Long term-care protection for older persons
27
Figure 10. LTC Staff access deficits as percentage of the population aged 65+, selected European
countries, 2015 Threshold 4.2 formal LTC workers FTE per 100 persons aged 65+
Source: ILO estimates, 2015; OECD, 2014.
3.2.3. The reliance on unpaid informal LTC workers is unacceptable
While formal LTC workers are at the centre of the few international debates that exist on LTC, they are only providing a small percentage of the bulk of care giving currently
provided: In some countries, such as Austria, it is estimated that about 80 per cent of care is covered informally BMASK, 2011. The very high numbers of informal care workers
reflect the gaps in the formal workforce.
Informal LTC services are carried out by paid andor unpaid LTC workers that work in private homes and are not declared to tax or social security authorities. This group
includes professional workers as well as family members, neighbours, friends and others. Reasons for informally employing LTC workers in private homes are often related to
the severe gaps in availability of formal LTC workers and the high costs and difficult administrative procedures involved in private employment of formal LTC workers. Thus,
the reliance upon informal LTC workers often arises from the absence or under funding of publ
ic LTC schemes. It often results in impoverishment of the “employers” – older persons andor their families
– despite low wage payments. Figure 11 provides an overview of the number of currently available informal care
workers per 100 persons aged 65 years of more. The wide range within regions is striking. In the Americas, for example the United
States we find nearly 123 informal LTC workers per 100 persons aged 65+ as compared to about half of this number
– some 61 informal LTC workers – in Canada. In Asia and the Pacific, countries such as Australia have nearly 84 informal care workers per 100 aged
65 years and older as compared to 4.8 in New Zealand. In Europe, figures range from just 2.3 informal care workers per 100 older persons in Denmark compared to as many as
nearly 145 informal care workers in the Netherlands.
49.4 73.5
22.9 56.6
90.4 73.5
10 20
30 40
50 60
70 80
90 100
28
Long term-care protection for older persons
Figure 11. Informal LTC workers HC per 100 persons 65 years and over in selected countries, 2014
Source: OECD 2014.
Thus, the quantity of the care work provided by informal LTC workers is by far exceeding those of the formal workforce
– even if we consider that informal LTC worker numbers are head counts as compared to full-time equivalents of formal LTC workers.
Paid informal LTC workers’ wages are usually far below those of formally employed LTC workers and working hours are often extreme, if specified at all, and usually not in
line with national legislation. In some countries they include a high share of migrant workers, such as in the Canada, USA, UK and Ireland Spencer et al., 2010, often due to
low payment and poor working conditions in their home countries.
However, the majority of the informal care workers are unpaid family members, often also aged 65 or more: Even in Europe with its smaller family sizes than in other
regions of the world, some 90 per cent of all informal care givers are relatives of the persons in need of LTC Leichsenring et al., 2013. In addition, informal care givers are
often providing care to more than one person for example to both parents Department of Health, UK, 1999.
Other than formal LTC workers, many of the informal care workers are not trained for giving care. In addition, they often spend as much time for giving informal care as
working in a part time job, sometimes in addition to full-time work in the formal sector. As a result, many informal family care workers experience a high degree of work-family
conflict:
For those who provide care and are additionally formally employed the risk of frequent absenteeism occurs: they are, due to ill health, more often absent from work
as non-carers Zuba and Schneider, 2013 and are likely to experience signs of burn- out.
83.8
21.4 23.2 60.9
17.6 2.3
20.7 19 13.3
35.5 37.2
3.3 144.9
4.8 87.2
23.9 8.6
4.9 12.8
55.6 122.8
20 40
60 80
100 120
140 160
In for
m al
LTC wo
rke rs p
e r
100 p e
rson s
65 +
