Health and Healthcare Systems

We need to reform the care sector and put workers at its centre 

Care workers and residents of the Scisset Mount Care Home react during the last day of the Clap for our Carers campaign in support of the NHS, following the outbreak of the coronavirus disease (COVID-19), Huddersfield, Britain, May 28, 2020

The pandemic has underlined the need for reform in the care sector Image: REUTERS/Molly Darlington

Christy Hoffman
General Secretary, UNI Global Union
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  • Demand for care services is only going to grow - but underinvestment and poor levels of pay mean recruiting and retaining staff is tough.
  • The pandemic has brutally revealed the sector's existing issues.
  • The time for reform is now. Here's what we need to do.

The COVID-19 pandemic has exposed long-existing dysfunctions in our healthcare systems and is forcing governments, employers and unions to re-evaluate, rethink and improve the quality of care that citizens everywhere expect. Policy-makers will need to start listening to those workers who for years have been demanding changes to our extremely fragile care systems. This is especially true when it comes to long term and home care.

It is no secret that as our population ages, the need for long-term care and long-term care providers will grow exponentially. A report released by the OECD last month found that by 2040 this global workforce will need to expand by 13.5 million. In some countries, like South Korea and Luxembourg, the number of workers would have to grow by at least 100% percent just to keep up with their ageing populations.

Currently, however, underinvestment in the sector has created grim working conditions that have made retaining and attracting new workers extremely challenging to this physically and mentally demanding profession.

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In the US, the median hourly wage of home health workers is roughly $10 an hour. This low wage and the precarious nature of their employment – with a lack of guaranteed hours and part-time schedules – is pushing one-in-four home care workers below the federal poverty line. Half of long-term care workers in the US rely on government anti-poverty assistance programmes. Across Europe, long term care givers earn 35% less than those in the acute care system for the same job.

Even worse, workers in many countries do not have paid sick leave, and are too-often forced to make a choice between their families’ financial survival and their physical health – an impossible decision when you are living paycheck to paycheck.

During the pandemic, the lack of personal protective equipment (PPE) was a particularly serious problem in long-term care globally. For example, nursing home workers in Austria struggled to gain access to proper protections at the beginning of the pandemic. In New Zealand, home care workers only received adequate PPE through union pressure on the government and employers. Nursing homes in the US reported nationwide shortages of PPE months after the first wave of coronavirus crashed onto the country. Across Africa, face masks and hand-washing supplies have been extremely limited.

In this critical moment, delay in protections has had disastrous consequences. Nearly half of all European deaths occurred in care homes, many of them care providers. In the United Kingdom, roughly half of the healthcare workers who have died worked in long-term or home care. In the hard-hit US state of New York, 37,500 nursing home staff members – one in four of the state’s 158,000 nursing home workers – were infected with COVID-19 between March and early June 2020.

By helping patients maintain independence, being a connection to the outside world, and administering vital medical treatments, long-term care work is rewarding. But improving the quality of patients’ lives does not allow many long-term care workers to earn a decent living. Many of these workers must work long hours at multiple facilities or clients to piece together a living income, which could expedite inter-facility or inter-household spread of the virus. Some workers are fearful of losing their jobs when they report problems, and so without job security, they feel unsafe reporting any issues they might be experiencing –especially those without a union.

The proportion of deaths from COVID-19 in care homes by country, as of late May
The proportion of deaths from COVID-19 in care homes by country, as of late May Image: The Economist

This workforce is mainly female and, in many cases, is composed of immigrants or racial and ethnic minorities. Many of these communities have been particularly impacted, both economically and health-wise by the virus, making the need to uplift their working conditions and wages even more urgent.

It is obvious if we do not address these fundamental flaws, we will not achieve sustainable change.

The systemic problems that exist in our long-term care systems will not be resolved unless we recognize the need to improve workers' compensation, staffing levels, and health and safety protocols. Without worker-centred reform, the sector will be woefully unprepared to provide decent care for the growing elder population or to face a future pandemic. That presents a risk to us all.

Care providers and care receivers alike need a solution now. We cannot wait for the pandemic to end to improve working conditions for essential workers. Decent pay, better staffing, safe workplaces, and union representation are a must in a sector that puts life at its centre, and would acknowledge the vital role that frontline care workers play in our societies.

Governments and employers around the world now have an opportunity to improve working conditions in long-term care. By partnering with care unions, they can instil a new level of humanity and dignity to a sector that – for millions of elderly and sick patients – operates as the first line of defence against COVID-19 and the crises to come.

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