OECD calls for improved pay and status for long term care workers

The influential Organization for Economic Cooperation and Development (OECD) has released a new report (Help Wanted? Providing and paying for long-term care ) that concludes that   aging populations in developed countries will cause spending on long term care to double or triple by 2050.  Spending on long-term care currently accounts for 1.5% of the economy in developed countries.

The growth in demand for long term care leads the OECD to conclude that pay and working conditions in long term care (including home care) must improve:

"Major reforms to attract more care workers and retain them in the sector should be put in place quickly. Most long-term care careers are dead-end jobs with a high turnover and low pay and benefits....Upgrading the status of the long-term care workforce by improving pay and working conditions is key."

These conclusions are particularly striking as the OECD is tightly tied to ruling elites, and is generally known for being boss-friendly rather than worker-friendly. 

Less surprisingly, the OECD raises the idea of privatization: "Countries have to spread the burden of such high costs, either by targeting universal benefits to those most in need of care or via public-private partnerships.  Private insurance could play a role in some countries... but is likely to remain a niche market unless made compulsory."

As well, the OECD is concerned about the impact of rising LTC costs on government, and is particularly keen to limit "institutional" long term care (i.e. nursing homes or homes for the aged):

Governments will need to find a balance between offering access to good-quality care and making their systems financially sustainable.... Around 70% of long-term care users receive services at home, but spending in institutional care accounts for 62% of total spending. Respite care, encouraging part-time work and paying benefits to family carers can all be cost-effective policies, reducing demand for expensive institutional care.

This line of thinking has already come to Ontario:  LHIN and government officials claim that up to 30% of people now in LTC facilities should be at home, and have slowed the growth of long term care facilities (even as wait lists for LTC beds explode).  

The OECD report also includes some information regarding Canada: 

  • In 2010, about 13%  of Canada’s population is aged over 65 (OECD average 15%), and about 3.5%  over 80 (OECD average 4%).
  •  In 2006, Canada’s expenditure on long term nursing care was equivalent to about  1.5% of its gross domestic product (about the OECD average).  More than 80% of these expenditures were  targeted to institutional care -- and that is significantly higher than the OECD average of 62%. 
  •  In 2008-09, about 0.7 % (250,000 individuals) of the Canadian population resided in an institution, of which about 75 % were 65 years and older. The 238,000 individuals are equivalent to about 4% of the population over 65.
  •  In 2008-09, there were approximately 4,850 residential care facilities across Canada with 270 000 approved beds.  Of these beds, about 217 000 were approved for homes for the aged.  
  • In 2006, more than 2.5 % (875,000 individuals) of the population reported receiving home health care and home support; about 60% of this group received home health care only.
  • In 2006, about 160,000 nurses and personal carers worked in the long-term care (LTC) sector on a full-time basis and close to 70,000 on a part-time basis.
  • Canada has a young and small LTC private insurance market.  In 2007, about 276 000 individuals (roughly 1% of the total population) subscribed to a long-term care insurance (75% as part of a group insurance plan).  A total of about $65 million (Canadian) was paid in premiums while about $9 million  in benefits were paid.

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