Long-term care workers
All OECD countries offer some degree of formal LTC to assist people in need of care in their daily activities. Care is provided by LTC workers, who are defined as paid staff – typically nurses and personal carers – providing care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals.
In 2021, there were on average 5.7 LTC workers per 100 people aged 65 and over across the 23 OECD countries for which data were available, ranging from 12 in Norway to 0.8 in Portugal (Figure 10.18). While almost all countries have seen an increase in LTC workers in terms of headcounts, the number of LTC workers per 100 people aged 65 and over has, on average, slightly decreased over time, from 5.9 per 100 in 2011 to 5.7 per 100 in 2021. This trend was observed in just under half of countries with time trend data, with decreases over 20% in the Netherlands, Estonia, the United States, Hungary and Ireland. This is indicative of increased supply of LTC workers not keeping pace with greater demand caused by rapidly ageing populations. In contrast, 13 of the OECD countries with available data saw an increase in LTC workers per 100 population aged 65 and over, with the largest increases in Portugal and Korea.
The demand for LTC workers will increase in the years to come due to population ageing and changing patterns of informal care. At the same time, the LTC sector is facing longstanding difficulties in meeting demands for supply. The COVID-19 pandemic has exacerbated these shortages. The LTC sector is characterised by poor working conditions, including low wages, high physical and mental risks, non-standard employment, as well as low recognition (OECD, 2023[1]).
LTC workers are predominantly women: a share of 80% or higher are female, and earn on average 20% less than the economy-wide average wage (OECD, 2023[1]). Non-standard employment is common in the LTC sector. In 31 OECD countries that reported data, the share of LTC workers in part-time employment amounted to 37% on average, with 66% of the LTC workforce in Korea, Iceland, Germany, the Netherlands and Australia working in part-time arrangements. Moreover, every eighth worker across 31 OECD countries worked on a fixed-term contract basis (Figure 10.19). This is particularly common in Australia, Spain and Sweden, where more than one-quarter of the LTC workforce works under fixed-term contracts.
Low salaries among personal care workers have long been identified as a major challenge for recruitment and retention in the sector. Across 28 OECD countries in 2018, both care workers in facilities and those working in personal homes made substantially less than the average wage, with workers in facilities earning just 71% of the average gross hourly wage, and home-based care workers earning just 67% of the average gross hourly wage (Figure 10.20). Wages were highest in the Netherlands, where care workers earned more than 90% of the country’s average gross hourly wage regardless of the location of their work, and lowest in the United States, where care workers earned just half (51%) of the country’s average gross hourly wage.
Educational and training requirements are particularly low for personal care workers, while a mismatch between education and skills needed – such as specific geriatric training, health monitoring and co-ordinating care – can negatively affect the quality of care delivered. Beyond low salaries and employment instability, limited access to training and education and career prospects might lower the attractiveness of the LTC profession. Several countries have introduced policies to improve the skills match between LTC workers and the tasks they perform to address this (OECD, 2020[2]).
LTC workers are defined as paid workers who provide care at home or in institutions (outside hospitals). They include qualified nurses and personal care workers providing assistance with ADL and other personal support. Nurses include both professional and associate professional nurses – International Standard Classification of Occupations 2008 (ISCO-08) classifications 2 221 and 3 221. Personal care workers (ISCO-08 classifications 5 321 and 5 322) include various categories of workers, who may be called different names in different countries. Because personal care workers may not be part of recognised occupations, it is more difficult to collect comparable data for this category of LTC workers across countries. Data from OECD Health Statistics 2023 also include family members or friends who are employed under a formal contract by the care recipient, an agency or public and private care service companies. They exclude nurses working in administration. The numbers are expressed as headcounts, not full-time equivalents. Some LTC workers might hold multiple part-time positions.
Average hourly wages are calculated for personal care workers, referring to those included in ISCO-08 category 53, which groups together personal care workers and childcare workers. Nomenclature of Economic Activities (NACE) sectors are 85 – education, 86 – healthcare, 87 – residential care and 88 – non-residential care. For the United States, the category home health and personal care aides (SOC 31-1 120) identifies personal care workers. Calculations are based on 2018 EU Structure of Earnings Survey (SES) data, and 2021 Occupational Employment and Wage Statistics (OEWS) Survey data for the United States (OECD, 2023[1]). For some countries, the sample size is small, affecting the comparability of the data.
References
[1] OECD (2023), Beyond Applause? Improving Working Conditions in Long-Term Care, OECD Publishing, Paris, https://doi.org/10.1787/27d33ab3-en.
[2] OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/92c0ef68-en.
Source: OECD Health Statistics 2023.
Note: Personal care workers are those included in ISCO-08 category 53, which groups together personal care workers and childcare workers.
Source: OECD calculations based on 2018 EU-SES data, and 2021 OEWS Survey data for the United States.