New reports reviewing application of EU standards governing working conditions in the long-term care sector

One of the objectives of the 2022 European Care Strategy is to improve working conditions and work-life balance of carers. In this sense the strategy announced that the Commission will review the application of EU standards governing working conditions, including for live-in carers, in cooperation with EU decentralised agencies.  

The 2022 Council Recommendation on affordable high-quality long-term care , part of the European Care Strategy, recommends that Member States support quality employment and fair working conditions in long-term care (LTC). This includes promoting the highest standards in occupational health and safety and addressing the challenges of vulnerable groups of workers, such as domestic long-term care workers, live-in care workers and migrant care workers, including by providing effective regulation and professionalisation of such care work.

Further, Member States are called to address skills needs and worker shortages in the sector, for instance by promoting national social dialogue and collective bargaining, strengthening professional standards and providing adequate social protection to long-term care workers. 

Following a call from the Commission, the European Social Policies Analysis network (ESPAN), the European Centre of Expertise (ECE) and the European Union information agency for occupational safety and health (EU-OSHA) looked at different aspects impacting working conditions of LTC, what is reflected in the following four reports : 

• Addressing knowledge gaps with regard to the long-term care workforce (policy brief prepared by ESPAN) 
• Application of EU labour law in the long-term care sector (Thematic Review 2022-2023, prepared by ECE) 
• Access for domestic workers to labour and social protection: An analysis of policies in 34 European countries (report prepared by ESPAN) 
• OSH in figures in the Health and Social Care Sector (prepared by EU-OSHA) 

Main findings 

The reports stress the significant labour shortages and skill gaps in the sector, against the background of a growing need for long-term care services in Europe’s ageing population and affecting the overall quality of the services provided. They point to specific challenges faced by particular groups of workers in the sector, including domestic workers and live-in carers and highlight good practices for improving the situation and working conditions of LTC and domestic workers. 

The long-term care ‘quadrilemma’: Addressing knowledge gaps with regard to long-term care workforce

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• Increasing LTC coverage, ensuring quality of services, improving working conditions and job quality, while managing public expenditure, constitute four major challenges for Member States. In this ‘quadrilemma’, the workforce dimension appears to be less prioritised.  
• In 2023, 3.1 million workers were employed in the LTC sector in the EU, which corresponds to around 1.5% of the whole workforce (Eurostat 2024). Demand for LTC workers will expand in the future with growing needs of an older population. To improve working conditions and attract more workers, Member States are taking policy measures such as wage increases, education and training opportunities, new models of work organisation for the delivery of LTC, higher structural requirements (e.g. work-client ratios) and quality standards for services, roll out of new technologies, strengthened collective agreements and tripartite agreements and targeted measures for the domestic and live-in care sectors 
• Addressing the challenges going forward requires structural measures such as the provision of public resources for LTC specifically dedicated to workers to increase wages and staff ratios, to fund training and innovation in the organisation of services, and to set higher quality and structural requirements for the provision of services. Rebalancing the differences in working conditions between LTC workers in public and private settings, when gaps are present, and strengthening social dialogue and collective bargaining in the homecare sector appear as high priorities for action. Improving the image and the public perception of the employment in the sector through media campaigns and combatting gender stereotypes are to be further encouraged. 

The application of EU labour law in the long-term care sector

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• Focusing on personal care workers, nurses and domestic care workers, the study analysed  how several EU labour law directives are applied in the Member States to LTC workers, with a cut-off date in January 2023.  
• Three elements appear relevant for the identification of the legal status of LTC workers: the type of employer (private or public sector), the type of employment contract (or lack thereof), and their workplace (home of care recipient or elsewhere). 
• The report shows that overall, nurses and personal carers are covered by general national law transposing EU labour law. 
• For domestic LTC workers, specific exceptions to certain provisions of labour law regulations were reported in about half of the Member States.  
• A number of countries have in place rules in national law and/or collective agreements that set specific rights and conditions for live-in carers. 
• A larger number of countries point to specific challenges in the enforcement of labour rights for domestic workers, particularly for live-in carers, for migrant and mobile workers. Main issues of concern reported relate to working time and undeclared work. 
• The report also points out good practices in improving working conditions and training opportunities, regulating undeclared LTC work and promoting alternative forms of collective organisation of these workers. 

Insights on domestic workers: Access for domestic workers to labour and social protection

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• Across the EU, it is estimated that at least 4 million domestic workers are in formal employment, engaged in care and non-care activities, representing 2.1% of the EU’s workforce. The type of employment arrangement determines access to labour and social protection.  
• Those domestic workers which are un- or underdeclared lack adequate access to social protection. Even if formal access is given, effective access, adequacy of benefits, gender disparities and access for migrant workers remain critical issues.  
• Domestic workers are more likely to face exploitative conditions and to suffer from a lack of enforcement of labour law.  
• The report offers several proposals for improving the social protection and labour rights of domestic workers, including a better evidence base, improved enforcement of rules and professionalisation of the sector, combatting undeclared work, giving (migrant) domestic workers a voice, raising awareness of their situation and maintaining EU support and exchanges. 

OSH in figures in the Health and Social Care Sector

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• According to EU-OSHA, workers in the health and social care sector are exposed to a higher levels of exposure to a multitude of risk factors compared to the average EU-27 worker. 
• They have the highest share of co-exposure to musculoskeletal (MSK) risk factors and psychosocial risks, are more frequently exposed to chemical and biological risks, have lower task autonomy due to greater likelihood of irregular schedules, including working at night and on short notice, and report higher levels of work-related stress.  
• Compared with other sectors, health and social care sector establishments indicate higher levels of exposure to several psychosocial risk (PSR) factors. 
• Healthcare workers and residential care workers are more often exposed to tiring or painful positions, lifting or moving people, carrying or moving heavy loads and repetitive hand or arm movements than workers in the social work subsector. 
• Despite the sector performing comparatively well in having a range of OSH risk mitigation strategies, a collaborative effort between stakeholders from different policy areas is needed to improve the workers’ health and safety.  

Next steps 

The Commission will support Member States in their efforts to implement the 2022 Council Recommendation on affordable high-quality long-term care including with regards to addressing workforce challenges.  

Background

These reports complement other activities of the Commission supporting the improving of working conditions in the sector, including: 

• the set up of the European social dialogue committee for social services 
• Pact for Skills 
• Digital Europe Programme 
• Mutual learning and exchange of best practices, such as on quality of long-term care, social protection for long-term care and on adequate long-term care workforce