Women and men in Europe are living longer than their parents and grandparents, thanks to:

 Medical advances.

 The development of public social protection systems.

 The development of corporate prevention initiatives and measures, chiefly in response to trade union action to improve health and safety in the workplace - although much still remains to be done in this area.

 A healthier lifestyle.

 A desire for more effective environmental control.

 A higher standard of education among all citizens.

All this is highly positive.

However, a new challenge must now be met, because, as the World Health Organization has pointed out, it is no longer a question of adding years to life, but of adding life to the years.

We need to make sure that this longer life expectancy is accompanied by a better quality of life, which calls for effective policies to prevent and delay dependency, notably by developing effective policies to combat poverty and social exclusion, with a particular focus on ensuring adequate incomes.

And this is a challenge for the European Union as whole.

To meet this challenge, the signatory organisations are sending this APPEAL to Europe’s decision-makers (Council, Parliament, Commission, Social Protection Committee and others) and to the Member States. The Appeal contains their proposals for common objectives to be defined as part of the Open Method of Coordination which, pursuant to the Council decision of 4 October 2004, is due to be implemented in the field of health and long-term care for the elderly.

There are four objectives in all, which encompass the following rights:

Objective 1: to respect and consider the human aspect of dependency

To achieve this first major objective it is necessary to recognise, and effectively implement, rights for dependent persons, as for any other human being, whatever their condition, especially those whose physical and/or mental integrity is compromised.

The objective can be subdivided into four rights:
The right to be considered and treated as a citizen in their own right, which means that nothing should be forced on dependent persons (treatment, placement, welfare measures, etc.) without their explicit consent or, if they are no longer capable of giving consent themselves, the explicit consent of their relatives or guardian. Neither may a dependent person be the object or subject of medical experiments to which they have not consented.

The right to quality, effective care, whatever a person’s geographical place of residence and/or means, which involves developing resources, not only in terms of services to encourage dependent persons to remain at home, but also in terms of residential institutions and qualified personnel.

The right to personal respect, which in particular excludes any act of violence against them, whether in the domestic or institutional sphere. The social services and/or personal care workers must be particularly vigilant and attentive to this, especially where the elderly person suffers from an illness or mental disability.

The right to participate in social life , including when dependent persons are living in a residential institution, that is to say communally. This means that activities must be developed to allow dependent persons to participate or take an interest in local life to the best of their abilities. Likewise, dependent persons must be informed and consulted on any change in the residential institution or in the conditions governing their stay there. They must also be allowed to go out freely and to decide on their own timetables.

Objective 2: to foster and develop access to residential institutions and services

Implementation of this second general objective is also broken down into three requirements:

Substantial services must be provided to meet continually growing needs, especially services to keep in their homes dependent persons in need of suitable housing and special care or physical assistance. This will necessitate not only the provision of enough qualified personnel, but also the development of cooperation, coordination and synergies between such services, as well as, where appropriate, between district councils faced with this type of care provision.

Quality residential institutions will be needed for those who so choose, which must be accessible to both family members and the dependent persons’ other carers. While such institutions must be situated in an urban context to facilitate social relations, there must be balanced geographical distribution throughout the national territory, and not only in or around major towns, to ensure that every woman and man has access to them, no matter where they live. This means that a sufficiently dense public transport network must be developed and adapted to cater for persons with reduced mobility.

Sufficient numbers of qualified personnel must be provided . It is a priority to enhance the professionalism of personnel responsible for elderly care. The Member States must release funding for such personnel, for training courses and resources, accreditation and skill assessment, notably by encouraging the social dialogue in the sectors concerned, and equally taking account of the quality of the care provided. This is not a matter of subemployment, but of specifically qualified jobs. And “voluntary work”, albeit necessary and useful in many instances, should not mask the need for skills. Goodwill, although useful in this area, is far from sufficient and, in isolation, could be counter-productive or even harmful. Likewise, there must be sufficient personnel, particularly in institutions, to provide the necessary care and attention to the dependent persons concerned. Elderly or disabled people themselves must be involved in personnel training and be able to control the treatments received.

In any case, integrated policies must be implemented to prevent dependency, notably by improving health and safety in the workplace and by paying adequate salaries, to enable male and female workers to live in dignity and to take proper care of themselves. Such integrated policies are at the same time likely to provide quality new jobs.

Objective 3: to prioritise and encourage the participation of all stakeholders

The successful and respectful care of dependent women and men calls for a wide-ranging process of participation, including:

The participation of the dependent persons concerned , or of their representatives where they are not capable of representing themselves, in decision-making regarding not only measures concerning them personally, but also their conditions of life and existence, especially in institutions, and, as far as the dependent persons concerned are able, in social life. Placing elderly people in an institution because they require care that can no longer be provided or dispensed in the home, should not systematically be synonymous with, or lead to, “exclusion” from social life.

The participation of all stakeholders. Successful long-term elderly care is not solely the business of health “professionals”. Although professionals are crucial for dispensing care or implementing any care protocols or therapeutic measures that have been decided, other actors apart from the person concerned must be consulted and involved, including:

 The family.

 The social partners , especially for defining the policies to be implemented and the resources to be made available.

  Pensioners’ and old people’s associations and the NGOs which, on account of their experience, expertise and commitment, are concerned with the provision of specific or complementary responses to a given situation.

 Not forgetting the public authorities, which have a major responsibility in the matter, because they have a role not only to promote, but also to control the quality of the responses provided, as well as the financial and/or technical assistance to be provided in each specific case.

Institutions must not confine their role to simply providing services, since they also have a responsibility for the quality of the care or services they provide. What is more, their experience and “professionalism” gives them a role to play in implementing the services.

Objective 4: to guarantee appropriate and sustainable solidarity finance

This involves:

Providing dependent care as part of public social protection systems.

Solidarity finance , meaning that funding is provided by all citizens, female and male.

Costs that everyone can afford, which is to say the costs for access or to benefit - where the persons concerned are required to contribute financially - must be affordable for all women and men and, where appropriate, the Member States must provide appropriate financial aid to the most disadvantaged people, to ensure that this is so.

To develop assessment tools

Good indicators are vital for monitoring and evaluating the implementation of these objectives. Such indicators must be quantitative , in order to judge and evaluate the scale of the resources made available. They must also be qualitative, in order to assess the relevance and effectiveness of the resources made available and implemented, compared with the declared objectives, as well as to guarantee real equality in the care of the persons concerned .

To respect the dignity of all citizens

First and foremost, sustainable and supportive dependent care is an eminently political issue, embodying the choice of a society that respects the dignity of all citizens.

The organisations signing this Appeal are demanding to be associated and involved in the various implementation phases of the Open Method of Coordination for long-term health care.