Book Review: Who Cares? Attracting and Retaining Care Workers for the Elderly

Abstract

This study was prepared and published at the onset of the COVID-19 pandemic and its themes have become all too familiar over the past 18 months. Elderly care and its workforce have been disproportionately impacted by the pandemic. Workers in the sector have faced terrible circumstances and many elderly people and their carers have lost their lives prematurely. The pandemic has confirmed the fragility and structural problems in the provision of long-term care around the world and exacerbated the recruitment and retention challenges that are the focus of this study. At the same time, the pandemic has focused more public attention on those who provide care, bringing a previously invisible low status workforce into the limelight. This has generated an EU commitment to a new European Care Strategy and prompted many reports looking at the employment and working conditions in long-term care. Nevertheless, the challenges facing the sector remain acute (European Commission, 2021; Kessler et al., 2020). The study looks at the evidence base and considers best practices for stemming the crisis in long-term care. It draws on survey responses and interviews with country delegates, supplemented by national data, EU Labour Force Survey data and additional literature. It considers the situation of long-term carers for the elderly who provide their services to recipients at home or in institutions. These carers comprise two main occupations, nurses and personal care workers. In OECD countries over 70 per cent of long-term care workers are personal carers. In a context of rising demand for care and the shift of care from hospital to community settings, care demand is outstripping the supply of long-term care workers, and workforce shortages will worsen without urgent action. In the aggregate, OECD countries need to more than double the current number of longterm care workers to maintain existing ratios of caregivers to the elderly. These structural challenges stem from insufficient recruitment and retention, connected to low status, poor pay and working conditions, inadequate training and limited attention to skill acquisition and deployment. Staff shortages have a severe impact on quality of care, including unmet care needs and unnecessary hospital admissions. The study details the main characteristics of the workforce, which comprises predominantly middle-aged women, with a high share of foreign-born workers. Foreign-born workers make a vital contribution and represent over 20 per cent of the OECD countries’ long-term care workforce. They are overrepresented in the care sector and are susceptible to exploitation, for many reasons. These include their employment and immigration status, for example, as undeclared workers hired privately by households and because compliance with employment regulations, such as minimum wage provisions, is uneven. Part-time working, often on an involuntary basis, is also significant. 109998010999801099980 TRS0010.1177/10242589221099980TransferBook Reviews book-review2022