YAŞLILARA YÖNELİK UZUN SÜRELİ BAKIM HİZMETLERİNİN DURUMU: OECD ÜLKELERİNE BAKIŞ

Öz

Dünya genelinde özellikle son otuz yıldır doğurganlık oranlarının azalması ve yaşam süresinin uzaması toplam nüfus içinde yaşlı nüfusun artmasına yol açmıştır. Birleşmiş Milletler tarafından 2023 yılında yayımlanan Dünya Sosyal Raporu’na göre, dünya genelinde 65 yaş ve üstü nüfus 761 milyon olup her on kişinden biri 65 yaş ve üzerindedir. 2050 yılına kadar bu sayının iki kattan fazla artacağı ve 2050 yılında 1,6 milyara yükseleceği tahmin edilmektedir. 65 yaş ve üzeri her yüz kişi başına düşen beş uzun süreli bakım çalışanı oranının korunması için sektördeki işçi sayısının 2040 yılına kadar 13,5 milyon artması gerekmektedir (OECD, 2020). Bu çalışmanın temel amacı nüfusun yaşlanmasına paralel olarak her geçen yıl büyümesi beklenen uzun süreli yaşlı bakım hizmetlerinde çalışanların çalışma koşullarına dikkat çekmektir. Bu amaçla Ekonomik İş birliği ve Kalkınma Örgütü (OECD) ve Dünya Sağlık Örgütü (WHO) raporlarından yararlanarak betimsel bir çerçevede ele alınmıştır. OECD genelinde uzun süreli bakım hizmetlerinde yarı zamanlı çalışma ve belirli süreli sözleşme ile çalışma yaygın olup ağırlık olarak göçmen kadınlar tarafından hizmet sağlanmaktadır. Dolayısıyla OECD genelinde bakım hizmetleri sağlamada toplumsal cinsiyet rollerinin önemli bir rol oynadığı ifade edilebilir. Ücretler ise ekonomi genelindeki ortalama ücretin beşte birinden daha düşüktür. Evde bakımın kurumsal bakıma göre daha az maliyetli olması, bakım alıcıların evlerinden ayrılmak istememeleri gibi faktörlere bağlı olarak evde bakım hizmetlerine olan talebin artma eğiliminde olduğu görülmektedir.

Anahtar Kelimeler

• OECD
• uzun süreli bakım
• yaşlı bakımı
• çalışma koşulları

Status of Long-Term Care Services For The Elderly: A Look At OECD Countries

Öz

Changes in fertility rates and lifestyles worldwide, especially over the last three decades, have led to an aging population. According to the United Nations' World Social Report published in 2023, the global population aged 65 and over is 761 million, meaning one in ten people is over the age of 65. This number is expected to more than double by 2050, reaching 1.6 billion. To maintain the current rate of five long-term care workers per 100 people aged 65 and over, the number of workers in the sector must increase by 13.5 million by 2040. The aim of this study is to examine the characteristics of individuals who benefit from long-term care services and those who work in these services, their working conditions, and the current policy practices of various countries. For this purpose, a descriptive study is presented using reports from the Organization for Economic Co-operation and Development (OECD) and the World Health Organization (WHO). As a result of the study, throughout the OECD part-time work and working on fixed-term contracts are common in the sector, and services are mainly provided by immigrant women. Wages are less than one-fifth of the average wage across the economy. The demand for home care services tends to increase due to factors such as home care being less costly than institutional care and care recipients not wanting to leave their homes.

Anahtar Kelimeler

• OECD
• Long-Term care
• Elderly care
• Working conditions

Kaynakça

1. Alcock, P., Erksine, A., & May, M. (2003). The student’s companion to social policy (2nd ed.). Blackwell Publishing.
2. Altunay, Z. (2020). Sosyo-kültürel değişme açısından yaşlı, yaşlılık ve yaşlı bakımı [Yüksek lisans tezi, Süleyman Demirel Üniversitesi Sosyal Bilimler Enstitüsü].
3. Andersen, G. E. (2011). Tamamlanmamış devrim: Kadınların yeni rollerine uymak. İletişim Yayınları.
4. Bettio, F., Simonazzi, A., & Villa, P. (2006). Change in care regimes and female migration: The “care drain” in the Mediterranean. Journal of European Social Policy, 16(3), 271–285.
5. Bonsang, E. (2008). Does informal care from children to their elderly parents substitute for formal care in Europe? CREPP Working Papers, 2008/01.
6. Cazes, S., Hijzen, A., & Saint-Martin, A. (2015). Measuring and assessing job quality: The OECD job quality framework. OECD Social, Employment and Migration Working Papers, (174). OECD Publishing.
7. Christianson, J. B. (1988). The evaluation of the national long-term care demonstration: The effect of channeling on informal caregiving. Health Services Research, 23(1), 99–117.
8. Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. Lancet, 381(9868), 752–762. https://doi.org/10.1016/S0140-6736(12)62167-9.

9. Çömez Polat, F., & Kaya Örk, E. (2021). Türkiye’de yaşlı bakımına ilişkin söylemler. Akademik MATBUAT, 109–120. England, P., Budig, M., & Folbre, N. (2002). Wages of virtue: The relative pay of care work. Social Problems, 49(4), 455–473.
10. European Commission. (2022). A European care strategy for caregivers and care receivers.
11. Ferrera, M. (2011). Sosyal Avrupa’da Güney Avrupa refah modeli. In A. Buğra & Ç. Keyder (Eds.), Sosyal politika yazıları (pp. 195–230). İletişim Yayınları.
12. Geyer, J., Haan, P., & Korfhage, T. (2017). Indirect fiscal effects of long term care insurance. Fiscal Studies, 38(3), 393–415.
13. Giesecke, J., Groß, M., & Stuth, S. (2020). Occupational closure and wage inequality: How occupational closure effects vary between workers. Kölner Zeitschrift für Soziologie und Sozialpsychologie, 72(2), 157–195.
14. Gorodzeisky, A., & Richards, A. (2013). Trade unions and migrant workers in Western Europe. European Journal of Industrial Relations, 19(3), 239–254.
15. Gökbayrak, Ş. (2009). Refah devletinin dönüşümü ve bakım hizmetlerinin görünmez emekçileri göçmen kadınlar. Çalışma ve Toplum, 2(21), 55-82.
16. Hellgren, Z. (2015). Markets, regimes, and the role of stakeholders: Explaining precariousness of migrant domestic/care workers in different institutional frameworks. Social Politics: International Studies in Gender, State & Society, 22(2), 220–241.
17. Hochschild, A. R. (2000). Global care chains and emotional surplus value. In W. Hutton & A. Giddens (Eds.), On the edge: Living with global capitalism (pp. 130–146). Jonathan Cape.
18. Hooren, F. (2012). Varieties of migrant care work: Comparing patterns of migrant labour in social care. Journal of European Social Policy, 22(2), 133–147.
19. Houtven, C. H., & Norton, E. C. (2004). Informal care and health care use of older adults. Journal of Health Economics, 23(6), 1159–1180. ILO. (2009). Decent work and equity at the heart of decent work.
20. Joshua, L. (2017). Aging and long term care systems: A review of finance and governance arrangements in Europe, North America and Asia-Pacific. World Bank, Social Protection & Labor, Discussion Paper.
21. Karakuş, B. (2018). Türkiye’de yaşlılara yönelik hizmetler, kurumsal yaşlı bakımı ve kurumsal yaşlı bakımında illerin durumu, Aile ve Sosyal Politikalar Bakanlığı
22. Kauppi, M., et al. (2021). Social network ties before and after retirement: A cohort study. European Journal of Ageing, 18(4), 503–512.
23. Kemper, P. (1992). The use of formal and informal home care by the disabled elderly. Health Services Research, 27(4), 421–451.
24. Kessler, I., Bach, S., Griffin, R., & Grimshaw, D. (2020). Fair care work: A post COVID-19 agenda for integrated employment relations in health and social care. KBS Covid-19 Research Impact Papers.
25. Khamisa, N., Peltzer, K., & Oldenburg, B. (2013). Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health, 10(6), 2214–2240.
26. Knijn, T., & Kremer, M. (1997). Gender and the caring dimension of welfare states: Toward inclusive citizenship. Social Politics, 4(3), 328–361.
27. Koray, M. (2003), Sosyal politika, İmge Kitabevi, İkinci Baskı, Ankara .
28. Langa, K. M., Chernew, M. E., Kabeto, M. U., & Katz, S. J. (2001). The explosion in paid home care in the 1990s: Who received the additional services? Medical Care, 39(2), 147–157.
29. Leibfried, S. (1993). Towards of a European welfare state? In C. Jones (Ed.), New perspectives on the European welfare state in Europe (pp. 120–143). Routledge.
30. Lightman, N. (2021). Comparing care regimes: Worker characteristics and wage penalties in the global care chain. Social Politics: International Studies in Gender, State & Society, 28(1), 94–117.
31. Lis, M., & Boulhol, H. (2023). Work and wages in long-term care today. In Beyond applause? Improving working conditions in long-term care. OECD Publishing.
32. Liu, K., Manton, K. G., & Aragon, C. (2000). Changes in home care use by disabled elderly persons: 1982–1994. Journal of Gerontology B: Psychological Sciences and Social Sciences, 55(5), S245–S253.
33. Lister, R. (1994). She has other duties: Women, citizenship and social security. In S. Baldwin & J. Falkingham (Eds.), Social security and social change: New challenges (pp. 1–44). Harvester Wheatsheaf.
34. Liversage, A. (2023). A challenging responsibility: Care for older parents in Turkish immigrant families. Journal of Family Research, 35, 286–303.
35. Massey, D. S., Arango, J., Hugo, G., Kouaouci, A., & Taylor, J. E. (1993). Theories of international migration: A review and appraisal. Population and Development Review, 19(3), 431–466.
36. Meier, V., & Werding, M. (2010). Ageing and the welfare state: Securing sustainability. Oxford Review of Economic Policy, 26(4), 655–673.
37. Moreno, L. (2001). ‘Süper kadınlar’ ve Akdeniz refahı. In A. Buğra & Ç. Keyder (Eds.), Sosyal politika yazıları (pp. 375–396). İletişim Yayınları.
38. OECD. (2011). Help wanted? Providing and paying for long-term care.
39. OECD. (2019). Health at a glance 2019: OECD indicators. OECD Publishing.
40. OECD. (2020). Who cares? Attracting and retaining care workers for the elderly. OECD Health Policy Studies. OECD Publishing.
41. OECD. (2021). COVID-19 in long-term care: Impact, policy responses and challenges. OECD Health Working Papers No. 131.
42. OECD. (2022). Supporting informal carers of older people: Policies to leave no carer behind. OECD Health Working Papers No. 140.
43. OECD. (2023). Health at a glance 2023: OECD indicators. Pavolini, E., & Ranci, C. (2008). Restructuring the welfare state: Reforms in long-term care in Western European countries. Journal of European Social Policy, 18(3), 246–259.
44. Saraceno, C., & Keck, W. (2010). Can we identify intergenerational policy regimes in Europe? European Societies, 12(5), 675–696.
45. Scheil-Adlung, X. (2015). Extension of social security: Long-term care protection for older persons. ILO. Spillman, B. C., & Pezzin, L. E. (2000). Potential and active family caregivers: Changing networks and the “sandwich generation”. Milbank Quarterly, 78(3), 347–374.
46. Standing, G. (2014). Prekarya: Yeni tehlikeli sınıf. İletişim Yayınları.
47. Şenkal, A. (2005), Küreselleşme sürecinde sosyal politika, Alfa Basım, İstanbul.
48. Taylor-Gooby, P. (2004). New risks, new welfare: The transformation of the European welfare state. Oxford University Press.
49. Tavernier, W., Reilly, A., & Boulhol, H. (2023). Social recognition, gender- and migration-related issues in long-term care. In Beyond applause? Improving working conditions in long-term care. OECD Publishing.
50. Tavernier, W., Boulhol, H., Cazes, S., & Garnero, A. (2023). Work environment and collective bargaining in long-term care. In Beyond applause? Improving working conditions in long-term care. OECD Publishing.
51. TUİK. (2024). Türkiye yaşlı profili araştırması, 2023.
52. United Nations. (2023). Leaving no one behind in an ageing world: World social report 2023.
53. Vasconcelos, S., et al. (2016). Nursing staff members’ mental health and factors associated with the work process: An integrative review. Clinical Practice & Epidemiology in Mental Health, 12, 167–176.
54. WHO. (2002). Community home-based care in resource-limited settings: A framework for action.
55. WHO. (2017). Women on the move: Migration, care work and health.
56. WHO & ILO. (2022). The gender pay gap in the health and care sector: A global analysis in the time of COVID-19.