What Can We Learn from Europe’s Long-Term Care Challenge?

Our population is growing older worldwide –a demographic shift that’s compelling various countries to rethink how they’re supporting older people and how their long-term care sectors are structured and financed.

The eldercare workforce—direct care workers, in particular—are central to long-term care programs, yet many countries are struggling to recruit and retain enough workers to meet demand. (For example, PHI estimates that the U.S. will need to fill an estimated 8.2 million direct care job openings across settings by 2028.)

A recent report from the European Ageing Network (EAN) speaks directly to these issues, outlining a long-term vision for prioritizing long-term care and meeting the needs of older people throughout the European Union. (EAN is comprised of more than 10,000 long-term care providers—organizations and individuals—throughout the majority of Europe. These providers together support more than 1 million older Europeans.)

The report, Long Term Care 2030, aims to compel providers and provider associations throughout Europe to transform their long-term care systems and bolster services and supports for older people. The report provides a vision (and conceptual model) for improving long-term care in Europe by 2030, describing sector-wide challenges and offering recommendations.

I met the President of the European Aging Network, Dr. Jiří Horecky, when he presented the report’s findings at a September 2019 international summit of eldercare workforce leaders in Toronto, Ontario, hosted by the Global Ageing Network. (I presented on the U.S. direct care workforce at this gathering.) Horecky is one of six co-authors of Long Term Care 2030.

Robert Espinoza: Tell me about the history of the European Ageing Network.

Jiří Horecky: The European Ageing Network (EAN) was created in 2017, though that doesn’t mean it’s a brand-new organization. Behind EAN are two European organizations with a long history: EDE, the European Association of Directors and Long-Term Care Providers (since 1991) and EAHSA, the European Association of Services Providers to Elderly (since 2010).

Dr. Jiří Horecky, President, European Ageing Network (EAN)

RE: As noted in the report, Europe is incredibly diverse across countries, histories, and cultures—and its approach to aging services also varies by country. What are some of the common aging-related challenges faced by European countries?

JH: European countries do have very different histories, languages, and styles of living, but they face very similar problems regarding long-term care. We have shortages of staff—up to 1.5 million caregivers and nurses are needed right now. The costs of long-term care, health care, and social security are rising very fast due to the demographic change of aging. Also, family values are changing, we face urbanization, and families are increasingly fragmented. Because of all of this, the demand for social services is rising at a very rapid pace.

RE: You and your co-authors wrote that “governments are in denial” about what will be needed to properly support older Europeans in the years ahead. What are the roots of this denial?

JH: The problem with European governments is their short-term thinking. Politicians think mainly through their four-year terms in office. But for long-term care and aging issues, we need strategies and solutions beyond this period. In terms of strategies, we need to start with the assumption that there will not be one perfect approach to long-term care policy that will work throughout all of Europe.

RE: According to the report, average life expectancy at birth will continue to rise in Europe in the years ahead; from 2016 to 2030, life expectancy will increase from 83 to 85 years for women and from 77 to 80 years for men. In addition to a rapidly aging and increasingly older population, what are some of the other primary factors shaping the long-term care sector throughout Europe?

JH: One of the most important factors is the prevalence of dementia. The number of people in Europe living with dementia doubles every 20 to 25 years. That’s a huge issue in long-term care and generally in society. The other challenge is the “dependency ratio,” or the number of economically active people compared to older people. Whereas 15 to 20 years ago, that was ratio was 6 to 1, in just a few years, it will be 2 to 1, or two working people for every older person.

From ‘Long-Term Care 2030’

“Workforce related consequences and implications is the other key area where there will be major challenges and implications for management and organization.

• Suitably trained and qualified staff is becoming an increasing challenge and this involves major implications across the entire aged care sector.
• A major fact, with big implications, is that reliance on staff from other countries is not a sustainable option.
• New recruitment and training strategies need to be developed. “Care and Service” must be developed and promoted as professional work. This requires developing jobs/professions that have much broader skill sets than those that currently exist, including ‘nurses.’
• The sector needs urgent action now to re-invent itself. Major industry wide initiatives are critical to create a modern, positive, professional and career-based image of the sector.”

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RE: The report highlights several workforce-related challenges facing long-term care in Europe, including a general lack of “suitably trained and qualified staff.” What explains this problem?

JH: Compensation for caregivers is not good and the caregiving profession is marginalized in most European countries, which are some of the main reasons (among others) for this shortage. In response to this shortage, a few countries have resorted to hiring workers from other European countries, but that causes problems for the original “poorer” countries.

RE: In fact, you and your co-authors observed that European countries cannot rely for long on other countries to fill workforce shortages in long-term care. Why is that?

JH: One reason is that economic growth in central and eastern European countries is much higher than in the western European countries, which compels improvement in salaries and wages. In other words, those countries are offering more economically for their workers, and their citizens are slowly coming back from countries like Great Britain, Germany, and Austria, among others. We need other solutions, such as better compensation, programs that recruit workers from countries outside of Europe, and new models of long-term care provision.

From ‘Long-Term Care 2030’

“[T]he changes in role models and expectations outlined above need to be taken into account with appropriate new training material, while fresh images of the career of caring for the elderly need to be presented. Whereas in the past it was mainly traditional carers with nursing expertise that were required, in the future multi-professional teams will be needed to satisfy all these demands. Not only will nursing staff with expertise in geriatric care be required but also therapists, doctors, psychologists and social workers. In addition to financing the necessary structures, decision-makers must also take steps early on to ensure that suitably qualified workers are available on the labour market. Here again, it is important to appeal to the sense of responsibility of society and government, because the individual institutions themselves have only a limited capability to influence the situation.”

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RE: What has been the reception to Long Term Care 2030?

JH: The feedback has been positive, though it’s not a perfect solution for everyone in the long-term care sector. The report and vision are meant for providers and provider associations. We have also recently added policy recommendations to our vision. (Editor’s note: this updated version of the report can be accessed by contacting EAN directly.)

RE: Building on this report, what do you hope to accomplish over the next few years?

JH: The main goal of this report is to spark an expert discussion within the European Union and the different European countries about the future of long-term care. We are also working on a future report that will explore the main dogmas and prejudices shaping long-term care.

RE: What primary lesson could this report offer to long-term care leaders in the U.S.?

JH: The underlying problems, current threats, and future challenges in long-term care throughout Europe are not that different from what’s being discussed in the United States. Sharing knowledge, as well as innovative solutions and approaches, would benefit all of us.

Read the full report here.