Health and long-term care benefits and the proposed revised coordination regulation: A brave new world or much ado about nothing?

Published date01 June 2020
AuthorStamatia Devetzi,Jean McHale
DOI10.1177/1388262720931229
Date01 June 2020
Subject MatterArticles
Article
Health and long-term care
benefits and the proposed
revised coordination
regulation: A brave new
world or much ado about
nothing?
Stamatia Devetzi
Fulda University of Applied Sciences, Fulda, Germany
Jean McHale
Birmingham Law School, University of Birmingham, Birmingham, UK
Abstract
This article examines the implications of the proposed Revised Coordination Regulation for long-
term care benefits. First, it explores what is meant by ‘long-term care’. This sets the debate around
access to long-term care in the context of developments regarding the safeguarding of fundamental
human rights for those with disabilities and increasing international concern regarding the human
rights of older persons. Secondly, it charts the response at the EU level to calls for safeguards in
long-term care. It contrasts this with the disparate approaches taken at the Member State level.
Thirdly, it examines the development of CJEU jurisprudence in this area. Fourthly, it considers the
proposals for amending Regulation 883/2004 and its inclusion of long-term care. It concludes by
questioning the extent to which these proposed developments will provide a radical change of
approach, one which may indeed impact on expectations of long-term care at the individual
Member State level and asks whether the drafting of an approach taken in relation to the proposals
suggests that, ultimately, this may be little more than ‘much ado about nothing’.
Keywords
long-term care, coordination regulations, sickness benefits, persons with disabilities, older persons
Corresponding author:
Stamatia Devetzi, Fulda University of Applied Sciences, Fulda D-36037, Germany.
E-mail: stamatia.devetzi@sk.hs-fulda.de
European Journal of Social Security
2020, Vol. 22(2) 180–195
ªThe Author(s) 2020
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DOI: 10.1177/1388262720931229
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1. Introduction
The extent to which reciprocal social security rights should apply in the context of long-term care
has been a matter of controversy. On the one hand, it can be argued that long-term care should be
simply regarded as part of the broader ‘health care package’. Long-term care needs can be seen as
an integral part of care and treatment. Helping someone to wash and eat, etc, can be seen as part of
a general ‘enablement’ to live. The reason why someone needs social care and support is usually
related to a long-term physical or mental disability and/or to frailty which may result from disease,
disability or old age. Nonetheless, there are acute policy discussions as to whether reciprocal long-
term care rights should be included in the social security rights package. What exactly is meant by
‘long-term care’? Who should pay for such care and to what extent should this be included in
reciprocal social security rights? The need for long-term care to be available is something which is
of particular concern for countries with an ageing population. Currently, there are distinct
approaches across EU Member States in relation to elderly long-term care. Some countries have
a fragmented approach where long-term care is not seen as a distinct matter of social policy,
1
some
countries where care is seen predominantly as something provided by the family
2
and others in
contrast that have much more structured developed systems.
3
Long-term care was not originally recognised as a separate category in the Coordination
Regulations and was expressly excluded from the EU Patients’ Rights Directive. Concerns have
been expressed as to the cost implications if reciprocal rights were to be extended in relation to
long-term care. However, over time, the case law of the ECJ developed to include such rights
within the scope of the Coordination Regulation. It was thus perhaps inevitable that the proposals
to reform Regulation 883/2004 would incorporate special provisions in relation to long-term care.
This article explores, first, what is meant by ‘long-term care’. This sets the debates around access
to long-term care in the context of developments regarding safeguarding the fundamental human
rights of those with disabilities and increasing international concern regarding the human rights of
older persons. Secondly, it charts the response at EU level to calls for safeguards to long-term care.
It contrasts this with the disparate approaches taken at the Member State level. Thirdly, it examines
the development of CJEU jurisprudence in this area. Fourthly, it considers proposals for amending
Regulation 883/2004 and the inclusion of long-term care. It concludes by questioning the extent to
which these proposed developments will provide a radical change of approach, one which may
indeed impact on expectations of long-term care at the individual Member State level, or whether
the drafting of an approach taken in relation to the proposals suggests that ultimately this may be
little more than ‘much ado about nothing’.
2. Long-term care: A ‘not-so-new’ independent risk in Europe
Long-term care, or as it is often referred to ‘social care’, can exist in a variety of situations. It may
be seen as care of older persons. However, in practice it is much broader than that. Long-term care
may become necessary due to life events from traumati c accidents to devastating illness and
consequent disability. An individual may need long-term care due to a mental or physical disability
1. Poskute (2016).
2. Tinios (2016).
3. Greve (2016).
Devetzi and McHale 181

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