Introduction: time to address the growing demand for long-term care workers

Long-term care (LTC) is a labour-intensive sector and a sufficient supply of LTC workers, with the appropriate skills and training, is critical to delivering high quality care. However, service managers and policy-makers across many OECD countries often find it difficult to recruit and retain LTC workers. Relatively low pay and difficult working circumstances discourage many from working in the sector. Turnover is high and retention is notoriously low, leading to shortages in some OECD countries.

With ageing populations and higher expectations driving increased demand for LTC, OECD countries will need to increase the number of LTC workers in the future. In this context, challenges around the recruitment and retention of LTC workers are set to become even more crucial to the availability of high quality LTC services, and to ensuring that people can expect to live a good life in old age.

In recognition of this challenge, several OECD countries have implemented policies to mitigate the risk of workforce shortages. This chapter looks at what they have done, and argues that, despite the hurdles, workforce challenges are surmountable, as long as policy-makers and employers take steps to improve the dismal image of caregiving as low-paid, hard, and low-skilled work. Ensuring an adequate supply of care for the future may well require a ‘new’ vision for LTC workforce policies, one that is about improving LTC job quality.

Better jobs will mean a better quality of care, but may also mean a higher unit cost. This could be offset by productivity improvements, and this chapter offers an overview of possible approaches to productivity and discusses what options have been implemented to date. There is, however, a lack of robust evidence as to what works and a need for more research in this area.

Like the other chapters in this book, this chapter starts by presenting a brief framework that defines LTC care workers, and reviews empirical evidence on the supply of care workers across OECD countries. LTC workforce policies are then discussed, drawing from recent OECD analysis and other academic literature. The chapter presents the main policy options before discussing the merits of each and highlighting approaches that seem to be working successfully in countries – although the lack of systematic evaluation often limits the scope for generalisation.