NEUJOBS WP 12 Health care, goods and sevices for an ageing population
Societal Change, Care Need and Long-term Care
Workforce in Selected European Countries
Johannes Geyer
2nd NEUJOBS Validation Event: Employment 2025 - How Will Multiple Transitions Affect the European Labor Market?
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Long-term care workforce
• Long-term care is provided by informal and formal
caretaker
• Depending on the institutional settings, the long-term
care system relies more or less on formal care
• In most countries, informal care (family) is the main
source for people in need of care
• Demographic ageing increases the share of people in
need for care and – at the same time – decreases the
informal care potential
• The impact on the formal workforce depends on country
specific settings and assumptions on the future
development
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Research agenda
What is the impact of societal change on the demand for
and supply of formal care?
Detailed analysis for five countries
 Germany
 Denmark
 Italy
 Poland
 Slovakia
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4
Tasks
A
Employment situation in institutional long-term care
and professional home care services
B
Impact of demographic change
C
Impact of changing household structures, family
structures and living arrangements on the demand
for formal care
D
Impact on employment
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Outline
1
2
3
4
5
Need of care and care giving arrangements
Long-term care workforce – current situation
Future development of factors influencing the long-term care
workforce and demand for care; and changes in labour supply
Discussion
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Dependency rates (in %) by age groups in selected countries (2010)
70.0
60.0
Denmark
Germany
Italy
Poland
Slovakia
50.0
40.0
30.0
20.0
10.0
0.0
15-24
6
25-34
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35-44
45-54
55-64
65-74
75-84
85+
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Age-structure of the dependend population in selected countries
(2010)
100%
11
90%
14
80%
31
30
29
20
21
31
34
30
19
17
17
Poland
Slovakia
All
34
48
70%
60%
35
19
19
50%
18
40%
33
30%
21
41
20%
10%
17
12
Germany
Italy
0%
Denmark
0-44
7
45-64
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65-74
75+
Denmark: 0.37 Mio.
Germany: 7.9 Mio.
Italy: 3.1 Mio.
Poland: 2.5 Mio.
Slovakia 0.48 Mio.
Total: 14.3 Mio.
1
Formal and informal care arrangements
Total
(in 1000)
2010
Denmark
371
Germany
7847
Italy
3143
Poland
2490
Slovakia
475
Total
14326
Total
2010
46,5
31,0
31,3
3,6
24,6
26,5
Formal care recipients
at home
in institutions
2010
2010
34,6
11,9
21,4
9,6
19,0
12,3
0,1 ***
3,5
17,6
7,0
17,4
9,1
*) 2003; **) 2010;***)2006.
Source: Eurostat, EU SILC; OECD Health Data; calculation of DIW Berlin.
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Total
53,5
69,0
68,7
96,4
75,4
73,5
Informal or no care
Informal Care
No Care
2010
2010
5,0
48,5
41,5
27,5
128,4
*
0,0
48,8
47,6
12,0
** 63,4
59,9
26,7
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Informal caregiver
Denmark
Germany
Italy
Poland
Males Females Total Males Females Total Males Females Total Males Females Total
Share of people aged 50+ providing
regular personal care to
someone inside the
household
3,79
5,52
4,60
5,14
7,58
6,31
7,23 10,44
8,88
personal care to someone
outside the household
0,66 1,35 1,03 1,36 3,85 2,72 2,89 6,07 4,64
almost daily
Source: SHARE wave 1 and 2 (Poland wave 2 only); pooled data, weighted; calculation of DIW Berlin.
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8,59 10,58
9,66
1,26
2,49
3,42
2
Long-term care workforce – current
situation
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Employment in residential care and social work activities I
Country
Human health and social work activities
Total economy
Human health Residential care Social work without accommodation Total
Total nuring homes Total
for elderly and disabled
Employment in 1000 persons
EU27
13243
4521
1381
4876
1465
22640
217182
Denmark
188
122
200
509
2703
Germany
2855
1110
491
891
311
4855
39737
Italy
1268
223
86
203
74
1694
22967
Poland
705
96
20
123
43
924
16131
Slovakia
108
27
6
25
20
160
2351
Share of sectoral employment in total economy in %
EU27
6,1
2,1
0,6
2,2
0,7
10,4
100
Denmark
7,0
4,5
7,4
18,8
100
Germany
7,2
2,8
1,2
2,2
0,8
12,2
100
Italy
5,5
1,0
0,4
0,9
0,3
7,4
100
Poland
4,4
0,6
0,1
0,8
0,3
5,7
100
Slovakia
4,6
1,1
0,3
1,1
0,9
6,8
100
Source: Eurostat; LFS; calculation of DIW Berlin.
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Employment in residential care and social work activities II
• In 2011 about 80% of all employees in residential care
and social work were females (EU average)
• In the selected countries, their share ranges from 70% in
Germany to more than 90% in Slovakia
• The share of older workers (55+) is about 16% (EU
average). In the selected countries:
• Nursing homes: 9% (PL) 27% (SVK)
• Social work: 12% (IT) 18% (PL)
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Future development of factors
influencing the long-term care
workforce
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Demographic development
• Rising life-expectancy
• Constant dependency rates: an increase in life-expectancy leads
to a higher share of people with impairments in ADL
• Fertility rates
• Have an influence in the long-run on the informal care potential;
but less relevant for the projection until 2025
• Changing living arrangements
• Constant age/gender-specific probability of being a caregiver,
taking into account changing living arrangements
• Increase in single households (exception SVK with a decline in
single households)
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Demographic devolpment 2010 – 2025 (by demographic scenario)
2010
2025
Changes 2025/2010 Changes 2025/2010
Friendly
Tough
Friendly
Tough Friendly Tough
in 1000
in 1000
in 1000
in %
Oldest old (80 years old and older)
Denmark
228
312
261
85
34
37,2
14,9
Germany 4.181
6.197
5.169
2.016
988
48,2
23,6
Italy
3.478
5.091
4.356
1.613
878
46,4
25,3
Poland
1.257
1.627
1.333
370
75
29,4
6,0
Slovakia
147
207
171
60
24
40,6
16,0
Total
9.291
13.435
11.290
4.144
1.999
44,6
21,5
EU27
23.284
32.587
27.489
9.303
4.205
40,0
18,1
Source: Huisman et al. (2013); calculation by DIW Berlin.
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People (65+) with impairments in ADL in selected countries 2010 2025
2010
Changes 2025/2010 Changes 2025/2010
Friendly
Tough
Friendly Tough
in 1000
in 1000
in %
65+
Denmark
90
110
118
20
28
22,6
31,8
Germany
3909
4316
4844
407
935
10,4
23,9
Italy
2085
2516
2787
431
702
20,7
33,7
Poland
1254
1679
1853
425
598
33,9
47,7
Slovakia
235
322
353
87
119
37,3
50,6
Total
7572
8943
9955
1370
2383
18,1
31,5
Source: Huisman et al. (2013); EU SILC; calculation of DIW Berlin.
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2025
Friendly Tough
in 1000
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Changes in the number of informal caregiver (50+)
2010
Denmark
Germany
Italy
Poland
90
2 476
2 704
1 385
Denmark
Germany
Italy
Poland
21
864
1 090
325
Denmark
Germany
Italy
Poland
70
1 612
1 615
1 061
Changes between 2010 and 2025
2025
friendly
tough
friendly
tough
friendly
tough
in %
in 1000 persons
Informal caregiver total
17,52
12,27
16
11
106
101
16,11
10,21
399
253
2 875
2 729
25,81
20,59
698
557
3 402
3 261
10,83
4,55
150
63
1 535
1 448
Informal caregiver outside the household
11,48
7,60
2
2
23
22
13,42
9,64
116
83
980
948
26,26
22,35
286
244
1 376
1 333
7,68
4,49
25
15
349
339
Informal caregiver inside the household
19,30
13,65
13
9
83
79
17,55
10,52
283
170
1 894
1 781
25,50
19,39
412
313
2 027
1 928
11,80
4,56
125
48
1 186
1 109
Source: SHARE wave 1, 2, and 4; weighted and pooled data; Huisman et al. 2013; calculation of DIW Berlin.
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Changes in number of recipients of formal care 2010 - 2025
Changes between 2010 and 2025
2010
friendly tough friendly
tough
tough friendly
in %
absolute
Recipients of institutional care
35,0
15,0
15
6
57
48
42
39,4
17,8
293
132
875 1 036
743
44,9
26,3
159
93
513
447
354
26,6
15,2
37
21
177
161
140
26,1
17,7
10
7
46
43
37
Recipients of formal home care
32,0
17,5
57
31
234
208
177
36,3
16,5
209
95
785
671
576
26,0
15,9
155
95
752
692
597
37,5
20,1
56
30
205
179
149
46,2
34,6
12
9
38
35
26
Recipients of cash benefits for informal care at home
24,7
9,9
292
117
1 182 1 299 1 474
498
26,3
17,5
15
10
72
67
57
2025
Countries
Denmark
Germany
Italy*
Poland
Slovakia
Denmark
Germany
Italy*
Poland
Slovakia
Germany
Italy*
Slovakia
*) In Italy most severe disabled persons receive a special transfer (universal cash benefit) to
cope with the care expenditure which is often used to engage privat financed caretakers.
Source: Schulz (2013); Coda Moscarola (2013); Golinowska et al. (2013); Radvansky and
Lichner (2013); calculation of DIW Berlin.
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Countries
Changes in demand for formal long-term care workforce (national
statistics)
2010
2025
Friendly Tough
Denmark
140
163
Germany
952
1117
Italy*
334
387
Poland
72
84
Slovakia
25
31
*) Only staff in residential care
185
1318
420
93
33
Friendly
in 1000
24
165
53
11
6
Changes 2025/2010
Tough
Friendly
Tough
in %
46
366
86
20
8
17,06
17,33
15,87
15,77
21,83
32,62
38,45
25,75
28,08
30,56
Source: Schulz (2013); Coda Moscarola (2013); Golinowska et al. (2013); Radvansky and Lichner (2013); calculation
of DIW Berlin.
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Changes in employment between 2010 and 2025 (NEMESIS)
Employment by sectors - results of the NEMESIS model
Employment (in 1000)
Residential
Health care
Human
care and
Non market and social
health
social work
Country
total
services
work (Q)*
(Q86)*
(Q87+88)*
Changes between 2010 and 2025 tough scenario
Denmark
-1
64
33
11
22
Germany
-3 459
-246
-355
-309
-47
Italy
-323
-999
-292
-214
-79
Poland
-531
358
91
69
21
Slovakia
83
4
1
1
0
total
-4 231
-818
-523
-441
-82
Changes between 2010 and 2025 friendly scenario
Denmark
107
126
64
22
42
Germany
161
2020
491
132
359
Italy
2 149
- 18
-5
-4
-1
Poland
810
1 016
258
197
61
Slovakia
251
96
25
19
5
total
3 478
3 239
832
366
466
*) Estimation of DIW Berlin with the exception of Germany.
Source: Boitier, B., Lancesseur, N. and Zagamé, P. "Global scenarios for
European socio-ecological transition", NEUJOBS Deliverable D9.2, 2013, for
scenarios results; calculations of DIW Berlin.
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Changes in demand for long-term care workforce and supply of
residential care and social work 2010 - 2025
Tough scenario
Friendly scenario
demand*
supply**
demand*
supply**
Denmark
17,1%
6,6%
32,6%
12,9%
Germany
17,3%
-2,7%
38,5%
20,9%
Italy***
18,7%
-17,7%
31,2%
-0,3%
Poland
15,8%
9,9%
28,1%
28,1%
Slovakia
21,8%
0,9%
30,6%
18,8%
*) Demand for formal long-term care workforce based on
national statistics. -**) Results of the NEMESIS model for the
sector non-market services; Germany for residential care and
social work.-***) Change in dependent people as a proxy for
formal labour demand.
Sources: Boitier et al., 2013; Schulz, 2013; Coda Moscarola, 2013;
Golinowska et al., 2013; Radvansky and Lichner, 2013;
calculation of DIW Berlin.
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Discussion
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Summary & Discussion I
• Projection of demand and supply of long term care workforce
• Assumptions:
• constant utilization rates
• No behavioral adjustments
• No changes in the long-term care system
• Informal care remains the main pillar of the long-term care system in
all countries with the exception of Denmark
• We expect an increase of dependent people until 2025; the number
of potential carer increases as well.
• The supply of formal care has to increase by 17% (tough) or 35%
(friendly)
• In general: the demand for long-term care grows stronger than labor
supply in this sector
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Summary & Discussion II
Possible strategies to increase the supply of long-term care
in the future:
a) Measures to increase informal care
b) Measures to increase the formal care workforce
c) Recruitment of long-term care workers from abroad
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Summary & Discussion III
a) Measures to increase informal care
•
Improve reconciliation of employment and informal care provision
•
Training, counselling
•
Increase the share (and amount of care provided) of male caregiver
b) Measures to increase the formal care workforce
•
Making jobs more attractive: wages, flexible working hours, reduction
of part-time jobs, career opportunities
•
Increase productivity by using more ICT
c) Recruitment of long-term care workers from abroad
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Vielen Dank für Ihre Aufmerksamkeit.
DIW Berlin — Deutsches Institut
für Wirtschaftsforschung e.V.
Mohrenstraße 58, 10117 Berlin
www.diw.de
Dr. Anika Rasner
Phone: +49 30 89 789 235
Email: arasner@diw.de