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Elderly care is Europe’s next major challenge – and possible job sector

That Europe’s population is ageing fast is not news. Most of the continent’s countries have the highest median ages on Earth (with only a few countries outside Europe demonstrating similar age structures in their populations, notably Japan). With these ageing populations and factors such as rapidly increasingly life expectancy both in Europe and elsewhere, and increased mobility leading to family members often living and working far away from each other and therefore unable to provide care, the question of providing sufficient elderly care is coming to the fore. So what does this mean?

Some figures for context

The ageing process that first began to manifest itself in Western Europe has now spread to the rest of the continent, and most European countries now experience a natural decline in population, coupled with an increased median age as life expectancy increases, but birth rates do not compensate death rates. This means that the proportion of elderly in national populations will increase in the short to middle term, and in many countries is already significant. Most age structures break down into people aged 0-14, 15-64, and 65 or over, or similar categories, with most definitions of elderly population use 65 or older as a benchmark. In Europe’s case, the EU-28’s share of population aged 65 or over hit 19.4% in 2017. This hides large divides, with Slovakia scoring the lowest percentage at 15% of the population, and Italy confirming its reputation as  “un paese di vecchi” (an “old” country) with 22.3%.

However, increases in this age category and decreases in the 0-14 category took place across the board, indicating that Eastern Europe’s increases in life expectancy, emigration and decreasing fertility are starting to shift its age structure. In fact, Eurostat has started documenting the share of population aged 80 or over in the EU and individual member states, and even here the numbers are significant. The EU-28 average is 5.5%, and once again Italy is the “greyest” EU state with 6.8% of its population aged 80 or over, while Ireland and Slovakia are most youthful with 3.2% of their population in this age group. Eurostat’s population predictions also suggest that this is not a temporary blip. From now through 2080, the EU-28’s share of people aged 80 or over is expected to rise to 12.7% (leading to the age bracket 65 or over accounting for 29.1% of the population) with the 0-14 bracket stagnant at approximately 15%, and the working age population decreasing from 65% today to 55.4%.

 

Median age population by NUTS 3 region, 2016

Median ages across Europe. Notice how a large number of regions have median ages 45 or over, and even 50 or over. Source: Eurostat

So what’s next?

Faced with these demographic shifts, Europe must start preparing to cater for this large share of elderly population. This however, is revealing itself to be problematic. There is already a shortage of elderly care specialists in Europe, which in itself is a manifestation of the wider shortage of healthcare workers that Europe already struggles with. For example, the UK, if Brexit leads to a no-deal scenario, is projected to face a shortage of 400,000 carers, exacerbating the existing shortage of 90,000 carers today (as per The Independent). Deutsche Welle reports a shortage of 15.000 elderly carers in Germany, compounding its shortage of carers in general. And to various degrees of severity, the situation plays out like this across Europe. And even if the problem is this serious only in Europe, it would be foolish to assume that it will be easy to recruit the necessary workers in the medium-to-long-term.  The CIA World Factbook lists 51 countries and territories with a median age (the age at which exactly half a country’s population is younger, and half is older) of 40 or over as per its 2017 estimates, and while most of those are in Europe, certain major countries such as Canada and South Korea are now firmly in this group.

Furthermore, several major countries are catching up. The Factbook’s current estimate for China’s median age is 37.4 years (Taiwan, listed separately, scores 40.7), the United States’ 38.1 years, and Australia 38.7. Even Africa, the world’s youngest continent, is seeing increases in most if not all countries, with the Seychelles scoring the continent’s highest median age at 35.4 years (which for context is older than Albania, at 32.4 years). This means that several countries outside Europe will soon begin to experience a rapid increase in their elderly populations (if they are not already), and therefore workers specialised in elderly care will be in high demand in far more places that at present. In fact, the World Health Organisation already declared a global shortage in elderly care workers in a report last year, and with median ages and life expectancy rising worldwide, this shortage will only worsen without drastic action.

As Europe is the continent where this process is already most advanced, this means that European countries (and the EU) must act urgently to meet this labour shortage. This will mean having to employ or train large numbers of such workers in the short-to-medium term. Programmes for reskilling the unemployed to fill these gaps as well as encouraging students to pursue university education in such fields can start to address this shortage, but I argue that the causes of this shortage run deeper than simple demographic shifts. This work arguably suffers a poor reputation in many places.

Work with the elderly is difficult, often poorly paid, with demanding hours and the need to deal with unpleasant situations on a regular basis, and I won’t attempt to deny that, seeing as I worked at a care home over summer and therefore write from experience (although as I worked in Sweden, the wage and overall conditions were far better than most other countries). However, this is not an article about glamorous or pleasant jobs, it one about necessary jobs. Several jobs are physically taxing and involve anti-social working hours and getting one’s hands dirty for uninspiring wages, yet don’t seem to attract the same revulsion. In this case, better supervision and visibility of this work can draw attention to key issues faced by carers, and better organisational and state support can improve working conditions and contractual obligations for those involved.

That said, re-skilling the unemployed and training care workers from scratch, as well as boosting minimum wage requirements and  takes time and money, and seeing as these workers are needed now, that will mean recruiting from outside Europe. Again, this isn’t new; there is a well-beaten path of care and medical workers from areas such as Latin America and the Philippines successfully filling posts in Europe, so workers from this region can continue to fill shortages. However, given the demand that needs filling, and to avoid relying excessively on a handful of countries (and by extension putting these countries’ healthcare systems in difficulty), the net will have to be cast wider and further. However, at a time of rising nativism and the temptation to score easy points off xenophobia, this isn’t happening, all this despite the fact that recruiting such staff who have trained abroad is more cost-effective as the destination country can focus on language training and adaptation to local medical standards rather than training someone from scratch, which also takes far longer.

It will be the citizens of Europe who lose out in the long run, especially if locally-trained medical staff are not entering the workforce quickly enough, leading to a worsening of healthcare coverage at the geographic level, which in certain regions is already patchy. And of course, simply raising birth rates to reduce the proportion of over-65s is not the magical solution nativists may sell it as. First of all, because any new cohort of the population must reach working age in order to ease the pressure off the existing working population cohort, and secondly, any moves to rapidly increase birth rates can lead to an increase in a population’s overall dependency ratio due to a sharp rise in the number of children using state services and resources, meaning that such measures must be supported by a sufficiently large and productive working-age cohort. In Europe’s case, the working-age section of the population would probably need augmenting with recruits from outside Europe to support any such measures, which in itself is rather ironic.

In other words, this is another issue that Europe needs solving, and unlike others, tends to affect all of Europe, often visibly manifesting itself, and while it is a large problem in terms of scale, it can be managed. However, it seems to be far down the list of priorities despite the clear need to provide this service, also from the point of view of having a solid base of working-age people employed and paying into the welfare state, and therefore allowing the elderly population’s pensions to be paid. Then again, European countries have sleep-walked into difficulty over other issues before, so why would this be an exception? Maybe for once we can learn that “looking after our own” doesn’t exclude the possibility of recruiting help from elsewhere, and that it might also involve less glamorous, but otherwise essential services and actions. Inaction now just means more pressure in resource and financial terms on future generations. It will be interesting, to say the least, which political faction, if any, decides to seriously confront this issue. The current noises do not provide grounds for optimism, and most probably, the real difficulties are yet to come.

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Categories: Authors, Luca Contrino

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