To accompany this issue, a special event was hosted by the Prospect in which various activists, writers and caregivers discussed family care, child care, elderly care, paid family leave to provide care, and long term support for caregiving services.
This event featured:
David Dayen, executive producer for the Prospect
Lynnea Redmon-Williams, a caregiver working fulltime
Tasmiha Khan, Prospect contributing writer
Rhacel Salazar Parreñas, Professor of sociology at the University of Southern California
Brittany Gibson, Prospect writing fellow
See the video below for the entire discussion:
This blog was authored by Jenn Brown, CWE-GAM Communications Assistant
OECD Health Policy Studies has released a 2020 report “Who Cares? Attracting and Retaining Care Workers for the Elderly.” This report addresses a number of important issues while acknowledging the tremendous impact that COVID 19 has had on elderly people and their caretakers. Across OECD countries, more than one out of every six individuals is above the age of 65, and of those roughly 60% live with multiple chronic conditions, making them even more susceptible to the potentially deadly impacts of the virus. Furthermore, many elderly individuals struggle with sufficient access to social support and lack the ability to properly deal with the mental strain of living in a world being affected by a global pandemic.
Beyond these strains, there is a crisis in workforce shortcomings of the Long Term Care (LTC) Sector, which becomes even more problematic in light of the fact that an estimated 50% of COVID 19 related deaths are occurring in LTC facilities. This OECD report begins by addressing many of these shortfalls within the LTC sector, and policies that have the potential to address them.
Within three-quarters of OECD countries, the aging population has outpaced the workforce within the sector since 2011. This is the case even in the countries that have a higher workforce supply than the OECD average such as Japan and the U.S. Within the sector, women make up 90% of the LTC workforce. Attracting a younger workforce has been particularly difficult, and on top of that maintaining workers over the age of 50 is also a challenge. This is even more concerning given that the median age of LTC workers is currently 45.
Many OECD nations have made moves toward relocating their elderly out of facilities and back into the community. This is provoked by the desire to match the preferences of their elderly populations with home-based care, in addition to containing LTC spending. However, a lack of home-based workers has made this challenging, and LTC institution-based workers remain representative of the sector’s workforce across the OECD. This is in large part due to the fact that these institutions cater to the most disabled, which requires a larger workforce. Furthermore, many community-based solutions are not yet equipped to take in these types of complex cases.
The aging of the postwar “baby boom” generation is a factor that will contribute to the increased need for LTC workforce. This also contributes to the predicted increase in labor shortages in the sector to meet the needs of this population going forward. Further, unpaid informal care workers, like that of family members that would care for this aging population, have seen an increase in their own professional workload burdens. When the workload of professional life and caretaking becomes too great, LTC facilities are a means in which to relieve some of that strain. Additionally, as birth rates decline, families become smaller and more women are pursuing professional endeavors, the availability of informal caregivers for the aging population decreases looking into the future. This contributes to another foreseen LTC workforce shortage in the future.
These shortages call for an increase in recruitment within the LTC sector. As the sector workforce ages, attracting younger workers has proven difficult as they, mostly women, are drawn to sectors that have a more appealing image such as a child or hospital care. Additionally, LTC jobs are still widely considered to be feminine positions, and the sentiment on this subject matter has been slow to change.
Foreign-born workers play a significant role in recruiting and retaining LTC workforce. They are highly over representative within LTC across the OECD when compared to other care sectors, and many of them are young, Often, they tend to come into the sector with high levels of skill sets, even overqualified. Micro-econometric analysis has shown that in the U.S. and the UK, these foreign-born workers have higher retention rates than others within the sector.
In terms of recruitment, drumming up interest in the available positions is also problematic. In some cases, many vacancies receive no applications at all. On top of this, recruiters often have a difficult time identifying qualified candidates out of those that do apply.
In order to address this, many countries have focused on four main policies:
– Target recruitment to the traditional pool
– Improve the Image of the sector
-Recruit outside the traditional pool
-Increase the recruitment of for foreign-born workers
Overall, better policies are needed in order to improve recruitment within the LTC sector, and thus far few OECD nations have implemented policies in order to do so. By addressing these issues addressed within the first section of this report, there is potential for effective improvement.
Attitudes towards family care are changing. Only 27% of Koreans surveyed in 2018 agreed that the family is responsible for elderly family member care. As for population aging, the middle age group of Korean society is becoming a true “Sandwiched Generation” (supporting both unmarried children and elderly parents) due to the longevity increase among elderly parents and postponement of marriage among the young generation. In addition, caring for grandchildren by the young elderly group is becoming more prevalent as the number of employed married women has increased in recent decades. To respond to this family burden, Long Term Care Insurance for the Elderly (LTCI) has been expanded since 2008. Statistics of the LTCI program show a stiff increase in care provision for supporting the daily lives of elderly who suffer from physical and mental ailments.
Cha & Moon (2019) investigate the nature of family care in the context of expanding public care provision. Using the 2018 Family Survey for Child and Elder Care, the authors assess the role of family care and how family members take part in the changing elderly care process. Family caregivers spend, on average, about 8 hours a day providing care to elderly family members on caring days, or about 50 hours a week. However, the average preferred number of hours for care is 24 hours per week, almost half of the actual care hours. Those who are classified as mildly or severely over-caring tend to live with their elderly family member, partly because the elder family member has a severe limitation in their Activities of Daily Living (ADL) and is unlikely to spend more than 3 hours per day alone.
On the other hand, care givers whose hours matched their desired hours are relatively young and the employment rate is higher than among other types. Compared to this matched case, over-caring is more common when attentiveness is required, when the caregiver perceives the necessity to take on greater responsibility for the elderly care recipient, and when time consuming care tasks are needed to care for the elderly family member. The authors speculate that the different types of care arrangements—under-caring, matched, and over-caring—appear to represent the sequential process of elderly care, from making regular care-visits to constantly ‘being there’ next to the recipient.
This paper will be available December 2019.