Long-term care (LTC) is a labour-intensive service, and formal care is in many cases a necessary complement to informal, unpaid work in supporting people with LTC needs (see indicators on “Informal carers”). Formal LTC workers are defined as paid staff – typically nurses and personal carers – who provide care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals. There are on average five LTC workers per 100 people aged 65 and over across 28 OECD countries, ranging from 13 in Norway to less than one in Greece, Poland, and Portugal (Figure 11.25).
In more than half of OECD countries, population ageing has outpaced the growth of LTC supply. The LTC workforce has stagnated or declined even in countries where the LTC supply is much higher than the OECD average (such as Denmark, the Netherlands, Norway, and Sweden). Nine countries experienced an overall increase in their LTC supply between 2011 and 2016. As populations continue to age, demand for LTC workers is likely to rise. Responding to increasing demand will require policies to improve recruitment; improve retention; and increase productivity.
Less than one-quarter of LTC workers hold tertiary education across OECD countries (see Figure 11.23). This can be explained by the fact that personal care workers represent 70% of the LTC workforce on average in OECD countries, and up to 90% in a few countries (Estonia, Switzerland, Korea, Israel, and Sweden). Only Germany, Hungary, and Switzerland have a supply of nurses greater than the supply of personal care workers. Very few countries currently require personal care workers to hold minimum education levels, licences and/or certifications. Despite being mostly staffed by lower-skilled workers, LTC involves spending significant time delivering more complex tasks than basic care. Personal care workers do not always have sufficient knowledge and training, which can affect the quality of care delivered.
Working conditions in this sector tend to be relatively poor. This tends to affect women disproportionately as, on average, women hold about 90% of the jobs in the LTC sector. For instance, 45.5% of LTC workers work part-time in OECD countries (Figure 11.24.) In northern and central European countries, more than half of workers are employed on a part-time basis. Part-time work is particularly widespread among personal carers and home-based workers. The fact that basic LTC services are mostly needed for reduced hours at specific times of the day may contribute to explain such high rates. In addition, half of LTC workers experience shift work and almost one quarter are on temporary contracts. Further, while LTC tends to be demanding, both physically and mentally, pay is often low.
