Health policies and data

Long-term care workforce: caring for the ageing population with dignity


Across OECD and EU countries, long-term care (LTC) systems are under pressure to adapt. The demand for elderly services will probably continue to increase - projections point towards an increase in number and share of people aged over 65 in the next decades - raising concerns over financial sustainability. Elderly preferences are also changing. Seniors do not want only to see maximised their remaining days; they are calling for better quality of life in their later years. They want care services that respect principles of dignity and well-being and is provided closer to home and their loved ones.

As a labour-intensive sector, the productivity and sustainability of LTC services highly depend on the existence of an effective and efficient workforce. Achieving the latter is an important challenge. Despite higher demand for LTC expected for the coming decades, barriers to recruiting and retaining suitable skilled staff prevail. Workers competencies developed through education and training do not always match LTC tasks, which raises questions around productivity. Many countries do not yet have comprehensive strategies for the professionalisation of LTC workers and career progression paths are limited.

The OECD examines barriers to and policy options for promoting a stronger LTC workforce. Some of the themes analysed include education and training, recruitment and retention, productivity and use of technology, coordination between social and health workers, and coordination between formal and informal workers.


Key insights

The number, competency and type of professionals providing LTC services varies greatly across countries, and so do their policies. For instance:

  • In several countries LTC workers do not receive a specific education or training to work in this sector
  • While in some countries the stock of LTC workers is extremely low and LTC spending has been cut in recent years, in others the situation is considerably less alarming
  • Low pay, high turnover and part-time work remain key features of many LTC labour markets, and working in this sector is still not attractive
  • Several countries still rely on informal workers – such as families and friends – to provide LTC services
  • Evidence on productivity improvements in LTC labour markets continue to be sparse, despite attempts to introduce ICT, reorganise work processes and delegation of tasks to lower cadres
  • Coordination across health and LTC settings remains an important challenge in ensuring quality and continuity of care services

Low numbers of carers relative to population aged 65+ persist in most countries
Number of LTC workers per 100 people aged 65 and over, in 2011 and 2016 (or nearest year)


Notes: EU-Labour Force Survey (LFS) data based on ISCO 4 digit and NACE 2 digit.1. Based on ISCO 3 digit and NACE 2 digit. 2. Interpret with caution as sample sizes small. 3. The decrease in the Netherlands partly due to a methodological break in 2012, as well as reforms.
Access the data.
The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.
Source: EU-LFS and OECD Health Statistics 2018, with the exception of the Quarterly LFS for the United Kingdom and the Current Population Survey (ASEC-CPS) for the United States; Eurostat Database for population demographics.

Documents and resources


Who Cares? Attracting and Retaining Care Workers for the Elderly 

June 2020 - This report presents the most up-to-date and comprehensive cross-country assessment of long-term care (LTC) workers, the tasks they perform and the policies to address shortages in OECD countries.
It highlights the importance of improving working conditions in the sector and making care work more attractive and shows that there is space to increase productivity by enhancing the use of technology, providing a better use of skills and investing in prevention.
Population ageing has outpaced the growth of workers in the long-term care (LTC) sector and the sector struggles with attracting and retaining enough workers to care for those dependent on others for care. Non-standard work is widespread, pay levels tend to be lower than similar-qualification jobs in other health sectors, and LTC workers experience more health problems than other health workers.
Further, educational requirements tend to be insufficient to perform more demanding and growing tasks of LTC. With growing demand for care at home, better co-ordination between the health and long-term care sectors and between formal and informal careers is needed.


Help Wanted? Providing and Paying for Long-Term Care 

May 2011 - This book examines the challenges countries face with regard to providing and paying for LTC. With populations ageing, the need for LTC is growing rapidly. Future demographic trends, policies to support family carers, ways to improve the supply and retention of LTC workers, financing arrangements, LTC insurance, and getting better value for money in LTC, are increasingly important.

This book shows that: the growing need for LTC has significant financing and labour-market implications, paying more attention to the needs of family carers is a win-win approach, all OECD countries need a system providing formal LTC services, LTC workforce challenges appear manageable, moving towards universal LTC benefits is desirable irrespective of financing model, and with growing cost pressure, seeking better value for money in LTC is a priority.



A Good Life in Old Age? Monitoring and Improving Quality in Long-term Care 

June 2013 - As ageing societies are pushing a growing number of frail old people into needing care, delivering quality long-term care services – care that is safe, effective, and responsive to needs – is a priority for governments. Yet much still remains to be done to enhance evidence-based measurement and improvement of quality of LTC services across EU and OECD countries.

This book shows that: external regulatory controls are the most developed quality assurance approach but enforcement might be lenient, settings standards based on best practices is not widely done, market-based and care co-ordination approaches are an appealing option to incentivise consumers, providers and payers, and there is evidence and examples of useful experiences to help policy makers, providers and experts measure and improve the quality of LTC services.


Measuring social protection for long-term care 

March 2017 - This report presents the first international quantification and comparison of levels of social protection for LTC in 14 OECD and EU countries. Focusing on five scenarios with different LTC needs and services, it quantifies the cost of care; the level of coverage provided by social protection systems; the out-of-pocket costs that people are left facing; and whether these costs are affordable.

This report shows that when designing social protection systems for LTC, countries need to look systematically at the level of protection provided to people in different scenarios. Many countries aim to support people with LTC needs to remain in their own home for longer, but the results presented here suggest that gaps in social protection make this unaffordable for people with low income. Addressing these gaps should be a priority for future reforms.



Health at a Glance 2021: OECD Indicators
November 2021 - Our flagship statistical publication includes a special chapter on Ageing and long-term care.

Care Needed: Improving the Lives of People with Dementia
June 2018 - This book is the most recent and comprehensive cross-country assessment of the state of dementia care in OECD countries, including a discussion of how to better support families and informal carers.

Preventing Ageing Unequally
October 2017 - This book examines how the two global mega-trends of population ageing and rising inequalities have been developing and interacting, both within and across generations, showing that inequalities in education, health, employment and earnings compound, leading to large differences in lifetime earnings across groups. It includes a section on the costs of LTC and the effectiveness of social protection.

The Pursuit of Gender Equality: An Uphill Battle
October 2017 - This book shows that gender inequalities persist in all areas of social and economic life and across countries. It includes sections illustrating how women are more likely than men to: need LTC and for longer periods, have lower labour market participation, earn less over their lifetimes and have lower pensions, be informal and formal carers of people with LTC needs.

Background information

The OECD and the European Commission are carrying out a joint a project on LTC workforce. This project aims to develop a better understanding of LTC workforce in these countries, and the policies that are needed to develop a workforce that can meet the LTC needs of ageing populations now and in the future. More specifically, the project will:

  • Analyse the current situation in EU and OECD countries, in terms of the size and composition of the LTC workforce, as well as trends and projections based on various sources of data
  • Identify the challenges and policy issues that must be tackled in order to ensure that the LTC workforce is fit for purpose now and in the future based on a questionnaire and selected interviews
  • Review the policies and reforms that countries have put in place to address the challenges identified, and the evidence that exists on the effectiveness of different strategies

The following definitions are used:

  • LTC DEFINITION: Long-term care (health and social) consists of a range of medical, personal care and assistance services that are provided with the primary goal of alleviating pain and reducing or managing the deterioration in health status for people with a degree of long-term dependency, assisting them with their personal care (through help for activities of daily living, ADL, such as eating, washing and dressing) and assisting them to live independently (through help for instrumental activities of daily living, IADL, such as cooking, shopping and managing finances).
  • SCOPE OF LTC WORKFORCE: The LTC workforce consists of a mix of professions with different levels of training and different functions at home or in institutions (hospital care is NOT included). The roles and skills of professions vary between countries, even for professions with similar names, making it difficult to define LTC workers by their job title. Instead the LTC workforce should be defined by the work that they do. 

Contact us

For any queries on the Long-term care workforce workstream, please write to Ms Ana Llena-Nozal:

Small follow us Twitter icon Follow us on Twitter via @OECD_Social


Related Documents