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This article was co-authored by Jisella Dolan, Chief Global Advocacy Officer of Home Instead, an Honor Company; Michael Hodin,CEO of the Global Coalition on Aging; and Francesca Colombo, Head of the Health Division at the OECD.
As we approach the first milestone report for the UN Decade of Healthy Ageing in the Fall of 2023, one powerful metric that cuts across all four of the Decade’s Action Areas—Long-term Care, Combatting Ageism, Age-friendly Environments and Integrated Care—is the state of the caregiving workforce, including home-based care workers.
A new summary report, Key Insights & Proposed Solutions From the Future of Care and the Caregiving Workforce: Lessons and Insights from the COVID-19 Experience—based on an expert workshop co-hosted by the Organisation for Economic Co-operation and Development (OECD), the Global Coalition on Aging and Home Instead, an Honor Company—gives us a roadmap for how the Decade’s milestone report should link to professional caregiving.
Of the multiple takeaways from the discussions, the most dramatic is the urgent requirement to increase the caregiving workforce. Given that demand far outweighs supply today, the rapid increase of older adults in need of care into mid-century will explode into crisis territory. More aging adults means a shrinking size of the labour market: jobs will be harder to fill. Continuing to improve the skills, training and value of workers is an absolute necessity, but more is required to elevate the role.
The demand for increasing our capacity to care also represents a push for smart investments in the home care sector, including better training and skill development and targeted applications of innovative technology. Home care is already one of the fastest growing sectors of OECD economies, and is a key component in the growing USD 17 trillion-dollar silver economy. Now is the time to act.
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It's estimated that OECD countries will need to add 13.5 million new care workers by 2040 to maintain the current care ratio. This requires a sector-wide transformation. As the 2021 workshop and report find, countries must elevate public perceptions of long-term care; develop high-quality standards and training; equip caregivers with the right tools; and provide a great job experience.
In short, it’s time to reframe and reimagine care. Care must rapidly become a valued, better skilled profession at the forefront of one of the most important issues of the 21st century. Our long-term care workforce is of incredible importance to maintain the health of older people, especially in their homes. We must grow and support today’s caregiving workforce to ensure that quality care can be assured for all of us in the future.
These advances aren’t just a nice-to-have or an altruistic gesture—they’re key to sustaining national budgets and health care systems. As policymakers, international organisations, care systems, and the private sector consider the path ahead, transforming long-term care and elevating its workforce should be a critical focus in line with the four pillars of the Decade of Healthy Ageing:
- Fight ageism by recognising the skill and value of care workers. For too long, professional caregiving has been perceived as “low skill”— a corollary of the widespread ageism that sees older people as “low value”. In fact, care workers have a tremendous set of both technical and soft skills, including emotional intelligence, communication, flexible thinking and resilience. In line with the World Health Organization’s global campaign against ageism, societies should recognise these skills to help attract and retain caregivers. Efforts like the OECD’s Beyond Applause campaign and upcoming analysis provide an important model to honor caregivers far beyond their extraordinary efforts following the COVID-19 pandemic.
- Embrace caregiving within integrated care for older people (ICOPE) guidance. The long-standing divide between medical care and long-term or social care is as unwise and unjust as it is unsustainable. Consider that between 36% and 88% of primary care providers across a selection of OECD countries did not frequently co-ordinate care with social care services. Yet these caregivers are ideally situated at the front line for better monitoring, earlier detection and more effective diagnosis and intervention for age-related health conditions, from osteoporosis and cancer to cardiovascular disease and Alzheimer’s. More closely integrating long-term care with health care, including through ICOPE guidance, can harness this potential—part of the wider shift to a 21st-century “predict and prevent” model. The caregiver, alongside technology and traditional health care, should be at the center of this 21st century health ecosystem—one that is also fiscally sustainable in an aging world.
- Provide long-term care where people want it: at home. The COVID-19 pandemic has underscored the essential role of home-based care and healthcare moving to the home. It’s not only more cost-efficient but also the preferred option for the majority of older people. The Decade calls for better access to high-quality long-term care, and home-based care is central to ensuring that access—supported by training, standards and technology to empower caregivers. As Home Instead’s Jeff Huber states: “We are coming into the largest demographic shift of its kind, and home is the only scalable place to take care of ageing adults”. We are learning how to do this, and how national and local budgets could spend their resources effectively implementing it.
- Position the care workforce as the heart of age-friendly communities. The role of care workers extends far beyond the tasks that they perform. They also provide social connection, a regular routine and assistance with mobility, so older people can continue to live and stay active in their communities for longer, even if their intrinsic capacity begins to decline. Therefore, investments in the long-term care workforce are also investments in healthy, multigenerational communities and societies.
OECD countries are fast approaching a future where there are more old than young; in fact, one-in-ten people will be over 80 by 2050. The systems and assumptions that guided care for the past 100 years will not continue to work today, and certainly won’t tomorrow. But this also presents an incredible opportunity: to reimagine long-term care, to support the health and independence of older people, to create a vibrant, attractive employment engine, and ultimately to strengthen and enrich our aging world.