In early 2014, the Bulgarian state introduced its National Strategy for Long-Term Care. Among other things, the Strategy sought to begin actively deinstitutionalising existing care provision on different levels. As part of a broader EU process, Bulgarian policies outlined in the Strategy aimed to increase the amount of care provision in a home environment, while at the same time closing existing institutions, such as elderly day-care centres or nursing homes. In theory, this was to done to create a long-term model of care provision that does not depend on state-funded care facilities (institutions of all kinds). In practice, it shifted the responsibility of elderly care onto the shoulders of society, once again externalising social reproduction from the politico-economic realm.
After the introduction of the Strategy, programmes on a national level were launched, supporting the active transformation of the largely state-supported elderly care regime. One such programme was the National Programme for Providing Care in a Home Environment (NPPCHE). As the name suggests, the Programme aimed to provide care in a home environment to people with disabilities and elderly people. In reality, however, the Programme had a different reasoning. Given the high numbers of unemployed people without a professional qualification in the country, ones with education below primary level, or the unemployed above the age of 50, the Bulgarian Ministry of Labour and Social Policy decided to tackle the deinstitutionalisation process by providing employment opportunities for these groups.
Of course, the employment provision would be in the sphere of care work, delivered to people with highly reduced work abilities, or elderly people above the age of 65 who cannot perform self-care. This created a disparity between the name of the programme (hence, the aim it suggested) and the actual goals of it. While it did tackle both issues (unemployment of specific groups and deinstitutionalisation of care), it seemed that care was only secondary. The necessity to address the care crisis exacerbated by the negative demographic statistics of the country was overtaken by the Bulgarian state as an opportunity to address the economic crisis too. Instead of placing care recipients to the forefront of the Programme, the state pushed them to the back of it, making unemployment issues the main target.
On yet another level of analysis, deinstitutionalisation itself, as executed by the NPPCHE, shifts care responsibilities (which are, as we know, essential for the reproduction of the economy) onto families and society. Cynically put, why invest in facilities which are of little to no economic return? Even more cynically put, the deinstitutionalisation process provided an excellent opportunity to halt subsidies for economically ‘less important’ facilities, while at the same time targeting unemployment. In the logic of our current economic system, labour and economic activity is prioritised before care for people whose contribution to the economy is lacking.
However, it is not like care provision was totally disregarded. The Strategy from 2014 aimed to develop a network of quality services outside of the institutional realm, within the family or society. How? Logically, by reducing the finding for existing institutions, increasing the funding for their transformation, as well as developing a new non-institutional network of facilities. It does not sound that bad in theory. Yet, in practice, this takes time.
State withdrawal from any economic activity always creates vacuum. In nowadays economy, vacuum is usually quickly filled with private enterprises providing the same services which were provided by state-funded facilities. Simply put, the reduction of subsidies for state-supported elderly care institutions allowed for an increase in private care provision. The lack of experience in deinstitutionalising care in the country also resulted in relatively loose legislation, which proved to be the case last year, with many cases of private care facilities being unsuitable (to put it very mildly) for such provision.
On top of private care facilities, the newly emerging regime featured the non-institutional, but also largely familial and society-based care provision. In a twofold way. Firstly, it was thanks to the creation of the new non-institutional facilities network and the various programmes for deinstitutionalisation. But also, secondly, by pushing many recipients of care back to the family, because of the families’ inability to transfer their people in need to private facilities. This latter case was and still is mainly present in the cases where the ones in need can no longer be recipients of publicly-funded care because of the cut in subsidies, but also could not make use of the new network of non-institutional care, as it is not as suitable as the institutional one could be.
So where is the new regime heading? We might agree that institutional care was not ideal. The idea of deinstitutionalisation is great in theory – it focuses on improving the quality of life of the ones in need of care. Yet, the way it is executed in Bulgaria is not really in line with the expectations.
Targeting two issues at once is not necessarily bad. However, positioning an economic issue before a societal one in a process that addresses societal issues per se, is not good. Yes, unemployment was tackled, but it was tackled by commodifying care provision. Not for the improvement of care per se, but for creating employment opportunities for a specific group of people. On top of that, in spheres where this could not be done, the family was there to once again take care for the ones in need.
The state actively altered the elderly care regime in Bulgaria. It shifted care responsibilities from the politico-economic realm to either the purely economic (thus commodifying care for the sake of the economy) or to the familial realm (placing yet another social reproductive activity back onto the shoulders of the family, while expecting from the family to continue being an active participant in the economy).
This is a rather critical analysis, of course. This is only one way to look at the elderly care reality in Bulgaria, and anywhere else in that matter. Yet, it is an analysis that offers a look into the many hidden things which are there for the sustainment of the economy, but are rarely accounted for. Even if they would be accounted for at some point, the lack of economic return from them is a reason enough for these things to be pushed back to other realms. Realms vital for the sustainment for the economy, but still far enough from it so that they could be considered external. Even if they are not…
For some people the altered care regime might look like a normal development in the constantly changing economic system we live in. For other, it might have created a burden. Some people would simply not pay attention to it, because their elderly in need have been in private facilities since the beginning of their needs. For others, private means too expensive. Such inequalities are everywhere. In all spheres of life, in all realms around us. They are normalised, they are taken for granted. Many people write about them. But even more people do not even question inequalities. In the next part of the Series Hidden from the Economy I shall discuss the issue of inequality. In terms of the politico-economic, in terms of the socio-political, in terms of the socio-economic. But mainly in terms of its hidden meaning.
- All the data in this article was derived from already existing research conducted by the author for the completion of his Master’s thesis. For more information, contact the author at borumovd@gmail.com.
