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Resilience of the Long-Term Care Sector: Early Key Lessons Learned from the Pandemic

Resilience of the Long-Term Care Sector: Early Key Lessons Learned from the Pandemic

Our colleague, let’s call her Petra, works in an elderly residential care home owned by a multinational private care provider. Like many care workers, she is still suffering from the impact of the COVID-19 pandemic on her physical and mental health.

During the pandemic her workload increased due to the spread of the virus amongst staff. This made the already difficult working conditions even harder. At the same time, being unable to care for the residents to a dignified standard led to an overwhelming sense of failure, betrayal, and powerlessness, resulting in psychological distress. Many of Petra’s colleagues have now left the profession, and despite her moral commitment to the role and the residents she cares for, it is becoming increasingly hard for her to see a future in the sector.

Petra’s case is not unique. Her story is one of many care worker testimonies collected for the Global Day of Action for Care Workers. Since 2019, over 421,000 residential care workers have left the sector across the EU-27. Many care workers were infected with COVID-19 and several thousand died. In Europe, Amnesty International and the European Federation of Public Service Unions (EPSU) estimate that at least 4,100 health and care workers in 26 European countries died in the first year of the pandemic. Hundreds of thousands more are now suffering from long-Covid.

On the occasion of the Global Day of Action for Care, EPSU has published a new report to better understand what happened in the care sector in the EU, the problems encountered and how such a tragedy can be prevented in the future.

The epicentre of the pandemic

The neglect of long-term care facilities in the beginning stages of the pandemic was felt by workers and residents alike. As one report on COVID-19 in the care sector pointed out: “The conditions of work are the conditions of care”. Faced with staff shortages, a lack of clear guidance, and without proper protective equipment, residential care facilities quickly became the epicentre of the pandemic.

The vulnerability of elderly people, and especially long-term care residents, to COVID-19 was evident from the outset of the pandemic. The severity of the disaster which would soon overwhelm Europe’s long-term care sector was anticipated from mid-March 2020, as shocking images emerged of Spanish nursing home residents left dead in their beds. During the first months of the pandemic, it has been found that the death rate of elderly long-term care residents across 12 OECD countries was 24.2 times higher than the death rate of older persons living in the community.

Initial government responses to the pandemic largely prioritised health care over social care. In long-term care facilities, most measures were implemented on an emergency ad-hoc basis, which proved insufficient. Strategies to minimise the risk of introducing COVID-19 into long-term care, and to minimise the risk of transmission within facilities have been criticised as equating to “no more than bans on visits to care homes.”

In many cases, the closure of nursing homes to outside visitors led to the confinement and isolation of residents, creating conditions of neglect, while also compounding workloads and staffing shortages. In Belgium for example, Amnesty International has criticised the detrimental effects of blanket policies to close facilities to all visitors, without regard to individual risk assessment, describing this as an abuse of human rights.

But the tragedy that occurred in Europe’s long-term care facilities is not simply a result of inadequate responses to the outbreak of COVID-19. The capacity of care services to respond to this unprecedented crisis was severely undermined by over a decade of privatisation, underfunding and austerity, staff shortages, low pay, and precarious working conditions. Indeed, the failures of governments to adequately respond to the pandemic served to exacerbate and expose the pre-existing structural weaknesses of Europe’s long-term care services, that public service trade unions have long been criticising.

A tragedy waiting to happen

Perhaps the biggest challenge facing the long-term care sector is staff shortages. For more than a decade, the growth of the care workforce has seriously lagged behind growth in the demand for care. In turn, inadequate staffing levels have had a negative impact on the attractiveness of the sector, and have led to low levels of recruitment and retention. In Belgium, employers are becoming desperate, appearing on the news and talk shows to plead for more flexibility and migration. There are now 150 Indian nurses working in Flemish care homes.

Inadequate staffing levels correlate directly with increased risks of COVID-19 in long-term care facilities. Where there are fewer staff members per care recipient, there is a higher chance of care workers contracting and transmitting the virus to others. In the US, nursing staff shortages, measured both in terms of total hours per resident and registered nurse hours per resident, were associated with higher COVID-19 cases. Similarly, in the UK, where there were 10% more beds per staff member, there was a 23% higher infection rate.

Another associated weakness of the long-term care sector is the prevalence of precarious contracts and lack of sick pay in some countries. Again, poor working conditions equate directly to poor services and increased risks. Figures from England show that care homes relying on temporary agency staff had 1.58 times higher infection rates among residents, compared to care homes not using temporary agency staff.

One reason for low staffing levels and poor working conditions is that austerity driven policies and for profit care provision have prioritised cost-cutting over quality services and workers’ rights. In fact, private care provision is also found to have increased the risks from COVID-19. For example, in Canada, for-profit nursing homes were found to have nearly double the odds of an outbreak, and 78% more resident deaths compared with non-profit homes.

Transforming the care sector

A report on long-term care prepared by the EU Commission and endorsed by the EU Council calls for systemic reforms in the sector, based on the lessons learnt from the pandemic. The need to reform long-term care from a human rights perspective was also reflected in the positions of the Human Rights Commissioner of the Council of Europe, covering 47 European countries.

It is clear that addressing workforce shortages needs to be a priority, both in the EU and across Europe. This is one of the key recommendations of the Pan-European Commission on Health and Sustainable Development, made for 53 countries in the WHO European Region. Decisive measures aimed at improving working conditions – starting with significant wage increases and needs-based staffing levels – are required to increase the attractiveness of the sector and reverse the growing staff shortages. We expect this to be addressed in the European Care Strategy, recently announced by European Commission President Von der Leyen.

Trade union involvement is essential to ensure that, as the long-term care sector continues to grow, it develops in a way that is fair for both recipients of care, and care workers. To ensure this, EPSU and the Federation of Social Employers recently submitted a joint request for the establishment of a Sectoral Social Dialogue Committee for Social Services. We are ready to play our role as EU level social partners.

The big elephant in the room is funding. It is important that governments increase funding for improved working conditions and staffing levels in national budgets, and stop awarding public funds to private care providers that prioritise profit over quality care. For this, the EU economic governance rules need to be changed.

We cannot return to austerity if we believe in developing accessible and affordable care for all. The human rights of the elderly, people with disabilities, and others in need are not goods for sale.

On the Global Day of Action for Care Workers, trade unions called for improved working conditions, safe staffing levels, and trade union representation across the sector. Without these systemic changes, care workers such as Petra cannot provide the quality services they so deeply want to provide, for the people we all care about.

By Jan Willem Goudriaan (EPSU General Secretary) and Tuscany Bell (EPSU Policy Assistant for Social Services)


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