• There are five long-term care workers per 100 people aged over 65, and the sector urgently needs to retain and recruit more staff, according to a new report.
  • But by 2050 there will be 1.2 billion people aged over 80 in the OECD nations.
  • As populations across much of the developed world continue to age, the provision of sustainable, effective long-term care will become more pressing.

By 2050, there will be 1.2 billion people older than 80 living in the 37 OECD nations. That’s up from 57 million in 2016.

Formulating plans that will meet the long-term care (LTC) needs of this growing section of the population is set to be one of the biggest challenges facing governments.

Currently, there is a ratio of five long-term care (LTC) workers per 100 people aged over 65. Unless there is a significant attempt to retain and recruit more staff into the sector, there will not be enough carers to look after everyone who needs help.

That’s the stark conclusion of an OECD report titled Who Cares? Attracting and Retaining Care Workers for the Elderly. In it, the OECD warns there needs to be a rethink of LTC, to protect both the people who work in the sector and those they look after.

In over three-quarters of OECD countries growth in LTC workers per 100 elderly people has stagnated or decreased.
Recruitment of new staff into the sector has stalled in many OECD countries.
Image: OECD

Care during a pandemic

As COVID-19 has swept through the world's care homes it has laid bare many of the challenges the sector faces.

Older adults needing LTC often have compromised immune systems or chronic conditions that put them at a higher risk of severe complications from the disease. The report says that it’s estimated up to 50% of deaths related to the virus have been in LTC facilities.

Some of the safety failures that led to this situation, it adds, could have been prevented with more investment in staff training, working conditions and prioritizing care quality and safety.

“The poor record in protecting care workers from COVID-19 is likely to make more people question whether working in the sector is for them,” the report states.

Retain and recruit

The report also finds LTC work to be poorly paid and lacking in career development opportunities. While the median wage for LTC workers is just over $10 per hour, equivalent roles within the hospital sector pay almost $16 per hour. Combined with the need to work unsociable hours, the prevalence of temporary contracts and the perception of the job as being low-status, the LTC sector faces a challenge attracting and retaining staff.

Japan, home to the world’s oldest population, arguably has a greater incentive than most to focus on LTC. It increased the size of its LTC workforce by 20% between 2011 and 2015. But since 2011, just half of the OECD member countries have developed strategies to boost recruitment into the sector, according to the report.

Trends in the share of the population aged over 80 years, 1990 - 2050
Japan leads the way for ageing populations.
Image: OECD

The report highlights work done in Norway and the UK to attempt to widen the appeal of work in the LTC sector to men, while other countries have been more focused on training programmes. The US and France are two countries that have increased rates of pay.

Perhaps unsurprisingly, the report finds that increased pay leads to improvements in recruitment and retention. But it cautions against simply raising wages in the hope that will make things better. Unless care centres are adequately staffed and resourced with the funds to do so, increased pay could be offset by reduced headcount. This would in turn put more pressure on staff.

LTC workers are mostly middled-aged women with a high share of foreign-born workers in some countries.
Who cares? Mostly middle-aged women.
Image: OECD

Creating healthier working environments is cited as another important goal for the LTC sector, along with the prevention of workplace accidents and taking steps to protect staff from illness.

Technology and value-for-money

From monitoring patients to recording data, there is an important role for technology in the care sector. The OECD report highlights the use of assistive technology like alarms and sensors in Estonia, Norway and the Netherlands.

There are examples elsewhere among OECD countries of more ambitious uses of elder-care tech, particularly in Japan. The Shin-tomi nursing home in Tokyo has around 20 different types of robot, according to a Reuters report from 2018. Some are humanoid in shape, while others are designed to resemble small animals and act as companions.

Robots won’t always be the most appropriate course of action, however. Other countries favour bringing together teams of people with complementary skills to improve overall LTC outcomes. In the US and Portugal, for example, “multidisciplinary teams help co-design and co-decide care plans to support the elderly,” the OECD report says. While in Australia, the families providing their own informal LTC services have been given access to tools and platforms to keep them connected to external agencies.

As populations across much of the developed world continue to age, the provision of sustainable, effective LTC will become more pressing. The report also notes that few countries have made it a priority to help those receiving care to maintain their independence for longer. But with more people living longer, that may have to become a more widespread approach.