significantly. Duration of care, individual requirements and the carer’s qualifications are some of the special features which must be taken into account when placing the carer. These are some of the unique characteristics associated with long-term care services, which are of little or no importance for standard platform-based delivery services.

Carers

Platform providers usually act as intermediaries between careers and care seekers (or their relatives). Platform-based carers are generally categorised as self-employed workers. This results in flexible working arrangements which are matched to the special features of individual care mentioned above. In some cases, this allows the carer a higher degree of flexibility in the organisation of their work. However, unlike conventional platform services, the aim here is to provide personalised care based on strong mutual trust between the care seeker (or their relatives) and the carer, as well as a continous long-term care relationship. In addition, higher demands are placed on the qualifications of carers, which in turn means higher barriers to market entry.

This results in a more detailed contractual process including a discovery phase, exchange phase and a relationship phase. During the discovery phase, carers already compete with one another and have to set themselves apart from the competition, for example, through their qualifications. The ability to evaluate a career based on ratings from services previously provided means that relatives tend to carry out the evaluation rather than the care seeker. This places new requirements on evaluation systems to assess actual care as opposed to domestic services.

Platforms

The platform acts as an intermediary between carers and care seekers (or their relatives). This can be viewed as an open marketplace for mediating contractors and clients. Private companies charge a service fee for the intermediated service. Services can be provided on demand for specific work or periods of time (e.g. sick leave or holiday replacements). As long as the platform provider charges a service fee for each placement, this may be in the interest of the care seeker, in the sense of ensuring continuous and personal support.

Dynamic working conditions in line with care requirements

A detailed investigation of the applicability and challenges of platform work in the field of long-term care requires special attention due to the personal character of the service and the desire for a long-term relationship.

Platform work, compared to traditional employment relationships in the long-term care sector, offers carers the opportunity to monetise their available working time in a flexible manner. The large number of individual or partial service contracts generated is in the financial interest of the platform provider, but it does not necessarily result in needs-oriented care services which meet quality standards.

Therefore, the challenge is to reconcile dynamic working relationships with the individual needs of care seekers and their families. In addition, whether long-term care or any other sector, the risks to the social security and occupational safety and health of platform workers remains (see also article Oct 2019).

In order to protect care seekers and their relatives, platform operators should be obliged to offer platform workers further training and conduct pre-assessments in order to avoid increased risks at the client’s home and counteract the de-professionalisation of a demanding and trusted profession.

The complete EWSA report can be read here.