OECD Report: Urgent, Caregiver-centered reform in care sector needed to avoid worker shortage


OECD Report: Urgent, Caregiver-centered reform in care sector needed to avoid worker shortage

The high mortality rates in nursing homes during the COVID-19 pandemic has exposed severe and structural deficiencies in long-term care systems around the world, and as a result, the sector is unprepared to meet future demand without reforms. A new report of the Organization for Economic Cooperation and Development (OECD): Who Cares? Attracting and Retaining Care Workers for the Elderly, recommends improving working conditions in the sector to attract more workers and keep care receivers safe.

The recommendations in the report (summary below) are largely in line with the reforms UNI Global Union is calling for to improve the care sector for workers and care receivers. UNI believes social dialogue and expanded collective bargaining necessary steps to improve the working conditions and retention of workers. Additionally, the union is demanding improved safety through training and access to personal protective equipment. The elder care system remains inadequately funded and regulated, a problem COVID-19 deaths brought into sharp relief. Appropriate funding for staffing would not only raise the quality of long-term care, it would provide much needed employment in a key sector of the economy. The long-term care would benefit from a set of global guidelines and minimum standards to ensure resiliency and better working conditions.

“Decent pay, advancement opportunities and union representation are a must in a sector that needs to put life at the center and acknowledge the vital role that front line care workers play in our societies,” said General Secretary of UNI Hoffman. “Governments and employers around the world have now an opportunity to improve working conditions in long-term care by partnering with care unions in dignifying a sector that for millions of elderly and sick patients operates as the first line of defense against COVID19.”

The report outlines the deplorable systemic problems that exist in our long-term care systems and recognizes that without improving workers compensation, staffing levels and health and safety protocols the sector will be woefully unprepared to provide decent care for the growing elder population or face a future pandemic.

“The COVID-19 pandemic is exposing the failed long-term care policies of the past – understaffing, poor working conditions, low-pay, job insecurity, inadequate public funding and minimal social protection. The message that we are bringing to the OECD should be clear: the care workers who have risked their lives in the front lines aren’t only indispensable actors in our economies, they should be at the center of any plan to promote social cohesion and inter-generational solidarity,” said Pierre Habbard General Secretary of  The Trade Union Advisory Committee (TUAC) to the OECD.

The report comes on the heels for increased scrutiny of conditions in care. Across Europe last week, care workers protested demanding improvements to pay and conditions.

Key Finding of OECD report: Who Cares? Attracting and Retaining Care Workers for the Elderly:

Care workers are underpaid, overworked and endure poor working conditions

  • Pay is 35% lower than in the acute care system for the same job, part-time work is almost twice as prominent, and temporary work is also prominent.
  • Almost 20% of long-term care workers have a temporary contract.
  • The report profiles long-term care workers as 90% women, 20% foreign-born, and 70% of long-term care workers are personal carers with low entry requirements, with 56% working in institutions and the rest in individual homes.
  • Long-term care work is among the most physically and mentally demanding, 60% report being exposed to physical risk factors, 46% are exposed to mental well-being risk factors (including violence from care receivers, as well as sexual harassment.)

Care receivers suffer the consequences of the poor working conditions that caregivers have to endure;

  • Workers cannot provide high-quality care unless they have decent working conditions.
  • Lack of continuity in staffing also affects quality of care (i.e. casual and temporary staffing has negative impact on care receivers.)

The care sector is facing a work shortage tsunami

  • Workforce will need to increase by 13.5 million by 2040 to keep up with current ratios.
  • If countries wish to keep the current ratio of caregivers to the elderly population, they need to more than double the current number of long-term care workers. For some countries, such as Luxembourg and Korea, long-term care worker numbers need to increase by 100% or more.

OECD Recommendations:
Working conditions will need to improve to meet demand

  • Investment is needed to improve overall worker conditions which will inherently improve resident and client care standards, this includes pay, training opportunities, and worker safety
  • Increases in pay improve retention and ability to attract new workers.
  • Safety standards related to appropriate and sufficient skill-mix workforce could be developed and enforced to ensure that minimum standards are met.
  • To ensure an adequate level of care, some countries have requirements regarding staffing standards related to the number of workers needed.

Improved social dialogue and access to collective bargaining

  • Collective bargaining and social dialogue can help to implement comprehensive policy measures, including on pay, training and working conditions.
  • Long-term care workers often lack representation and therefore have little collective bargaining power to negotiate better conditions.
  • Need to adapt the legislative and collective bargaining framework for self-employed workers who deliver long-term care at home.

Unions can ease access to training for workers

  • Jurisdictions which allow workers to bargaining directly with the government see more concrete improvements for all workers (U.S. home care workers in Illinois and California won the right to bargain directly with these states, which are considered to be the “employer for the purpose of bargaining”, and have achieved wage increases.


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