Elderly people and their care workers have been disproportionately affected by the COVID‑19 pandemic. Older adults and those with multiple chronic conditions or health risk factors are at a significantly higher risk of severe complications from the disease than other groups, and indeed most of the deaths have been among the elderly. Across the OECD, more than one in six people are older than 65, with 60% of them living with multiple chronic conditions. In addition to the added health risks, certain elderly people significantly struggle to access social support, or to cope with the mental strains provoked by the COVID‑19 crisis.

The COVID‑19 crisis is hitting the long-term care (LTC) sector very hard, both because of the large numbers of people dependent on care falling ill and because of the added exposure of LTC workers to infections. The pandemic is highlighting LTC’s structural problems in terms of insufficient staffing, poor job quality and insufficient skills, all of which have a toll on quality of care and safety.

This introductory chapter provides an overview of the entire report, drawing on the analyses carried out in the five subsequent chapters. It documents the difficult working conditions many workers in the sector face and the training gaps, given the relatively complex tasks they have to perform. It also highlights the likely shortfall in the long-term care (LTC) workforce, given the rising in demand and little attractiveness of the sector. The chapter also stresses how these structural shortcomings have been fully exposed during the COVID‑19 pandemic. It also looks at policies implemented across OECD countries to improve recruitment, training and retention. The report discusses how improvements to working conditions and skills are important to attract and retain workers while improving the quality of care, particularly to address safety. Strengthening co-ordination and increasing effectiveness will also help OECD countries to face the rising demand for LTC while ensuring early recognition of infections and other safety risks.

This chapter explores recent trends in the long-term care (LTC) workforce and the demographic characteristics of LTC workers, and outlines recruitment policies to attract LTC workers in OECD countries. It shows that in most countries the LTC workforce supply has increased more slowly than the number of people aged over 65, and that countries expect shortages of workers in the future. The chapter highlights the predominance of female workers and personal care workers and the important of foreign-born workers in some countries, together with the relative importance of institution-based workers. Several policies could be implemented to find new workers and address the shortfall: widening the pool of applications to recruit younger workers, unemployed people and men; targeting the traditional pool; and improving the image of LTC. However, only half of the countries studied have implemented policies or reforms in any of these directions since 2011.

This chapter presents new analysis of the tasks and functions of long-term care (LTC) workers, providing a comparative overview of what workers do and how this varies across OECD countries. The tasks and knowledge required are compared with their training and education requirements to assess skills gaps. The chapter concludes by discussing policies to improve training and skills: both initial training and life-long learning.

This chapter reports new analysis on tenure and working conditions for long-term care (LTC) workers. It highlights in particular the fact that LTC workers tend to have lower than average tenure, and quantifies the extent of non-standard work, low pay and health problems among LTC workers in OECD countries. The chapter also identifies policy options to address challenges in working conditions that may thereby contribute to retaining workers in the LTC sector. These include measures on wages, social dialogue, occupation health and improving workers’ autonomy.

This chapter explores recent policy developments to improve co-ordination between the long-term care (LTC) and health care sectors, and their effect on the LTC workforce. In the coming years, LTC services will be more people-centred and organised nearer to communities; they will also require closer interaction with health services and family caregivers, as elderly people develop more complex needs and suffer more chronic diseases and other disabilities. The chapter discusses how countries are trying to provide more integrated care between hospital and home care, and what this means for workers in terms of their skills and care models. It also discusses the changes towards more teamwork and case management to provide LTC co-ordinated services at the community level. Finally, it highlights changes to leverage the help of family carers by increasing co-ordination with formal LTC workers and supporting family carers.

This chapter discusses innovative solutions to help long-term care (LTC) workers achieve more by increasing their productivity and increasing prevention effort to delay a worsening of LTC needs. Such policies are important to allow LTC workforce focusing on essential care and make the best use of their skills. The chapter discusses three important axes of action – use of technologies, improving the skill mix and helping elderly people to age healthily – and their implications for the current LTC workforce. The analysis finds that, while such policies hold the promise of improved outcomes, workforce barriers in terms of skills, allocation of tasks and worker engagement also need to be addressed.