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7 June 1993
Doc. 6857
1403-2/6/93-2-E
REPORT
on social policies for elderly persons
and their self-reliance
(Rapporteurs: Ms ÖZVER,
Turkey, Group of the European People's Party
and Mr SCHWIMMER,
Austria, Group of the European People's Party)
Summary
The Assembly has agreed to make a contribution in 1993 to European Year of the Elderly and of Solidarity between Generations. The ageing of the population in the Council of Europe member states — over 60 million people in the elderly category — and the weakening of the position of the elderly owing to economic recession in western Europe and the consequences of the transition to democracy in eastern Europe call for new approaches geared to preserving their independence and securing their participation in social life. To this end, a number of recommendations are put forward: pensions guaranteeing an adequate income, suitable accommodation, appropriate medical care, aid and services, adjustment of social security systems; financial support for families and voluntary associations; and also the promotion of political organisations and self-help groups to defend their interests and uphold their rights, and the provision of appropriate remedies in the event of infringement of such rights.
I. Draft resolution
1. The European Community has declared 1993 European Year of the Elderly and of Solidarity between Generations.
In the Council of Europe member states, over 60 million people out of a total population of 480 million are in the elderly category, and the proportion is growing constantly. In view of the increasing ageing of society, the current economic recession with its repercussions on social welfare budgets, and the new geopolitical situation in Europe, it is time to reconsider the thrust of European social policy.
2. These three trends have a particular impact on the very concepts of social policy for the elderly because they affect the whole of Europe and thus call for a redefinition of social protection in order to guarantee social cohesion.
3. Social protection for the elderly must counter the effects of functional inequality which are caused by ageing, and secure to the elderly a high degree of independence. However, the various European social security systems are in many cases unequal to these complex demands.
4. In eastern Europe, the general transformation taking place is also affecting the social field. This uncertain period of economic transition renders social security provision for the entire population inadequate or even non-existent, and the elderly suffer especially from this state of affairs. Consequently, financial and administrative assistance from international organisations to the east European states undergoing reform should also place emphasis on social protection.
5. The Assembly considers that the time is ripe to call upon governments and the competent authorities in its member states to take the following action:
a. re-define or initiate policies which promote self-reliance for the elderly, with due regard to their rights and with their participation;
b. ensure that the elderly receive an adequate pension which enables them to live independently, and that individual choice between retirement and continued employment is possible;
c. in order to maintain an elderly person's quality of life and independence, and to postpone admission to an institution, make it possible for all people to have accommodation suiting their wishes and requirements and allowing for various types of housing as well as for support measures;
d. commit themselves to the provision of appropriate forms of assistance, irrespective of the beneficiaries' financial means, by way of:
—su pport for the elderly in their efforts to help themselves (telephone networks, emergency radio systems);—
—fi nancial and logistic support for families looking after elderly people (holiday beds in retirement homes to provide temporary welfare services during relatives' absence on holiday; greater sharing of work between men and women in family care for the elderly;—
—in centives to charitable organisations providing voluntary assistance (including tax deductibility of donations to charities);e.
e. adjust current arrangements as necessary under existing social security systems with a view to improving the use of resources and to recognising the social risk of dependence;
f. guarantee that old people who are sick and in need of care receive medical treatment in keeping with their needs, a strict distinction being drawn in the public health system between old people who are chronically or acutely ill and those in need of care:
—in tensive hospital care for old people with chronic illnesses;—
—sp ecial departments for the elderly in all hospitals;—
—mo re use of psychiatrists with geriatric skills so as to ensure a carefully personalised blend of psychotherapy and pharmacotherapy, modified as appropriate during treatment;—
—sp ecialised medical staff, for example for regular and highly qualified gerontological consultations in homes and institutions;—
—de velopment of domiciliary care;—
—pr omotion of rehabilitation opportunities for the elderly (rehabilitation must be available to the elderly as of right, irrespective of the consideration whether or not intensive efforts are still worthwhile);g.
g. support all arrangements conducive to more open and humane attitudes between the generations, for example care of the elderly by the family;
h. foster greater opportunities for senior citizens to join together in political organisations and self-help groups, defend their interests and uphold their civic rights, and in the event of infringement of such rights, provide remedies through institutions such as an "ombudsman" or "parliamentary commissioner"; and thus ensure that older people are represented in decision processes on rules and standards which shape their ways of life and choices of lifestyle;
i. aim at fuller application of the subsidiarity principle, so that social welfare administration and local authorities operating services shall be more accessible to the citizen with a better supply to the elderly of information about the help available;
j. ratify and implement the Additional Protocol to the European Social Charter, Article 4 of which is concerned with social protection for elderly persons.
II. Explanatory memorandum1
by Ms ÖZVER and Mr SCHWIMMER
Contents
Page
A. INTRODUCTION 5
B. POLITICAL AND ECONOMIC TRANSITION IN 5
EASTERN EUROPE AND SOCIAL PROTECTION
OF THE ELDERLY
C. SITUATION IN WESTERN EUROPE 8
D. MAIN THEMES OF SOCIAL POLICIES FOR 9
THE ELDERLY
Line of action 1: An adequate income guarantees 9
independence
Line of action 2: Adequate and accessible housing 10
guarantees independence
Line of action 3: Appropriate aid and services encourage 10
independence
i. Support for the elderly 10
ii. Support for the family 11
iii. Voluntary associations 11
Line of action 4: The state must guarantee cover for the 12
risk of dependence
Line of action 5: Representation and participation must 13
be intensified
Line of action 6: Citizen-oriented administration encourages 14
independence
E. CONCLUSION 15
A. Introduction
1. In 1993, at this particular stage in the history of "Social Europe", three factors are changing the overall picture of social policy in Europe, making it necessary for us to review some of its features.
The first factor, which is widely recognised, is the phenomenon of the ageing of our populations and the need to provide social protection for the elderly.
The second factor, even though it may be short-term, is the effect of the current economic recession with its repercussions on the public budgets on which social policy largely depends.
The third factor that must be taken into account is the new geopolitical situation in Europe, with the growing cohesion in western Europe and the collapse of the economic and political unions in eastern Europe.
2. These three factors have a considerable impact on social policy concepts for the elderly: the number of elderly persons (and very elderly persons) is a phenomenon which affects the whole of Europe and demands a redefinition of social protection in order to safeguard the social cohesion of our populations. This involves major financial burdens at a time when conditions are more difficult. To differing degrees in the different parts of Europe, the difficulty therefore lies in achieving a compromise between essential social priorities and current economic realities.
B. Political and economic transition in eastern Europe and social protection of the elderly
3. In eastern Europe, the demise of the communist system has led to the disintegration of the Soviet Union into politically independent states and the transition from a heavily-subsidised, state-controlled economy to the free market. In the new Commonwealth of Independent States, the political and economic changes (respectively democracy and the free market) are intrinsically linked and determine the social policy provided for the people.
The economies of the former Soviet republics used to be highly interdependent. The Soviet Union was governed as a single economic unit and most decisions were taken centrally. While its economy was cut off from world markets for years, there were no internal frontiers between the republics. This allowed high levels of trade to be conducted using a single, inconvertible currency throughout a single political and economic entity covering twenty-two million square kilometres.
In the short term, trade with the rest of the world will be able to replace only a very small part of the trading links between the republics of the former Union.
Political over-reaction could well cause trade to collapse,2 and those responsible for economic policies should ensure that trading links between the states are maintained.
In the longer term, as the former Soviet republics make the transition from the centrally-planned to the free-market system, their mutual trading links will need to be redefined and decentralised methods will become necessary.
Without adequate guarantees, losses in income will be accompanied by major job losses.
At the same time as these economic changes, there is also the question of demilitarisation and resulting high unemployment.
4. These income losses, job losses and the shortages that will persist until the economy begins to function properly have combined with the opening-up of frontiers to bring about large-scale migration to the west. The influx of eastern Europeans into western Europe3 means social protection is having to be shared out more widely, and social solidarity and the rights to social protection are increasingly being called into question in our societies.
There is thus an urgent need to modernise the whole range of social provisions for migrants (refugees and workers). At present, in fact, there are no uniform provisions for all nationalities: for instance, some groups are able to enter the labour market easily, while others are barred from it by restrictive regulations, leading to serious social problems.
What is the situation regarding social protection in eastern Europe?
5. Under the communist system, the former Soviet Union and its satellite countries had universal social protection systems which operated in a state-controlled economic, political and social context. The transformation of their economies is now leading to financial shortages that are having an impact on social protection. Political leaders are striving to find solutions, and their decisions will have a crucial effect on social policy.
Deciding between the social market economy and the American model raises many difficult questions. The two offer very different options and choices will have to be made. The implementation of any social protection system presupposes the existence of a sound fiscal and financial system, as well as effective control of inflation in a wealth-generating economy.
The social policy budget that has just been adopted by the Russian Parliament will ensure only very limited social protection in the country. As regards the difficult task of protecting the elderly in Russia (over twenty million citizens aged over sixty-five), attempts have been made to provide more immediate solutions to the problems involved.4
A further example of the situation in eastern Europe is Romania, a country which is undergoing difficult changes, where doctors5 are seriously concerned by the deterioration in the living conditions of the elderly6 (low incomes, inadequate care facilities, housing shortage) as a result of the deepening economic crisis.7
6. The protection of elderly persons in other eastern European countries, for instance Poland,8 the Czech Republic, the Slovak Republic and Hungary, will probably benefit from more favourable economic conditions since these countries are more likely to enter into association with the European Community at an earlier date. At present, however, social protection is still unsatisfactory (inadequate incomes and aid) as incomes are not keeping pace with inflation.
7. Social policy in eastern Europe is not in a reform process, but is in a situation of wholesale reconstruction. It seems too early to make choices between social protection models because, although social policy is at the heart of political debate, it is subsidiary to the overall economic situation.
Emphasis must be placed on the role that can be played by international organisations (United Nations, World Health Organisation, Council of Europe, etc.) in view of their undoubted influence on states.
C. Situation in western Europe
8. All twelve countries of the European Community are now embarking upon the construction of an expressly transnational, democratic political entity with a genuine common market.
In the social field, however, the results of the Maastricht Treaty appear much more limited, in spite of the European Council's insistence in Madrid in 1989 on the need for social aspects to be accorded the same importance as economic aspects in the construction of Europe. The field of social protection policies (for the elderly) is and remains the responsibility of the member states.
9. Nevertheless, the application of the quadruple principle of freedom of movement (of persons,9 capital, goods and services) will have some effect on national systems. The European Community Social Charter10 of 1989 tends to suggest that the Single European Act is not only economic. This Charter, which enables recommendations to be issued, is not, however binding. The right of social protection which it contains (including social protection for the elderly) remains subject to each country's own procedures. The member states are therefore responsible for finding appropriate mechanisms to implement social rights.
10. Social policy has had a long history in the various countries of Europe. The levels of protection vary from country to country in accordance with differing political, economic and ideological options (pension levels and health cover levels vary, access to benefits and services differs). As regards "Social Europe", the member states of the Council of Europe in 1961 adopted a "European Social Charter" in the form of an international convention. A protocol adopted in 1988 includes an article on the protection of the elderly, in particular those in institutional accommodation. However, only two of the twenty states that have ratified the Charter have accepted this article.
11. Elderly people, who now make up a large section of the population, often remain fit and well but may at some stage also develop great needs in terms of assistance and protection. Such assistance, care and services involve major costs for social policy budgets. We also know that the elderly like to be as independent as possible and that this has a positive effect on their quality of life.
In recent decades, all too many problems have arisen, particularly as regards aid and services for the elderly, and the measures provided do not always meet the requirements or wishes of the elderly.
Today, the elderly both form a significant political force and impose a heavy burden on social budgets, not to mention the importance to our societies of achieving social protection for the elderly at an acceptable cost to our economies.
D. Main themes of social policies for the elderly
12. Which means will enable the elderly to keep their place in society while respecting their freedom of choice?
Only solutions which promote the independence and abilities of the elderly will enable us to "accept" the large numbers of elderly people in our societies and also the budgetary implications of the need to ensure their social protection.
Line of action 1: An adequate income guarantees independence
13. Although pensions are now an accepted social right in all European societies, it has to be ensured that they are adequate to allow elderly people to lead independent lives.11 As this objective is financially expensive, the various pension schemes in Europe are being called widely into question at present.12
Perhaps in future a less absolute and exclusive distinction will have to be made between the right to a pension and the right to work. Indeed, older workers themselves stress that work gives structure to their lives. It will therefore be necessary to reconcile — with the state's protection — the individual's right to choose between retirement or continued employment.13 Many countries are already introducing greater flexibility as regards working life/the age of retirement in order to deal with increases in pension expenditure and the constraints of unemployment.
14. In addition to flexibility as regards working life and retirement age, various other solutions also enable elderly people to continue to exercise their skills, for instance, either by remaining in paid employment (with different arrangements in individual countries14), or acting as unpaid advisors15 or instructors for companies or associations, or by performing voluntary work for relief associations or public services.16
15. In the face of these major developments, the right to retirement on an income sufficient for leading an independent life must be fully guaranteed, and measures must be introduced to allow individuals to choose between retirement and continued employment. Only in this way can the abilities and independence of the elderly be respected, and their place in society ensured.
Line of action 2: Adequate and accessible housing guarantees independence
16. Some countries have already included a genuine right to housing (inter alia for the elderly) in the economic and social rights they guarantee, and provide adequate housing at prices the elderly can afford. Others deal with the question through housing benefit schemes which enable the elderly to remain in their homes despite reductions in their income.
17. All aspects of housing are of crucial importance to the independence of the elderly and, hence, to preserving their abilities. In fact, the proper equipping of elderly people's existing homes (irrespective of the type) or the provision of a well-equipped alternative dwelling, which offers them a real home, preferably within their usual area of residence, enables them both to keep their independence and cope with the difficulties that come with age. These solutions delay entry into institutional accommodation, offering three significant advantages: they meet the aspirations of the elderly and guarantee them a higher quality of life for the longest possible time, they allow institutional accommodation to be used for people who really need it, thus ensuring more efficient use of resources, and, lastly, they cost less in budgetary terms.
Line of action 3: Appropriate aid and services encourage independence
18. Various people are involved in the process of providing appropriate aid for the elderly: the elderly themselves, their family circle and the authorities.
i. Support for the elderly
19. The general philosophy of social protection (including that for the elderly) in Nordic countries is based on the principle that "individuals should be helped to help themselves", thus encouraging them to exploit their abilities to the full and preserve their quality of life.
This approach to aid and services takes account of the individual's needs as a whole,17 and, in the long term, helps reduce the burden on public budgets.
ii. Support for the family
20. Social policy must also take account of the potential of families.
The assistance provided by families is still greater than that provided by the public services. It allows for considerable budgetary savings and is a contribution which the authorities cannot afford to do without.
The families involved must, however, be given appropriate support and encouragement18 according to the Scandinavian principle that "helpers should be helped" because the members of elderly people's families are often fairly old themselves and have other responsibilities (unwell spouse, children requiring support, several elderly persons in the family, etc.).
The moral and physical equilibrium of the family must therefore be maintained so that the support network it provides is preserved.
iii. Voluntary associations
21. Support must also be provided for the actions of welfare associations, which make an important contribution in both human and budgetary terms. Although some countries and local authorities have recognised the usefulness of such associations and support them systematically, this is not a general rule: all too often, voluntary aid associations for the elderly receive no support from the authorities despite their role in organising and providing essential services for certain categories of the elderly for whom, for various reasons, public services are not available.
22. The support of families and voluntary associations highlights the solidarity between the generations inherent in social policy for the elderly. It involves human values which can make a significant economic contribution when supported by the authorities. Under no circumstances, however, should the complementary roles of the family and voluntary associations be seen as replacing the duties of the authorities. The action of the authorities in this field remains a fundamental priority: every state19 must continue to protect the elderly and their human rights, while retaining its role of regulator between economic and social interests.
Line of action 4: The state must guarantee cover for the risk of dependence20
23. Social protection plays a decisive role in allowing elderly persons to get the most out of their remaining abilities. While we have already discussed adequate incomes, housing, family support and voluntary associations as factors which help the elderly to stay independent, we must also focus on the importance of the principles governing protection in the case of chronic illness and dependence.
24. Some systems provide health-care schemes that make no distinctions as regards the nature or consequences of a person's illness. In such cases, chronic illness is covered by the general health-care system (Scandinavian systems).
However, other systems exclude chronic illness from general health-care schemes and employ separate, less favourable schemes with inadequate responses, thus creating exclusion based on particular types of illness (Belgian or French systems). This is extremely unfavourable to people with reduced abilities and makes it more difficult for them to preserve their remaining abilities. In the long term, this system leads to higher medical costs (hospitalisation, institutional accommodation). The exclusion of chronic illness21 is all the more unacceptable given that general health-care schemes are often marked by excessive uptake.
25. In view of the ageing population and the problems of public deficits, there is an urgent need to improve the efficiency of the chronic illness sector, in terms of both the quality and accessibility of care, so that the individuals concerned can lead as independent a life as possible. Germany has clearly demonstrated22 that substantial improvements can be achieved in the long term without the need for additional expenditure. It is therefore possible to make better use of resources, improve the organisation23 of aid and services, and ensure more efficient care without increasing expenditure, while also preserving the human quality of the services provided.
26. In order to achieve this, the medical, health-care and social aid and services must be organised on the basis of overall consideration of the individual's needs in the long term, taking account of the different helpers involved (family circle, professionals from various fields) and of their need for adequate support.
The aid and services provided must allow elderly people to live at home, in more community-like structures (for instance sheltered housing, etc.) and also in retirement institutions or nursing homes and long-stay centres.24
International comparisons show that greater expenditure is not necessarily more effective and that it is possible to spend less and still achieve good results.
Social protection which fully respects the rights of the elderly can therefore be reconciled with economic considerations. Although the principle of collective solidarity is generally accepted, improved control of expenditure is necessary. If this requirement is ignored, budgetary problems could be invoked as grounds for ending genuine solidarity with certain categories of the population and in support of plans to privatise cover for certain major risks.
Line of action 5: Representation and participation must be intensified
27. In the search for the right solutions to protect the elderly, we must take close account of the citizens themselves so as to understand their situation, meet their need for protection effectively and adopt the appropriate measures.
In order to achieve this, elderly persons must themselves be involved in the process of deciding the rules and norms that will govern their way of life and choice of existence.
The total number of elderly persons is also an important factor: in Council of Europe member states alone there are now over sixty million. They include increasingly large numbers of individuals, who, throughout their professional lives, were able actively to participate (and protest) in the worlds of work, business, trade unionism or politics. Today, these sixty million people are both a political force and a pressure group that will not passively accept inadequate social protection.
28. It seems inevitable that they should be represented and participate actively in planning and applying the relevant rules and standards, not only from the point of view of democracy but also because of their own determination. Genuine representative and participative structures and mechanisms for contesting laws and regulations have already been incorporated in the democratic institutions of some states.
In fact, although the right to vote confirms an individual's identity and citizenship, it is not enough in itself to guarantee citizen participation. Consultative bodies (for instance councils of elders, pensioners' committees) are undoubtedly a good way of getting to know elderly people's views on certain matters, but the procedures as regards decision-making are not yet sufficiently binding in practice.
29. Some European countries do already allow more direct representation and participation.
The more participative approaches can take different forms: there is, for instance, a corporatist type of representation in Sweden under which the wishes and proposals of the elderly regarding health care are passed on to the members of the Riksdag by the health workers' federation.
Citizen participation is ensured through the right to comment when rules and standards are being drafted, as provided for example, by Article 105 of the Spanish Constitution.25
30. If we want rules and standards that are compatible with the needs and wishes of the elderly and enable them to make the most of their abilities, and if we want to protect their place in society, effective means of participation must be introduced into the decision-making process as a matter of urgency.
Appropriate administrative responses to the demands of the elderly for social protection can be achieved only through genuine consensus between political leaders and the elderly themselves. Only such a process of democratic participation will enable the demands of social cohesion to be reconciled with the budgetary constraints currently facing governments.
31. At individual level, elderly persons in institutional accommodation require particular attention and protection because they very often have only limited opportunities for expressing their needs or reporting any infringements of their rights (ill-treatment, etc.). In addition, some are particularly disadvantaged in this respect if administrative decisions have restricted their liberty (confinement in psychiatric hospitals, imprisonment).
Line of action 6: Citizen-oriented administration encourages independence
32. The quality of life of dependent elderly persons is to a large extent determined by the proper functioning of the administration and the public services. Without quality administration, their protection would be compromised.
In this context, the administration has an essential role to play in protecting the elderly and guaranteeing their rights. It must therefore be responsible, open, accessible and citizen-oriented, and elderly persons must have guaranteed access to a citizen's commissioner26 such as the Scandinavian ombudsman or Spanish defensor del pueblo.
E. Conclusion
33. Social policy in Europe is now at a crossroads.
Following continuous progress over a period of 150 years, during which social protection has expanded to cover the maximum number of people against an increasingly broad range of risks, Europe is now, in fact, experiencing significant population movements27 on a larger scale than in recent decades, at a time when an economic recession is leading to reduced solidarity28 and to moves towards capitalisation-based schemes or privatisation.
These general social policy factors have been accompanied by the phenomenon of the ageing population, with over sixty million elderly people now living in Council of Europe member states.
34. Central and eastern European countries will have to build a social policy model that takes account of economic and administrative changes, new funding methods and a tax system that remains to be established.
35. For Europe as a whole, the two guiding principles on the protection of the elderly that must be upheld and developed are:
Equality of access with other citizens to aid and services, including refusal to exclude the elderly from general protection systems (medical, health and social);
The provision of special measures, which take account of age-related needs, in order to keep the elderly integrated in society (through all measures designed to support and maintain their abilities).
The combination of these two principles (equality of access to aid and services and the right to special measures for social integration) in fact guarantees equality while preserving distinctiveness.
36. The means required are:
—ef fective organisation of aid and services, accompanied by open administration and measures to make the public and private officials involved aware of their responsibilities;—
—fu nding based on long-term considerations, and proper monitoring of expenditure;—
—gr eater participation and responsibilities on the part of the elderly themselves (this being crucially important).Am
Among these various measures, collective cover for the risk of dependence would seem essential if the quality of life of the elderly is to be preserved. In countries where this has been introduced, it operates either through the general health-care system or through a tax-based national insurance scheme.29
Reporting committee: Social, Health and Family Affairs Committee.
Budgetary implications for the Assembly: none.
Reference to committee: Doc. 6699, Reference No. 1819, Doc. 6706 and Reference No. 1822 of 5 November 1992.
Draft recommendation unanimously adopted by the committee on 29 April 1993.
Members of the committee: Mr Pini (Chairman), Mrs Hĺvik, Mr Rathbone (Vice-Chairmen) (Alternate: Baroness Hooper), Mrs Albrink, MM. Banks, Beix (Alternate: Oehler), Benvenuti, Bloetzer, Bowden, Curto, Diaz de Mera, Mrs Fleetwood, MM. Foschi, Gerontopoulos (Alternate: Anthopoulos), Gouteyron, Mrs Guourova, Mr Gusenbauer, Mrs Haarstad, Mrs Halonen, MM. Hörcsik, Jurgens, Karakaş, Koehl, Liberatori, Libicki, Marques, Menzel, Meyer zu Bentrup, Mrs Moynihan-Cronin, Mr Ottenbourgh, Ms Özver, MM. Palacios, Pécriaux, Pottakis, Psaila Savona, Mrs Ragnarsdottir, MM. Regenwetter, Reimann, Schwimmer, Mrs Soutendijk-van Appeldoorn, MM. Ternak, Wielowieyski (Alternate: Malachowski).
N.B. The names of the members present at the meeting are printed in italics.
Secretaries to the committee: Mr Hartland and Ms Meunier.
1 1This report was drafted by a consultant, Mrs Delperée, Researcher at the Study Centre on Ageing, University of Louvain, Belgium.
2 1In addition, some republics are attempting to obtain hard currency reserves at the expense of other republics.
3 2Western countries are currently introducing measures to restrict immigration in response to the unfavourable reactions of their own populations.
4 1The Russian Minister for Social Protection has set up a foundation for the protection of persons at risk (including the elderly).
5 2The Academy of Medical Science, the Romanian Gerontological and Geriatrics Society and the Anna Aslan Foundation have issued a joint declaration on the socio-medical problems of the elderly, criticising the lack of effective social provision by the state for the elderly, reiterating the need to respect the human dignity and fundamental rights of the elderly, and recommending the setting-up of a national programme for the elderly.
6 3The population of 23,5 million includes 3,5 million elderly persons, 70% of whom live below the poverty line.
7 4In order to deal with this situation, a "National programme to improve the health and quality of life of the elderly" was presented in Bucharest on 29 and 30 October 1992. This plan, which was drawn up by the Anna Aslan Foundation in follow-up to the above-mentioned joint declaration on the socio-medical problems of the elderly, has been submitted to the World Health Organisation. It is part of a social-democratic movement to support the elderly, and, when implemented, will contribute to the democratisation of Romanian society.
8 5There is currently a general trend in eastern European countries to make families bear the costs of caring for the elderly. In Poland, families must now make a financial contribution towards the costs of institutional care for dependent elderly parents.
9 1The introduction of complete freedom of movement has been delayed and will not take effect on 1 January 1993; difficulties have arisen in some countries regarding the harmonisation of the relevant policies.
10 2Also known as the Community Charter of the Fundamental Social Rights of Workers.
11 1Elderly people in southern Europe (Greece, Italy, Spain and Portugal) often receive inadequate pensions, especially in the case of the very elderly. Although family solidarity in these countries allows this situation to be overcome in certain cases, able-bodied elderly people are sometimes forced into institutional accommodation simply because they have inadequate resources to stay in their own homes. There is thus unjustified expenditure on the one hand, and a lack of independence on the other.
12 2The future of pension schemes is confronted with the foreseeable growth in pension expenditure: there are more and more retired people who are living longer and whose schemes are reaching maturity. Various proposals have been made to deal with this situation: raising the retirement age, extending contribution periods, increasing contributions, reducing the amounts paid out, encouraging capitalised pension schemes.
13 3Changes in working time are in any case now an urgent requirement that goes beyond purely economic considerations (see Quebec Act No. 15 of 1982 which provided state protection for the individual's right to choose as regards retirement age).
14 4Denmark is very favourable to this approach and allows earned income and pensions to be combined; attractive fiscal arrangements are also offered.
15 1For example, the CONEX association in Barcelona.
16 2This requires society to hold voluntary work in the same high regard as, for instance, is traditionally the case in Great Britain.
17 1See "Comprehensive Plan for the Elderly" in Catalonia.
18 2This support may take the form of financial assistance or, especially, practical aid in the home.
19 3The state should be neither a police-like body running ineffective social policies nor a welfare state creating a dependency culture, but should be a manager of well-organised, properly assessed and effectively controlled services that respect the human rights of the elderly and take account of economic constraints.
20 1In Europe, there are almost as many health-care systems as there are states. Following the second world war, social protection was extended throughout Europe, both in the form of universal schemes with national health services and in the form of social insurance systems where compulsory insurance was extended to categories that had not previously been covered.
21 2Social security systems should therefore reincorporate chronic illness in general health-care schemes or set up a new branch of social security, ie cover for dependence.
22 3With the Act of 20 December 1988 (effective from 1 January 1991) under which chronic illness was reincorporated in the general health-care system.
23 4Well-organised action by public and private services must be based on individual "helpers" who are responsible for responding to the elderly person's needs. One example is the "single-chord" approach in Denmark, where the elderly person's needs are attended to by one official who is responsible for dealing with all aspects of his/her request.
24 1The support and services provided must prevent elderly people being forced into institutional accommodation (because assistance at home is inadequate, unavailable or too expensive) or into remaining in their own homes (because there are no places in institutional accommodation or the costs are too high - this being a particular risk in countries where families still have maintenance obligations).
25 1Under an Act implementing Article 105 of the Constitution citizens have the right to be heard directly or through legally recognised organisations and associations in respect of the drafting of administrative regulations which concern them. This provision clearly demonstrates the political will to allow the elderly, among others, to express their views regarding social protection. It allowed for the direct involvement of elderly persons in the preparation of the Comprehensive Plan for the Elderly in Catalonia.
26 165% of these officials' work concerns elderly people.
27 2East-west population movements, migration of workers from Mediterranean basin countries to the EC, intra-EC migration, north-south migration by some retired persons.
28 3This trend is part of the general world economic situation but is also the result of the economic policy changes in central and eastern Europe.
29 1In the Netherlands, the General Act on Special Care (AWBZ) of 1968 covers the risk of dependence for all citizens.