Long-Term Care in Turkey: Towards a Growing Crisis of Aged Care

Main Article Content

Serkan Değirmenci

Abstract

Turkey exemplifies a typical familialistic long-term care regime as having a negligible degree of state and market participation in the active delivery of aged care services. However, demographic and economic changes necessitate a transition towards a new type of care regime. An upward shift in the population’s age structure and increasing economic strains weaken the caregiving capacities of Turkish families. This paper analyzes demographic and economic factors within a demand-supply framework to question the future sustainability of the existing care regime. It presents descriptive evidence for a growing crisis of aged care in Turkey by focusing on long-term care. It also assesses the implications of a cash-for-care (CfC) scheme devised by the government to keep the care provision of disabled older people within the family sphere. Overall, this paper contributes to the ongoing debates on the distribution of aged care responsibilities by conceptualizing the proposed solution as semi-familialized care–namely, a set of alternative strategies to overcome the aged care challenges families face in Turkey. The main pillars of this proposal are much greater involvement of the state in aged care, together with some support services and entitlements granted to the family caregivers.

Article Details

How to Cite
Değirmenci, S. (2022). Long-Term Care in Turkey: Towards a Growing Crisis of Aged Care. Journal of Population and Social Studies [JPSS], 30, 542–561. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/255908
Section
Research Articles
Author Biography

Serkan Değirmenci, Department of Economics, Faculty of Economics and Administrative Sciences, Muğla Sıtkı Koçman University, Turkey

Corresponding author

References

• Adaman, F., Aslan D., Erus, B., & Sayan S. (2018). ESPN thematic report on challenges in long-term care: Turkey. European Social Policy Network, Directorate-General for Employment, Social Affairs, and Inclusion. https://ec.europa.eu/social/BlobServlet?docId=19872&langId=en

• Akkan, B. (2018). The politics of care in Turkey: Sacred familialism in a changing political context. Social Politics: International Studies in Gender, State & Society, 25(1), 72–91. https://doi.org/10.1093/sp/jxx011

• Akkan, B., & Canbazer, C. (2020, June). The long-term care response to COVID-19 in Turkey. LTCcovid, International Long-Term Care Policy Network. https://ltccovid.org/wp-content/uploads/2020/06/The-COVID-19-Long-Term-Care-situation-in-Turkey.pdf

• Altuntaş, B., & Atasü-Topcuoğlu, R. (2016). Engelli bakımı: Sosyal bakım ve kadın emeği [Disabled care: Social care and women’s labor]. Nika Yayın.

• Anttonen, A., & Sipilä, J. (1996). European social care services: Is it possible to identify models? Journal of European Social Policy, 6(2), 87–100. https://doi.org/10.1177/095892879600600201

• Aran, M. A., & Aktakke, N. (2016, June). Women’s invisible contribution: Quantifying the economic value of women’s unpaid care activities in Turkey and policy options to reduce women’s care burden (Research Paper Series No. 1601). Development Analytics. https://ssrn.com/abstract=2798620

• Atasü-Topcuoğlu, R. (2021). Gender inequality, the welfare state, disability, and distorted commodification of care in Turkey. New Perspectives on Turkey, 1–31. https://doi.org/10.1017/npt.2020.35

• Aybars, A. İ., Beşpınar, F. U., & Kalaycıoğlu, H. S. (2018). Familialization of care arrangements in Turkey: Questioning the social inclusion of ‘the invisible.’ Research and Policy on Turkey, 3(2), 115–137. https://doi.org/10.1080/23760818.2018.1517447

• Bettio, F., & Plantenga, J. (2004). Comparing care regimes in Europe. Feminist Economics 10(1), 85–113. https://doi.org/10.1080/1354570042000198245

• Braunstein, E. (2015, September). Economic growth and social reproduction: Gender inequality as cause and consequence (Discussion Paper No. 5). UN Women. https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2015/gender%20inequality%20as%20cause%20and%20consequence.pdf

• Braunstein, E., Seguino, S., & Altringer, L. (2021). Estimating the role of social reproduction in economic growth. International Journal of Political Economy, 50(2), 143–164. https://doi.org/10.1080/08911916.2021.1942963

• Buğra, A. (2012). The changing welfare regime of Turkey: Neoliberalism, cultural conservatism, and social solidarity redefined. In S. Dedeoglu & A. Elveren (Eds.), Gender and society in Turkey: The impact of neoliberal policies, political Islam and EU accession (pp. 15–30). I. B. Tauris. https://doi.org/10.5040/9780755607471.ch-002

• Buğra, A. (2020). Politics of social policy in a late industrializing country: The case of Turkey. Development and Change, 51(2), 442–462. https://doi.org/10.1111/dech.12566

• Buğra, A., & Adar, S. (2008). Social policy change in countries without mature welfare states: The case of Turkey. New Perspectives on Turkey, 38, 83–106. https://doi.org/10.1017/S0896634600004933

• Buğra, A., & Candaş, A. (2011). Change and continuity under an eclectic social security regime: The case of Turkey. Middle Eastern Studies, 47(3), 515–528. https://doi.org/10.1080/00263206.2011.565145

• Buğra, A., & Keyder, Ç. (2006). Turkish welfare regime in transformation. Journal of European Social Policy, 16(3), 211–228. https://doi.org/10.1177/0958928706065593

• Buğra, A., & Yakut-Çakar, B. (2010). Structural change, the social policy environment and female employment in Turkey. Development and Change, 41(3), 517–538. https://doi.org/10.1111/j.1467-7660.2010.01643.x

• Celebi, E. (2020). Rescaling social care services: The case of district municipalities in Istanbul. International Social Work, 65(1), 160–174. https://doi.org/10.1177/0020872819901156

• Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted? Providing and paying for long-term care. OECD Publishing. https://read.oecd-ilibrary.org/social-issues-migration-health/help-wanted_9789264097759-en#page6

• Da Roit, B. (2010). Strategies of care: Changing elderly care in Italy and the Netherlands. Amsterdam University Press. https://www.jstor.org/stable/j.ctt45kfbw

• Da Roit, B., & Le Bihan, B. (2010). Similar and yet so different: Cash-for-care in six European countries’ long-term care policies. The Milbank Quarterly, 88(3), 286–309. https://doi.org/10.1111/j.1468-0009.2010.00601.x

• Daly, M. (2001). Care work: The quest for security. ILO. https://www.ilo.org/public/english/protection/ses/info/publ/care.htm

• Daly, M. (2002). Care as a good for social policy. Journal of Social Policy, 31(2), 251–270. https://doi.org/10.1017/S0047279401006572

• Daly, M., & Lewis, J. (2000). The concept of social care and the analysis of contemporary welfare states. The British Journal of Sociology, 51(2), 281–298. https://doi.org/10.1111/j.1468-4446.2000.00281.x

• Dedeoglu, S., & Elveren, A. Y. (2012). Introduction: Gender, society and the welfare state in Turkey. In S. Dedeoglu & A. Y. Elveren (Eds.), Gender and society in Turkey: The impact of neoliberal policies, political Islam and EU accession (pp. 3–14). I.B. Tauris. http://doi.org/10.5040/9780755607471.ch-001

• Deusdad, B. A., Pace, C., & Anttonen, A. (2016). Facing the challenges in the development of long-term care for older people in Europe in the context of an economic crisis. Journal of Social Service Research, 42(2), 144–150. https://doi.org/10.1080/01488376.2015.1133147

• Duben, A. (2013). Generations of İstanbul families, the elderly, and the social economy of welfare. New Perspectives on Turkey, 48, 5–54. https://doi.org/10.1017/S0896634600001874

• Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Policy Press.

• Feng, Z. (2019). Global convergence: Aging and long-term care policy challenges in the developing world. Journal of Aging & Social Policy, 31(4), 291–297. https://doi.org/10.1080/08959420.2019.1626205

• Geissler, B., & Pfau-Effinger, B. (2005). Change in European care arrangements. In B. Pfau-Effinger & B. Geissler (Eds.), Care and social integration in European societies (pp. 3–19). Policy Press. https://doi.org/10.1332/policypress/9781861346049.001.0001

• Ilkkaracan, I. (2013). Political economy of caring labor, gender and deepening conservatism in a developing economy context: The case of Turkey. Istanbul Technical University, Women’s Studies Center Working Paper Series.

http://www.kaum.itu.edu.tr/dosyalar/3013WorkingPaper.WorkFamilyBalance.Turkey.pdf

• Ismail, M., & Hussein, S. (2021). An evidence review of ageing, long-term care provision and funding mechanisms in Turkey: Using existing evidence to estimate long-term care cost. Sustainability, 13(11), Article 6306. https://doi.org/10.3390/su13116306

• Kagitcibasi, C., & Ataca, B. (2005). Value of children and family change: A three-decade portrait from Turkey. Applied Psychology, 54(3), 317–337. https://doi.org/10.1111/j.1464-0597.2005.00213.x

• Kaya, A. (2015). Islamization of Turkey under the AKP rule: Empowering family, faith and charity. South European Society and Politics, 20(1), 47–69. https://doi.org/10.1080/13608746.2014.979031

• Kim, K., Ilkkaracan, I., & Kaya, T. (2019). Public investment in care services in Turkey: Promoting employment & gender inclusive growth. Journal of Policy Modeling, 41(6), 1210–1229. https://doi.org/10.1016/j.jpolmod.2019.05.002

• King, E. M., Randolph, H. L., Floro, M. S., & Suh, J. (2021). Demographic, health, and economic transitions and the future care burden. World Development, 140, Article 105371. https://doi.org/10.1016/j.worlddev.2020.105371

• Knijn, T., & Kremer, M. (1997). Gender and the caring dimension of the welfare states: Towards inclusive citizenship. Social Politics, 4(3), 328–361. https://doi.org/10.1093/oxfordjournals.sp.a034270

• Kremer, M. (2007). How welfare states care: Culture, gender, and parenting in Europe. Amsterdam University Press. https://www.jstor.org/stable/j.ctt46mvjz

• Leitner, S. (2003). Varieties of familialism: The caring function of the family in comparative perspective. European Societies, 5(4), 353–375. https://doi.org/10.1080/1461669032000127642

• Lister, R. (2002). The dilemmas of pendulum politics: Balancing paid work, care and citizenship. Economy and Society, 31(4), 520–532. https://doi.org/10.1080/0308514022000020661

• Martin, C. (2015). Southern welfare states: Configuration of the welfare balance between state and the family. In M. Baumeister & R. Sala (Eds.), Southern Europe? Italy, Spain, Portugal, and Greece from the 1950s until the present day (pp. 77–100). Campus Verlag. https://halshs.archives-ouvertes.fr/halshs-01179541/document

• Ministry of Family and Social Services (MFSS). (2020). Disability and ageing statistical bulletin. General Directorate of Services for Persons with Disabilities and the Elderly. https://www.aile.gov.tr/media/46090/bulten_en_200508.pdf

• Onaran, O., Oyvat, C., & Fotopoulou, E. (2016). The effect of income distribution and gender equality on growth and employment: A gendered macroeconomic model for the UK. Paper presented at the 20th Anniversary of FMM Research Network Conference: Towards Pluralism in Macroeconomics, Berlin. https://www.boeckler.de/pdf/v_2016_10_21_fotopoulou.pdf

• Orloff, A. S. (1993). Gender and the social rights of citizenship: The comparative analysis of gender relations and welfare states. American Sociological Review, 58(3), 303–328. https://doi.org/10.2307/2095903

• Österle, A. (2010). Long-term care in central and south-eastern Europe: Challenges and perspectives in addressing a ‘new’ social risk. Social Policy & Administration, 44(4), 461–480. https://doi.org/10.1111/j.1467-9515.2010.00723.x

• 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. https://doi.org/10.1177/0958928708091058

• Pfau-Effinger, B. (2005). Development paths of care arrangements in the framework of family values and welfare values. In B. Pfau-Effinger & B. Geissler (Eds.), Care and social integration in European societies (pp. 21–45). Policy Press. https://doi.org/10.1332/policypress/9781861346049.003.0002

• Pfau-Effinger, B. (2012). Analyses of welfare-state reform policies toward long-term senior care in a cross-European perspective. European Journal of Ageing, 9, 151–154. https://doi.org/10.1007/s10433-012-0233-9

• Pfau-Effinger, B., & Rostgaard T. (2011). Care between work and welfare in European societies. Palgrave Macmillan. https://doi.org/10.1057/9780230307612

• Ranci, C., & Pavolini, E. (Eds.) (2013). Reforms in long-term policies in Europe: Investigating institutional change and social impacts. Springer. https://doi.org/10.1007/978-1-4614-4502-9

• Razavi, S. (2007, June). The political and social economy of care in a development context (Paper No. 3). Gender and Development Programme. UNRISD. https://cdn.unrisd.org/assets/library/papers/pdf-files/razavi-paper.pdf

• Sainsbury, D. (1994). Gendering welfare states. Sage. https://dx.doi.org/10.4135/9781446250518

• Saraceno, C. (2010). Social inequalities in facing old-age dependency: A bi-generational perspective. Journal of European Social Policy, 20(1), 32–44. https://doi.org/10.1177/0958928709352540

• Saraceno, C., & Keck, W. (2010). Can we identify intergenerational policy regimes in Europe? European Societies, 12(5), 675–696. https://doi.org/10.1080/14616696.2010.483006

• Stark, A. (2005). Warm hands in cold age – On the need of a new world order of care. Feminist Economics, 11(2), 7–36. https://doi.org/10.1080/13545700500115811

• Stone, R. I. (2015). Factors affecting the future of family caregiving in the United States. In J. E. Gaugler & R. L. Kane (Eds.), Family caregiving in the new normal (pp. 57–77). Academic Press. https://doi.org/10.1016/B978-0-12-417046-9.00006-4

• Super, N. (2002). Who will be there to care? The growing gap between caregiver supply and demand (NHPF Background Paper 89). National Health Policy Forum. https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1082&context=sphhs_centers_nhpf

• Swartz, K. (2013). Searching for a balance of responsibilities: OECD countries’ changing elderly assistance policies. Annual Review of Public Health, 34, 397–412. https://doi.org/10.1146/annurev-publhealth-031912-114505

• Toksoz, G., Dedeoglu, S., Parmaksiz, E. M., & Kaya Bahce, S. (2014). Türkiye’de kadın işgücü profili ve istatistiklerinin analizi [Analysis of female workforce profile and statistics in Turkey]. T. C. Aile ve Sosyal Politikalar Bakanlığı Kadının Statüsü Genel Müdürlüğü [T.R. Ministry of Family and Social Policies General Directorate of Status of Women]. https://ailevecalisma.gov.tr/uploads/ksgm/uploads/pages/dagitimda-olan-yayinlar/turkiye-de-kadin-isgucu-profili-ve-istatistiklerinin-analizi-nihai-rapor.pdf

• Turkish Statistical Institute (TurkStat). (2020, February). The results of Address Based Population Registration System, 2019. https://data.tuik.gov.tr/Bulten/Index?p=The-Results-of-Address-Based-Population-Registration-System-2019-33705&dil=2

• Turkish Statistical Institute (TurkStat). (2022a). Demographic indicators [Data set]. https://data.tuik.gov.tr/Kategori/GetKategori?p=Population-and-Demography-109

• Turkish Statistical Institute (TurkStat). (2022b). Labor Force Statistics [Data set]. https://data.tuik.gov.tr/Kategori/GetKategori?p=istihdam-issizlik-ve-ucret-108&dil=1

• Ungerson, C. (2003). Commodified care work in European labour markets. European Societies, 5(4), 377–396. https://doi.org/10.1080/1461669032000127651

• United Nations. (2019). World Population Prospects: The 2019 Revision. Department of Economic and Social Affairs, Population Division. https://population.un.org/wpp/Graphs/DemographicProfiles/Pyramid/792

• United Nations Data. (2019). Total fertility rate (live births per woman). The United Nations Population Division. http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3A54

• Williams, F. (2010). Claiming and framing in the making of care policies: The recognition and redistribution of care. UNRISD. https://www.unrisd.org/80256B3C005BCCF9/search/F0924AD817FE8620C125780F004E9BCD

• World Health Organization (WHO). (2021). Turkey–Country case study on the integrated delivery of long-term care. WHO Regional Office for Europe series on integrated delivery of long-term care. https://apps.who.int/iris/bitstream/handle/10665/349928/WHO-EURO-2021-4212-43971-61980-eng.pdf?sequence=1&isAllowed=y

• Yazıcı, B. (2008). Social work and social exclusion in Turkey: An overview. New Perspectives on Turkey, 38, 107–134. https://doi.org/10.1017/S0896634600004945

• Yazıcı, B. (2012). The return to the family: Welfare, state, and politics of the family in Turkey. Anthropological Quarterly, 85(1), 103–140. http://www.jstor.org/stable/41427090

• Yılmaz, V., & Yentürk, N. (2017). Türkiye’de engellilere yönelik kamu harcamalarının on yıllık seyri [Public Expenditures for People with Disabilities in Turkey in the Last Decade]. Çalışma ve Toplum [Work and Society], 52(1), 59–74. https://www.calismatoplum.org/makale/turkiyede-engellilere-yonelik-kamu-harcamalarinin-on-yillik-seyri

• Yılmaz, Z. (2015). “Strengthening the family” policies in Turkey: Managing the social question and armoring conservative–neoliberal populism. Turkish Studies, 16(3), 371-390. https://doi.org/10.1080/14683849.2015.1067863