Elderly Care Skills Observatory

National Data

Data date of extract 08/2024
🇪🇺 EU Level
Demographic The share of the population above 65 years old in the EU is expected to increase from 20% in 2019 to 29% by 2080 and the percentage of people above 80 years will more than double to 13% in that time. A rapidly ageing population leads to an ever-growing need for long-term formal and informal care.

Link/source: EIGE (2019) Gender equality and Long-Term Care at home
In 2017, one in four people in the EU had a long-term disability, a greater number of that group being women (27%) than men (22%).

Link/source: EIGE (2019) Gender equality and Long-Term Care at home
In the EU, while women enjoy a higher life expectancy – 83.5 years compared to 78.3 years for men (a difference of 5.2 years in 2017) – this advantage is partially offset by the fact that women spend more years in ill health. According to data from 2016, for example, women in the EU spent, on average, approximately 20 years of their lives in poor health compared to 16 years for men.

Link/source: EIGE (2019) Gender equality and Long-Term Care at home
In 2014, an average of 20% women and 14% of men aged 75 and over in the EU used home care services.

Link/source: EIGE (2019) Gender equality and Long-Term Care at home
Employment in care work Around 6.2 million people were professional care workers in 2022, accounting for around 3% of total EU employment.

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
Across the EU, 12% of people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week.

Link/Source: Eurofound EQLS 2020
While the population aged 65 or over will grow by 23% until 2035, the projected employment growth in the care sector is just 7%.

Link/Source: CEDEFOP (2023) Care workers: skills opportunities and challenges

150.000 care worker jobs were lost. Employment fully rebounded in the following years, and by the end of 2022, it had 316 thousand workers above the pre-COVID-19 level.

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
Professional care workers are mainly women. In 2021, only 12% of care workers were men.

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
Women represent 62% of all people providing informal long-term care to older people or people with disabilities in the EU.

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
2 in 5 (42%) LTC workers work part-time, double the rate for the entire workforce (19%). Many do so because they cannot find full-time work (30% in non-residential LTC, 20% in residential LTC).

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
7 in 10 (71%) LTC workers indicate that they always ‘have the feeling of doing useful work’, which is more than in healthcare (66%) and in the entire workforce (50%).

Link/Source: Eurofund (2020)”Long-term care workforce: Employment and working conditions”
The number of persons potentially in need of LTC in the EU27 is projected to rise from 30.8 million in 2019 to 33.7 million in 2030 and, further, to 38.1 million in 2050. On average, 26.6% of people aged 65 or over living in private households needed LTC in 2019.

Link/Source: Caritas (2023) Growing old with dignity
The challenges of long-term care in Europe
The number of people aged over 80 years will climb from over 57 million in 2016 to over 1.2 billion in 2050 in 37 OECD countries. Keeping the current ratio of five LTC workers for every 100 people aged 65 and older across OECD countries would imply that the number of workers in the sector will need to increase by 13.5 million by 2040.

Link/Source: WHO “Progress report on the United Nations Decade of Healthy Ageing,2021-2023”
Most professional care workers – 68% in 2021 – are employed in the health and social care sector.

Link/Source: CEDEFOP(2023) “Handling change with care”
The employment of professional care workers is projected to increase between 2022 and 2035 slightly increase between 2022 and 2035

Link/Source: CEDEFOP(2023) “Handling change with care”
Training and Education Nearly 2 out of 3 of professional care workers (65%) attained a qualification level of ISCED 3 and 4 in 2021, equivalent to the level achieved after completing upper secondary education. The occupation’s qualification level is not expected to change over the period to 2035.

Link/Source: CEDEFOP (2023)Care workers: skills opportunities and challenges
2 in 3 personal care workers hold medium-level qualifications, while nurses typically have a diploma at a higher level (OECD, 2020). A notable share of care workers has only completed elementary education (19% in 2022).

Link/Source: CEDEFOP (2023)Care workers: skills opportunities and challenges
Skills and knowledge that care employers want (2022):- Transversal skills (adaptability; teamwork; language skills); – Task-related skills (working with computers; planning and scheduling; providing assistance and care to people; managing and coordinating); – Soft skills (problem-solving; coordinating activities with others; assume responsibility).

Link/Source: CEDEFOP (2023)Care workers: skills opportunities and challenges
Quality of care Two-fifths (40%) of LTC workers report lifting or moving people more than three-quarters of the time (compared with 5% of all workers and 23% in healthcare). Many LTC workers report handling infectious materials. LTC workers are less likely than healthcare workers to feel well informed about health and safety.

Link/Source: Eurofund (2022) COVID-19 and older people: Impact on their lives, support and care.
In the EU, about 1 in 5 care recipients aged more than 50 had difficulty obtaining adequate care from outside the household during the pandemic. Countries with longer stay-at-home orders had more unmet needs.Link/Source: Eurofund (2022) COVID-19 and older people: Impact on their lives, support and care.
Many LTC providers already use or are looking for ways to implement simple technologies such as alarm systems, fall sensors, and GPS tracking of the movement of elderly citizens in residential facilities or at home. Mobile devices with health apps can also support remote monitoring of the elderly and may reduce time spent by workers in promoting patients’ self-care skills.

Link/Source: OECD (2020) Empowering the health workforce Strategies to make the most of the digital revolution
Emerging trends Low-tech e-healthcare (such as phone consultations) improved access to healthcare, but 56% of people aged 50+ who required a consultation still opted for face-to-face consultations, as they preferred this over available e-healthcare options. 49% of people aged 50+ who used e-healthcare felt it did not fully meet their needs. In long-term care, the role of e-care remains limited.

Link/Source: Eurofund (2022) COVID-19 and older people: Impact on their lives, support and care
In platform work within LTC, an online platform is used to enable organizations or individuals seeking to provide LTC services with those needing assistance. Compensation is based on the completion of individual tasks or projects rather than continuous employment.

Link/Source: Eurofund (2022) COVID-19 and older people: Impact on their lives, support and care
Demographic In 2021 just over 2/3 of the population were of working age (between 15 and 64, 66.2%), while around 19% were over 64, i.e. of retirement age.

Link/Source: Census 2021 Austria (statistik. at)
In the period 2019-2050, the share of people aged 65+ in Austria is expected to grow from 18.8% to 27.2% (compared to a rise from 20% to 28.5% for the EU-28)

Link/Source: https://eurocarers.org/country-profiles/austria/
In the period 2019-2050, the share of people aged 85+ is expected to more than double, from 2.5% to 5.8%

Link/Source: https://eurocarers.org/country-profiles/austria/
Employment in care work The proportion of part-time employed people aged 15 to 64 among employees working in the “Health and Welfare” sector is well above average for both women (63.4%) and men (31.7%).

Link/Source: Census 2021 Austria (statistik. at)
By 2030, roughly 76,000 more professional care workers would be necessary to meet the needs of care receivers in Austria – 42,000 solely due to the retirement of care workers.

Link/Source: abstract_hanzl_momentum_kongress.pdf (momentum-kongress.org)
According to SHARE/OECD data, the estimated number of informal carers in Austria amounts to more than 800.000 people  (about 7% of the total population)

Link/Source: Austria – Eurocarers
Informal care remains the main form of care provision in Austria, with an estimated 7% of people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week. This trend persists despite the substantial expansion of institutional care services over the last two decades.

Link/Source: Austria – Eurocarers | Eurofound, EQLS 2020
22% of women report have had to reduce working time or give up their jobs entirely due to care responsibilities, compared to 3% of men.

Link/Source: Centre.org
Quality of care 33% of individuals believe they are unlikely to receive appropriate help when needed, with a significantly higher level of mistrust among women (38%) compared to men (21.5%).

Link/Source: Centre.org
Policy and regulation In Austria, there is currently no clearly defined and integrated quality framework, covering the different sectors of LTC. The ‘15a agreement’ on LTC between the Federal Republic and the federal provinces only defines rather general quality criteria and leaves considerable room for interpretation. On the sub-national level, the federal provinces enacted more detailed regulation to promote the quality of LTC services. The main instruments are the federal provinces’ legislations concerning the minimum income schemes, nursing home acts (five federal provinces) or nursing home decrees (four federal provinces), and specific directives on the organisation and implementation of different LTC services.

Link/Source: European Commission’s 2021 LTC report country profiles
Demographic By the end of 2022, the number of persons aged 65 and over is 1,515,383, or 23.5% of the country’s population. Compared to 2021, the share of the population aged 65 and over increases by 0.1 percentage points

Link/Source: Population and Demographic Processes in 2022 (nsi.bg)
In the period 2020-2060, the share of people aged 80+ in the Bulgarian population is expected almost to double. Over the same period, the old age dependency ratio was defined as the ratio of the number of older people at an age when they are generally economically inactive (aged 65 years and over) compared with the number of people of working age (15-64 years), will rise from 34.3% to 56.1%

Link/Source: Bulgaria – Eurocarers
Employment care work In 2016, the number of LTC workers providing informal care at home was 1 per 100 individuals aged 65 and over, 87.7% of whom were women.

Link/Source: Bulgaria – Eurocarers
Informal carers represent 8% of the population (people aged 18 years or over who care for one or more disabled or infirm family member, neighbour, or friend, of any age, more than twice a week).

Link/Source: Eurofound, EQLS 2020
In Bulgaria, there is no established information system for collecting data on professional carers providing long-term care, and even less information about the number of people providing informal care. But there is little doubt that informal carers in families provide the overwhelming bulk of LTC.

Link/Source: Bulgaria – Eurocarers
Quality of the Long Term Care services Social services are regulated by the Social Services Act (SSA). The SSA establishes a new Agency for the Quality of Social Services at the Ministry of Labour and Social Policy. The new structure will monitor how municipalities and private providers are delivering social services and spending state funds. Its objective is to verify compliance with the rights of users of social services, monitor national performance and license all private social services providers. It will create common standards for providers but, at the same time, will give them the freedom to develop their own practices and relationships between professionals, children and parents, since the system was previously highly restricted by methodological guidelines.

Link/Source: European Commission’s 2021 LTC report country profiles
Policy and regulation The action plan for the implementation of the National Strategy for Long-Term Care for the period 2018-2021 established in 2018, aims to address some of the challenges identified in the strategic document for LTC in Bulgaria, such as the development of quality standards for social services for older people and people with disabilities. However, implementation of these measures is yet to be seen and evaluated. There is ongoing implementation of the ‘New Standards for Social Services’ project; an important activity involving the development of quality standards with objective and measurable criteria and indicators and a monitoring and control system of the services.

Link/Source: European Commission’s 2021 LTC report country profiles
The action plan for the implementation of the National Strategy for Long-Term Care for the period 2018-2021 established in 2018, aims to address some of the challenges identified in the strategic document for LTC in Bulgaria, such as the development of quality standards for social services for older people and people with disabilities. However, implementation of these measures is yet to be seen and evaluated.

Link/Source: European Commission’s 2021 LTC report country profiles
Training and skills Since January 2019, the Personal Assistance Act  assistants (which can be family members of the disabled person, part of the extended family circle, or those outside) can receive training from the municipalities, but it is not mandatory.

Link/Source: Bulgaria – Eurocarers
The SSA introduced entirely free support and training services for family members who provide informal care at home for people with permanent disabilities and for people with disabilities over the working age who are unable to look after themselves.

Link/Source: Bulgaria – Eurocarers
Demographic The proportion of population aged 65 and over 20.5% AND is projected to increase to 30.4% by 2060.

Link/Source: Czech Republic – Eurocarers
In the period 2016 to 2070, the old-age dependency ratio i.e. the share of the population aged 65 and above as a % of the population aged 20-64 is projected to rise from 30.1% (EU-28: 32.2%) to 54.8% (EU-28: 56.4%) i.e. 24.7 pps. Most of this increase is driven by the old-age dependency ratio (people aged 80 and above relative to those aged 15-64).

Link/Source: Czech Republic – Eurocarers
The number of recipients of the care allowance increased from 260,000 in 2007 to almost 350,000 in 2016.

Link/Source: Czech Republic – Eurocarers
Employment care Informal carers represent 9% of the population (people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week).

Link/Source: Eurofound, EQLS 2020
Social care is mainly provided by informal carers and professional social services. Professional carers of social services can be registered or unregistered.

Link/Source: Czech Republic – Eurocarers
Training and skills  As of April 2020, there were a total of 318 registered respite care services/providers in the Czech Republic. Among these, 230 were specifically aimed at older individuals aged 65 and over. There is a notable absence of education and counselling for informal carers.

Link/Source: Czech Republic – Eurocarers
Certified educational seminars (funded by the Continued Education Fund) were organized in regions and towns for informal carers and professionals working in social services, municipal administration, and labor offices.

Link/Source: Czech Republic – Eurocarers
Demographic In the period 2019-2050 the share of people aged 65+ in the Greek population is expected to grow from 22% to 33.8% (EU-28: 20%-28.5%), with most of the growth happening before 2032. At the same time, the share of people 85+ will more than double from 3.3% to 7% (EU-28: 2.7%-6.1%).

Link/Source: Greece – Eurocarers
the percentage of 65+ compared to the population of 15-64-year-olds will rise from 34.1% (EU-28: 30.5%) to 67.1% (EU-28: 55.3%).

Link/Source: Greece – Eurocarers
Employment care work In 2019, there were on average five LTC workers per 100 people aged 65 or older in 28 OECD Member countries, ranging from 13 workers per 100 older people in Norway to less than one per 100 older people in Greece, Poland and Portugal.

Link/Source: OECD (2022) Providing long-term care: Options for a better workforce
Informal carers represent 10% of the population (people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week).

Link/Source: Eurofound, EQLS 2020
Policy and regulation Social insurance funds provide disability pensions and allowances. Other (non-contributory) disability benefits (in cash and in kind) are provided by social welfare institutions to persons who are in need of care because of a specific chronic illness or incapacity. According to 2011 administrative data (referred to in OECD 2013), about 60% of disability benefit recipients (either insurance or assistance-based) were above 50 years of age.

Link/Source: Greece – Eurocarers
There is no national or sub-national definition of LTC quality in Greece neither in the context of the healthcare sector nor of the social sector. This is congruent to the fact that the system is strongly based on informal LTC and, consequently, formal services play rather a residual role in the provision of LTC in Greece. Along with the absence of a definition of LTC quality, there is also a lack of a general LTC quality framework that would apply to all types of support (residential or home care) and to all kinds of providers (public or private, for-profit/ not-for-profit); neither is there a general healthcare and social services quality framework that applies to LTC.

Link/Source: European Commission’s 2021 LTC report country profiles
Articles 24-55 in part III of the Law 4808/2021, published on the 19th June 2021 and which is the transposition of the EU Directive on Work-Life Balance defines for the first time the concept of informal carer as “an employee who provides personal care or support to a relative or person who resides in the same household as the employee and who is in need of significant care or support for a serious medical reason.”

Link/Source: Greece – Eurocarers
Education and training The only support services available to informal carers are those provided by a few NGOs, operating mainly in Athens and other big cities and offering – among other things – information, practical advice, psychological/emotional support and training.

Link/Source: Greece – Eurocarers
Demographic In the period 2013-2060 the share of people aged 80+ in the Spanish population is expected to grow from 5.5% to 14.9% (EU-28: 5.1%-11.8%)

Link/Source: https://eurocarers.org/country-profiles/spain/
Employment care work Spain has one of the highest prevalence of informal carers, with 13% of people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week.

Link/Source: Eurofound EQLS 2020
Spanish legislation on the Promotion of Personal Autonomy and Attention to people in a situation of dependency (Law 39/2006), recognises the status of a carer (informal carer) as a person who, exceptionally, provides care to a spouse or relative by consanguinity, affinity or adoption, up to the third degree of kinship, for at least a year. Both the carer and care recipient should live under the same roof.

Link/Source: https://eurocarers.org/country-profiles/spain/
Policy and regulation The LAPAD provides the main regulatory framework for LTC in Spain. This law does not include a specific definition of quality in LTC, although Articles 34-36 refer to quality in terms of services and the training of professional carers and informal carers. The regulation of these aspects is developed in detail through the CISAAD.

Link/Source: European Commission’s 2021 LTC rpeort country profiles
Institutional LTC service providers include regional and municipal centres, as well as private sector institutions
Demographic In the period 2019-2050 the share of 65+ people in the French population is expected to grow from 20% to 26.6% (compared to an increase from 20% to 28.5% in the EU-28)

Link/Source: France – Eurocarers
It is estimated there would be 8,3 million informal carers in France (12.9% of the population), among whom 4,3 million provided regular care at home to a person over 60 years old

Link/Source: France – Eurocarers
Employment care work Women represent 57% of informal carers of older people in the country. The proportion of female carers even increases to 74%, along with the level of dependency of the cared-for person

Link/Source: France – Eurocarers
The rate of informal carers is high compared to other countries: approximately 26% of people aged 18 years or over care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week.

Link/Source: Eurofound EQLS 2020
It is estimated that between 8 and 11 million individuals provide informal care for a relative who needs care because of age, disability or a chronic or disabling illness in France

Link/Source: European Observatory on Health Systems and Policies (2023) France. Health system Review
Quality of the social care system Data on care quality are lacking in the primary and long-term care settings

Link/Source: European Observatory on Health Systems and Policies (2023) France. Health system Review
Policy and regulation The dependent elderly is also entitled to receive the Allocation Personnalisée d’Autonomie – APA (Personalised Autonomy Benefit), which is a universal benefit for people over 60 that came into force in 2002.

Link/Source: France – Eurocarers
The national Strategy to support informal carers includes an action plan to reinforce and diversify the offer of respite care services, which is accompanied by an additional budget of €100 million for the period 2020-2022.

Link/Source: France – Eurocarers

Disclaimer

“Not all LTC is provided by paid professionals, and it is important to reflect that informal carers are also part of the LTC workforce. Informal carers are defined as any person who provides – usually – unpaid care to someone with a chronic illness, disability or other long-lasting health or care need, outside a professional or formal framework. This typically includes family members, partners/spouses, friends and neighbours. Informal carers are sometimes referred to as family carers, or unpaid carers, depending on the context.”

The European Commission support for the production of this publication does not constitute endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.