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:
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.
Japan, Korea and Germany introduced universal, mandatory public long-term care insurance (LTCI) as their populations began to age. LTCI is a social insurance program that covers the cost of care in case people need assistance to manage their daily living activities. In these countries LTCI covers a broad range of activities for daily living associated with aging and disability, from light home-helper services to intensive institutional care. The coverage is available for any level of care need, not simply for the most severe cases of disability.
These countries serve as good examples of countries that have paved different paths by focusing on the continuum of care, public insurance system and regulations. Japan, Korea and Germany share a couple of basic principles in the set-up of the financial mechanisms for LTCI:
1) a universal public social care system dedicated to LTC; and
2) a continuum of care system, starting from light home-based services all the way to intensive institutional care.
In developing LTCI, governments also developed regulations to cover how care needs could be assessed and by whom, who can provide care and under what conditions, the costs of care services, and the training, skills and wages of care workers. Government regulation is also important to ensure good-quality, accessible LTC.
With COVID-19, we see that the benefits of the continuum of care principle extend beyond economics and quality of life: this approach also removes people from the types of multi-residential locations that are most prone to the rapid spread of infection.
Many of our international peers have been more active and thoughtful with LTC policies than Canada, and we have lots to learn as we go about reforming our LTC systems. This system would help people with activities of daily living where they need it, and it would not cost the government much more than what it is spending now. Further, Canada also needs to develop a better set of regulations if we want to ensure good-quality and accessible LTC for all.
Original article “We can draw lessons from countries with strong long-term care system” was published in Policy Option, the digital magazine by the Institute for Research on Public Policy (IRPP), June 5, 2020.
This article is part of the Facing up to Canada’s long-term care policy crisis special feature.