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OECD puts spotlight on low pay and poor working conditions in long-term care

27 June 2023

The OECD has today published a report on long-term care workforce, highlighting low pay and poor working conditions, and makes a number of recommendations to reduce staff shortages and high staff turnover in the sector.

The ‘Beyond Applause’ report finds that across OECD countries

  • Care workers earn only 70% of the average national hourly wage. A quarter of long-term care workers earn less than 54% of the average wage. In Latvia, the United Kingdom, Estonia, Portugal, Poland and Lithuania the wage of care workers was lower than 60% of the average wage in 2018.
  • Taking into account factors that might lead to lower wages – eg education, tenure, hours worked and gender – care workers earn 12-16% less than similar workers.
  • Women workers in the sector are paid 7-8% less than their male colleagues with similar characteristics.
  • Three quarters of care workers report physical health risks (heavy loads, tiring and painful positions) compared to 59% of all employees. Two-thirds of care workers report mental health risks (workload, time pressure, difficult patients) compared to 43% of all employees.
  • Over one-quarter of LTC workers are on fixed-term contracts in Japan, Poland, Spain and Sweden

The report makes a number of useful recommendations, including:

  • Increasing wages, including by raising the national minimum wages (where they exist) and/or sectoral minimum wages (OECD cite Australia, Germany, Latvia as having done so recently.
  • Reducing workloads (for example by raising the staff to client ratio as Finland did this year from 0.5 workers per client to 0.7).
  • Public funding for long term care on condition of staff being covered by collective bargaining (OECD cite Germany as an example of this).
  • Governments to set up a forum for social dialogue at the national level to discuss issues and find shared solutions.
  • Supporting collective bargaining and social dialogue by encouraging union membership through tax policy (OECD mention Norway, Sweden and Finland as doing this) and by extending collective bargaining to all long-term care workers (OECD mentions the examples of Belgium, France, Italy, Germany, Australia).

“The OECD has done everyone a service by highlighting the problems in long-term care and making recommendations to improve the attractiveness of working in that sector. Their report deserves attention and follow-up action to rebalance the bargaining power of workers in almost every OECD country.”

— Veronica Nilsson, Acting General Secretary, TUAC

“Taking care of our loved ones is not something that should be done on the cheap” says Veronica Nilsson, Acting General Secretary of TUAC (the Trade Union Advisory Committee to the OECD). “Despite the applause during the COVID pandemic, long-term care remains in crisis with low pay, poor working conditions, and a high turnover and shortages of staff.



See OECD Beyond Applause report here Key facts and figures (Infographic) | Beyond Applause? Improving Working Conditions in Long-Term Care | OECD iLibrary (