R.O.S.A. – Network for Employment and Care Services: Promoting the regulation of undeclared work and increasing quality of care

Why was this example implemented?

In the last three years Puglia Region has redefined regional laws for social inclusion, setting as strategic priorities the quality of care work through promoting a better work/life balance and implementing home facilities for frail people needing LTC services.

In addition, it increased investment in care services in order to enhance the female employment rate by improving working conditions, giving value to personal competences and professional qualifications, and helping women to manage the burden of care.

R.O.S.A. is an acronym standing for “Network for Employment and Care Services”, because, through a network linking different institutional bodies, it established a system to support people who want to receive or to undertake care work.

 The general aim of the ROSA Project is creating a public network of services able to promote well-being and social inclusion for every citizen. This aim is carried out by implementing high quality home care services, by guaranteeing  transparency in matching supply and demand in home care work and by combating undeclared work. In particular, the project’s specific aims are:

• supporting families to find and choose qualified Italian and migrant care workers;
• sustaining the supply and demand of home care services (qualified and declared labour market);
• providing private (Italian and migrant) care workers with continuing education in order to guarantee quality of care work;
• improving knowledge about undeclared work in home care services in order to combat it;
• creating a system that allows working women to balance work and family life.

Description

R.O.S.A. is an experimental project that started in 2008 and is still in progress, co-financed by Puglia Region and the Italian Government. It entails implementing four methods which aim to improve care for older people in their own homes, and promote an integrated system of home care services for older people needing LTC. These four methods are:

• provincial lists of Italian and migrant care workers;
• financial incentives dedicated to informal carers to encourage employment of migrant care workers (MCW) with regular contracts;
• information and consultation points about employment contracts in each local social district;
• information campaigns involving “Patronati” (offices run by trade unions where people get free or cheap administrative/bureaucratic help). 

In response to the large number of home care assistance requests in Puglia, the project aims to increase home care services by including migrant care workers into local home care services networks and by guaranteeing adequate and appropriate professional solutions.

People who benefit are:

1. families of frail people (older or disabled) needing home care services;

2. qualified Italian and migrant care workers who offer home care services.

Puglia Region has defined and formally acknowledged the Migrant Care Worker profession by a specific regulation. Workers who have attended a special training course and whose competences have been certified by the Public Employment Service, are enrolled in an official list of home care workers maintained in each of Puglia’s Provinces.

Workers who do not have the necessary competences for the certification  of their professional qualifications, are enrolled on a special list and take part in training activities provided by the ROSA Project. Once they have completed the training (300h), they can be placed on the official list of home care workers.

Families who want to employ a qualified home care worker can apply to the Public Employment Service and search the list for the Italian/migrant care worker who meets their needs. Public Employment Service staff also offer consultancy and advice in recruitment.

In order to encourage the regulation of the employment contracts for MCW, Puglia Region provides a care voucher benefit, amounting to €2,500 per family (one-off payment). The benefit is assigned through a special public call and on the basis of a specified income indicator (ISEE – Indicator of equivalent economic situation). If ISEE exceeds €15,000 per year, the care voucher amount is reduced to 60% for ISEE values equal or lower than €25,000 per year. 

The total cost of the ROSA Project is €1,740,000, of which €1,010,000 is financed by the Equal Opportunities and Rights Department of the Italian Government Council of Ministers. Costs are allocated as follows:

• executive planning and project coordination: €120,000
• research on the families’ needs and social context: €10,000
• training programmes for migrant care workers: €80,000
• creation of services for matching demand and supply: €1,405,000
• communication and promotion activities: €110,000
• evaluation and monitoring: €15,000

What are/were the effects?

The project is part of a wider re-organisation process of the whole integrated regional system for continuity of care in Puglia Region. Evaluation is still on-going, but two important results are already evident:

1. Occupational increase

Home care in Italy depends mainly on private and informal initiatives. Family care is traditionally down to women, who, because of the current negative trend, are less and less involved in the labour market and have fewer opportunities to attend training programmes. The project aims to both provide women with qualifications in the home care field and to improve their access to the labour market. As a result of the ROSA project, from March 2010 about 2,000 people have been placed on the list of home care workers: 800 are fit to work and have been certified to do home care work and 1,200 are on the list to take part in training programmes provided by Puglia Region.

2. Regulation of undeclared work

Since the 1990s, for historical and geographical reasons, the Puglia Region has been an important centre of migration, with a high percentage of migrants finding jobs as home care workers. In most cases families do not draw up a regular contract to avoid the expense. The project’s aim is to stabilise the occupational positions of at least 800 migrant care workers and to support this effort by giving care vouchers to families which can partly cover social security taxes needed for employment contracts.

Until March 2011, only 82 families had requested a voucher. Data on the number of total employment contracts that have been signed are not yet available because the project is still in progress. This low number is partly due to the small amount of the voucher which does not act as enough of an incentive. However there is considerable resistance among families to making contracts because they are then obliged to comply with legal conditions such as base wages and rest times. For this reason the project has an important additional impact in bringing about cultural change.  

What are the strengths and limitations?

Puglia Region wanted to innovate the structure and organisation of the home care services network for frail people needing LTC. It stated as strategic priorities increasing the qualification of care work, improving the balance of work and family life, and implementing home facilities for frail people needing LTC services. The problem of the regulation of undeclared work still remains, because families have to face higher costs for assistance.  

Strengths

• the project promotes quality home care facilities for frail people needing LTC
• it supports home care work and informal carers by employing MCWs
• it promotes the matching of supply and demand, the regulation of undeclared work and female employment
• it promotes work and family life balance
• it improves the culture of work contracts.

Weaknesses                                                             

• There are no Municipality mechanisms to support the services, such as monitoring and home tutoring, respite services, emergency care, etc.
• The amount of the care voucher may not affect the regulation process because it only partially covers costs needed to assist frail older people at home and some families will be increasingly unable to afford family assistance.
• Older people and informal carers are not used to choosing migrant care workers or other kinds of services through a ‘special list’. Puglia Region needs to make lists and registers more user-friendly and to inform not only older people and families, but also all other people who might play a functional role in the relationship between the user and his/her migrant care worker.
• The time allocated to MCWs to take care of themselves is limited to a few hours per week: lots of migrant care workers do not give any priority to their own healthcare; some health care services are completely unknown to them.

Opportunities

• The project is undoubtedly a positive experience, because it incorporates private care work by MCW into the social services network, supports informal carers, promotes a better legal framework for this type of care work, improves work and family life balance, and improves female employment.

Risks

• Italian/Migrant care workers continue to be chosen through other channels such as word-of-mouth recommendations among neighbours, friends, acquaintances and parish members, not taking into account the special list.
• Another issue in this context concerns the acknowledgement of the qualifications that migrant women have achieved in their countries of origin, in particular social and health qualifications. At the moment, procedures are such that a MCW is unable to get this acknowledged on their own.

These initiatives to integrate MCWs in the LTC system are just a first step on a very long pathway of reforms. Thanks to migrant care workers, the Region can implement home care facilities for older people needing LTC, but unfortunately this care ‘model’ may also be a barrier to social policy innovation.

This project, while having positive effects for families in terms of tailored care and immediate access to services, will have to face a wide range of issues concerning long-term sustainability , in terms of both demand and supply of care work. In a context of progressive regulation, some families will be increasingly unable to easily afford family assistance. Additionally, it should not be taken for granted that the future supply of migrant care workers will remain stable,  as the countries of origin, in particular Eastern Europe, are trying to stop women’s emigration.

Credits

Author: Patrizia Di Santo, Studio Come s.r.l
Reviewer 1: Thomas Emilsson
Reviewer 2: Anja Dieterich
Verified by: Cristina Sunna, key person of Progetto Rosa in; Vito Belladonna Regional Project Manager Progetto Rosa

External Links and References

• http://www.sistema.puglia.it/portal/page/portal/SolidarietaSociale
• D.D. n. 577 del 03.09.2010 (BURP n. 146 del 16.09.2010), D.G.R. n. 1889 del 06.08.2010 “Deliberazione di Giunta regionale n. 2083/2008 – Progetto R.O.S.A. – Rete per l’Occupazione e i Servizi di Assistenza – Approvazione Schema di Avviso pubblico per l’erogazione di incentivi all’assunzione di assistenti familiari” – Pubblicazione Avviso e Impegno di spesa – Cap. 786030 del Bilancio regionale 2010.
• D.G.R. n. 1889 del 06.08.2010 (BURP n. 143 del 07.09.2010), Deliberazione di Giunta regionale n. 2083/2008 – Progetto R.O.S.A. “Rete Occupazione Servizi Assistenziali” – Approvazione Schema di Avviso pubblico per l’erogazione di incentivi all’assunzione di assistenti familiari;
• D.G.R. n. 1765 del 27.07.2010 (BURP n. 128 del 03.08.2010), Approvazione del Protocollo di Intesa tra Regione Puglia e INAIL per il coordinamento delle attività formative nell’ambito del Progetto R.O.S.A. (Rete per l’Occupazione e i Servizi di Assistenza) e per l’attivazione di forme di collaborazione interistituzionale;
• D.G.R. n. 2366 del 01.12.2009 (BURP n. 209 del 30.12.2009), approvazione delle Linee guida integrate per l’istituzione e la gestione di elenchi di assistenti familiari – Approvazione dello Schema di Avviso manifestazione di interesse rivolto ad Agenzie di somministrazione;
• D.G.R. n. 2496 del 15.12.2009 (BURP n. 11 del 19.01.2010), D.G.R. n. 2083/2008 – Progetto R.O.S.A. – Approvazione Schema di Avviso pubblico rivolto a Patronati per la selezione di Progetti per l’attività di animazione e sensibilizzazione territoriale;
• D.G.R. n 1270 del 21.07.2009 (BURP n. 124 del 12.08.2009), approvazione delle Linee guida per la istituzione e la gestione degli elenchi delle assistenti familiari; - PROFILO ASSISTENTE FAMILIARE -
• D.G.R. n. 93 del 31.01.2008, Avviso pubblico del Dipartimento per i Diritti e le Pari opportunità della Presidenza del Consiglio dei Ministri per il finanziamento di progetti pilota finalizzati all’emersione del lavoro sommerso nel campo del lavoro di cura domiciliare - Ratifica della candidatura della Regione Puglia Ente capofila del Progetto R.O.S.A. – Rete Occupazione Servizi Assistenziali