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The provision of long-term care (LTC)
is a labour-intensive activity. The data on formal LTC workers presented in this section
refer to nurses as well as personal carers (i.e. other
LTC workers who do not qualify as nurses) who are paid to provide care and/or assistance
with activities of daily living to people requiring long-term care at home or in
institutions other than hospitals.
In proportion to the population aged
65 and over, the number of formal LTC workers is highest in Sweden and Norway. Portugal
and Italy have the lowest number (Figure 8.6.1). In some countries
such as Norway, Denmark, the Netherlands, Switzerland and New Zealand, a majority of
LTC workers provide care in institutions, even though most LTC recipients may receive care
at home (see Indicator 8.4 "Recipients of long-term
care" ). This can be explained at least partly by the fact that people
receiving LTC in institutions often have more severe diseases and limitations and require
more intensive care. In other countries such as Estonia, Israel, Korea and Japan, there
are relatively few LTC workers in institutions, and most formal care givers provide care
in the patient's home.
Most LTC workers are women and work
part-time. For example, in Canada, Denmark, Korea, New Zealand and Norway, over 90% of LTC
workers are women. Foreign-born workers also play an important role in LTC, although their
presence is uneven across OECD countries. While Germany has very few foreign-born LTC
workers, in the United States nearly one in every four care workers is foreign-born
(Colombo et al., 2011). In other countries,
foreign-born workers represent an important share of people providing home-based services,
including LTC services. This is the case, for instance, in Italy where about 70% of people
providing services at home are foreign-born (Colombo et al., 2011). The recruitment of foreign-born workers to provide LTC at
home or in institutions can help respond to growing demand, often at a relatively low
cost. But the growing inflows of LTC workers from other countries have raised some issues
in certain countries, such as the management of irregular migration inflows and paid work
which is undeclared for tax and social security purposes.
The mix between nurses and
lower-skilled personal care workers providing LTC services vary significantly across OECD
countries (Figure 8.6.2). On average, about 25% of formal LTC providers
are nurses, while the other 75% are personal care workers (who may be called under
different names in different countries, such as nursing aides, health assistants in
institutions, home-based care assistants, etc.). In some countries (e.g. the United States and Switzerland), qualified nurses
represent the bulk of formal LTC providers, while in others (Estonia and Korea), they
represent only a very small proportion of LTC workers. This wide variation may be partly
explained by institutional factors, such as public health insurance coverage in certain
countries that includes some LTC services (Switzerland) or a relatively high share of LTC
services provided in institutions where higher-skilled LTC workers are more likely to work
(the United States). Many countries are looking at possibilities to delegate some of the
tasks currently provided by nurses to lower-skilled providers to increase the supply of
services and reduce costs, while ensuring that minimum standards of quality of care are
maintained.
The LTC workforce still represents
only a small share of total employment, but this share has increased over the past decade
in many countries, along with the broadening of public protections against LTC risks and
increased demand stemming from population ageing. In Japan, the number of LTC workers has
grown by 9% per year since the implementation of the universal LTC insurance programme
in 2000, while there was a slight decrease in total employment in the economy during that
period (Figure 8.6.3). In contrast, in Sweden, the average growth
rate of LTC workers between 2000 and 2009 was much more modest, at only 0.3% per year.
Given population ageing and the
expected decline in the availability of family care givers, the demand for LTC workers as
a share of the working population is expected to at least double by 2050. A combination of
policies is needed to respond to this growing demand for formal LTC workers, including
policies to improve recruitment (e.g. encouraging more
unemployed people to consider training and working in the LTC sector); improve retention
(e.g. enhancing pay and work conditions); and
increase productivity (e.g. through reorganisation of
work processes and more effective use of new technologies) (Colombo et al., 2011).
Definition and comparability
Long-term care workers are defined
as paid workers who provide care at home or in institutions (outside hospitals). They
include qualified nurses (see definition under Indicator 3.7
"Nurses" ) and personal care workers providing assistance
with ADL and other personal support. Personal care workers include different
categories of workers who may be called under different names in different countries.
They may have some recognised qualification or not. 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. LTC workers also include family members or friends
who are employed under a formal contract either by the care recipient, an agency, or
public and private care service companies. The numbers are expressed as head counts,
not full-time equivalent.
The data for Germany exclude
elderly care nurses, formal workers working predominantly in administration, and
persons declared to social security systems as care givers, resulting in a substantial
under-estimation. The data for Italy exclude workers in semi-residential long-term
care facilities. The data for Japan involve double-counting as some workers may work
in more than one home. The data for Ireland refer only to the public sector.
Information on data for Israel:
http://dx.doi.org/10.1787/888932315602.
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| Indicator in PDF |
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| 8.6.1 Long-term care workers as share of population aged
65 and over, 2009 (or nearest year) |
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| 8.6.2 Share of nurses in relation to all long-term care
workers (nurses and personal care workers), 2009 (or nearest year) |
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| 8.6.3 Trends in long-term care employment and total
employment, 2000-09 (or nearest year) |
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