LeadingAge Magazine · July-August 2019 • Volume 09 • Number 04

Worker Shortages Challenge Providers Worldwide

July 15, 2019 | by Debra Wood, R.N.

The whole world is aging, and worker shortages to serve older adults afflict almost all countries. Here is a look at what other nations face, and how they are coping with this ongoing challenge.

Around the world, demand for health care workers remains high, with shortages predicted for the future.

“Many of the poorest countries in the world are facing severe shortages of health workers,” says Jenny Liu, Ph.D., assistant professor of health economics in the Institute for Health & Aging at the University of California, San Francisco. “In many places, there is not formalized care for [older adults] or commensurate social support systems for health care or income during old age, leaving the responsibility mainly to informal support through family and social networks.”

Liu explains that the focus in many lower-income countries is more concentrated on maternal and child health, which represent the larger share of burden of disease, rather than elder services. In middle-income countries, Liu says, the picture is slightly different as some of these countries are undergoing both an epidemiological transition, reduced communicable diseases and more burden from non-communicable chronic conditions; a demographic transition with reduced mortality at younger ages and increased life expectancy, which is contributing to population aging; and economic development that can lead to greater institutionalization of social safety nets.

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Liu and colleagues reported on global health worker labor market projections for 2030 in Human Resources for Health. Liu and fellow researchers predict demand for health care workers will increase to 80 million by 2030, but supply will only reach 65 million, creating a health care worker deficit of 15 million. The investigators anticipate the largest shortages in upper middle-income countries. Shortages also will persist in some middle-income countries, and in low-income countries, demand will often be lower than supply.

“Economic demand may be so feeble that these poorer countries can’t employ the health workers that they have on hand, meaning trained workers can’t find jobs, and they may end up finding employment in another sector,” Liu explains. “And their level of population health is also so poor that they have much fewer health workers than they should have to provide the basic set of services that the population needs.”

“Dramatic health worker shortages” were reported in The Global Burden of Disease Study 2017, editorialized in the Nov. 10, 2018, issue of The Lancet. Additionally, the report found an “unequal distribution of health workers.” While many countries in Europe have highly resourced health workforces, other countries, particularly in Asia, sub-Saharan Africa, and parts of Oceania, lack health workers. Altogether, only about half of the countries in the world have enough health care workers to deliver quality care, according to the report.

What are Some Countries Facing?

On any given day in England, the adult services workforce agency Skills for Care reports 110,000 vacancies exist for adult social-care service workers, according to Vic Rayner, executive director of the National Care Forum in the United Kingdom.

“On top of this, we are experiencing very high levels of turnover, making the challenges twofold around not only the recruitment of quality social care staff, but also keeping them in post,” Rayner says. “Based on demographic trends, we know that there will be significant growth in demand for care workers.”

The social care workforce already makes up 7% of the UK working population. Skills for Care predicts an additional 650,000 workers will be needed by 2035, Rayner reports.

While many countries in Europe have highly resourced health workforces, other countries, particularly in Asia, sub-Saharan Africa, and parts of Oceania, lack health workers. Altogether, only about half of the countries in the world have enough health care workers to deliver quality care.

Likewise, the Australian government’s 2016 Aged Care Workforce Report states that the aged-care workforce in that nation will need to grow from 235,764 workers in 2016 to about 980,000 workers by 2050. About 45% of aged-care workers are between 31 and 50 years old, and another 35% are older than 51, reports Kate McCormack, a Fellow of the Australian Human Resources Institute, and executive director of People, Learning, & Culture at Mercy Health in Melbourne.

“Overall [workers have] relatively high levels of job satisfaction; however, aged-care workers are least satisfied with their total pay and with time available to them to care for residents,” McCormack adds. “Our workforce and care models continue to lag behind the accelerated and shifting expectations of those we serve. The aged-care industry in Australia is moving towards a consumer-driven and market-based system where consumers have greater choice and control.”

China faces different obstacles. Its population is aging quickly, Liu says.

However, the aging service sector is just beginning to develop, adds Mark Spitalnik, principal of The China Healthcare Advisory Group in Shanghai.

“There is a dearth of trained workers who can provide care to seniors in need of it,” Spitalnik says. “Historically in China, the family has provided care to seniors in need. The number of young people in each family who are available to provide such care is decreasing.”

What is at Stake?

Without sufficient health care and aging-services workers, people requiring care may suffer.

“Ultimately, we will not have a workforce,” McCormack predicts. “The answer is not employing more nurses. They are too expensive and too qualified to be delivering the direct care our residents require.”

And, nurse shortages exist. Nurses should practice at the highest level of their education and experience, according to the 2010 Future of Nursing: Leading Change, Advancing Health report from the Institute of Medicine.

“The impacts of limited access to a steady and stable quality workforce are manifold and recognized both by our social care regulator and individual provider organizations,” Rayner says. “The immediate response is the extensive use of temporary workers at all levels within organizations.”

This use of temporary staff adds significant additional operational costs and reduces the potential for consistent care and the establishment of effective teamwork.

In China, Spitalnik expects that family members will step up.

“Ultimately, however, family members will continue to provide care if alternatives are not available, thereby increasing the pressure on such family members,” Spitalnik says.

Efforts at Improvement

Organizations will need to become more creative and change the culture to value caregivers. Providing aging services in the United Kingdom is not perceived as a career of choice.

“There is very important work to be done to increase the status of the role within society, and to encourage a wider variety of people to enter the profession at all different stages within their working lives,” Rayner says. “The solutions are not necessarily straightforward or easy to implement.”

McCormack indicates a need to attract younger people, and more men, to the aging services workforce. Yet, gender stereotypes persist.

“It is critical our recruitment process focuses on emotional intelligence, leadership qualities, commercial capability, people management, and communications,” McCormack says.

The Australian government has developed a 10-year plan for the aged-care field. Its Aged Care Roadmap identifies the need for a well-trained, well-led workforce able to deliver flexible care to meet resident needs and preferences. The government also has convened a Royal Commission into Residential Aged Care, which will report in the fall. McCormack anticipates it will discuss funding for caregivers’ wages and nursing ratios.

The U.K. recently conducted a national recruitment campaign for professional caregivers, emphasizing that every day is different when delivering services. The campaign produced case studies and worker profiles, which can be used by employers.

“It is critical our recruitment process focuses on emotional intelligence, leadership qualities, commercial capability, people management, and communications.”

Wages also are challenging in the U.K., which has introduced a national living wage, increasing the minimum pay rates. This policy has put pressure on employers to meet the standards and maintain a differential for senior positions.

“Yet, we know that pay is not the only motivator for staff, and increasingly employers are approaching the recruitment of staff through a value-based lens,” Rayner says.

Employers are looking less at previous skills and experience, she reports, instead concentrating on motivations and how they see their role in key agendas, such as sustaining independent living, providing dignity and respect, and working to a rights-based agenda.

“There is evidence of success around this way of working in attracting a wide range of candidates and, most importantly, retaining them,” Rayner says.

In China, both the government and the private sector are trying to develop relevant training programs, reports Spitalnik. “The expectation is that there will be enough workers to serve the aging service field after these programs come on line.”

Liu reports that primary care in low-income countries may be increasingly provided through drug stores, which are more convenient and available to people than health facilities.

Suggested Solutions

McCormack reports that Mercy Health has developed a new approach that will sound familiar to American providers: small household living, in which residents live in small households and continue to live their lives with the support of consistently assigned and multiskilled care companions, who assist with cooking, cleaning, personal hygiene, laundry, and social and community activities.

Mercy Health has identified the need to attract and retain talent, build a positive culture, deliver person-centered care, and enhance a culture of continuous learning. The organization also has created “The Mercy Way,” for training care companions.

We “hire for heart and train for skill,” McCormack says. “Multiskilled care companions, with high emotional intelligence, higher levels of digital literacy, and increased cultural competence for working with diverse residents and workforce cohorts, replace the traditional personal care worker.”

At Mercy’s aged care home in Bendigo, the company is embarking on an intergenerational project, engaging Year 9 and 10 students to help spark their interest in a caregiving career.

Rayner questions whether people have held sufficient debate to understand what future care workforces will be doing, and what role technology might play. The possibilities include elimination of paper-based systems, the application of smart technology to support independence within the home and care homes, and the application of robotics in both physical care and household tasks.

Liu explains that technology can assist with training and mentoring health care workers, improving patient education, care seeking, and access to diagnostic and informational services.

Although technology will not replace direct-care workers, Spitalnik says, it may increase those workers’ efficiency.

“As with other environments transformed by technology, the roles that remain are likely to be more complex, more intense and many might argue—more rewarding and valued by society,” Rayner concludes.

Debra Wood, R.N., is a writer who lives in Orlando, FL.