What is the state of play of formal and informal carers in long-term care? The working conditions of 3.1 million workers, making up 1,5% of the total EU workforce, are explored in four recent reports commissioned by the European Commission and produced together by 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).

The reports are part of the European Care Strategy, adopted in 2022 and aiming to ensure quality, affordable, and accessible care services across the EU, while improving the working conditions and work-life balance of both formal and informal carers.

From working conditions and work-life balance to issues specific to carers for persons with disabilities, these four reports paint a vivid picture of the realities faced by those on the frontlines of care delivery across EU Member States.

Main findings

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

This report identifies four key challenges for Member States in the LTC sector: expanding coverage, ensuring service quality, improving working conditions, and managing public spending. It presents how countries are addressing these issues through reforms and investments, such as raising wages, providing training, improving work organisation, and setting higher service standards. The report also urges Member States to allocate public funding to enhance worker conditions, improve working environments in both public and private sectors, and strengthen social dialogue. Additionally, it calls for campaigns to improve the sector’s image and challenge gender stereotypes.

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

This second report examines the application of EU labour law in the LTC sector. It identified three key elements influencing the legal status of LTC workers: the type of employer (public or private), the type of employment contract, and the workplace (care recipient's home or elsewhere). The report found that nurses and personal carers are generally covered by national laws transposing EU labour law, while domestic LTC workers face specific exceptions in about half of the Member States. Challenges in enforcing labour rights, particularly for live-in carers, migrant workers, and mobile workers, were highlighted, with key issues including working time and undeclared work. Finally, the report highlights good practices in improving working conditions and promoting collective organisation for domestic workers.

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

Often classified under “personal and household services,” domestic workers, including those providing LTC for elderly and persons with disabilities - notably personal assistants - do not enjoy the same legal status and rights as other healthcare workers. The report shows that, within the EU, they often face poorer and exploitative working conditions as well as a lack of access to social protection schemes. A situation similar in (potential) candidate countries, where only Moldova has established a legal framework in 2023 to regulate homecare services for elderly and disabled people requiring LTC. To improve their conditions, measures like better data collection, stricter rules’ enforcement, professionalisation of the sector, combating undeclared work, empowering (migrant) workers, raising awareness, and ensuring continuous EU support are recommended. Finally, the report highlights key national initiatives funded by the EU, such as Cyprus's ESF+ project on training home care professionals for persons with disabilities and Greece’s RRF-funded programme supporting personal assistants for persons with disabilities.

OSH (occupational safety and health) in figures in the Health and Social Care Sector

The report looks at health-related outcomes in the health and social care sector. Workers face poor working conditions, which have negative consequences for their health in both the short and long term. These workers are more exposed to a variety of risks, including musculoskeletal and psychosocial issues, chemical and biological hazards, as well as the development of long-term health conditions or disabilities. Moreover, irregular schedules and heavy workloads can contribute to higher levels of work-related stress. In particular, the report underlined that healthcare and residential care workers notably experience significantly greater physical strain, including tasks such as lifting, moving individuals, and performing repetitive activities.

To conclude, as the demand for long-term care grows, it is essential to understand the realities faced by carers in order to shape policies that ensure not only better care for those in need but also fair conditions and support for those providing it.

To explore these findings further, read the full report: Access for domestic workers to labour and social protection: An analysis of policies in 34 European countries - European Commission