DESK REVIEWS | 03.03.06.01. What is the organisation and working conditions of the long-term care workforce?
DESK REVIEW | 03.03.06.01. What is the organisation and working conditions of the long-term care workforce?
The work is performed in households or in care institutions. The LTC workers may be hired as either self-employed or salaried workers and their working hours vary between full time, upon demand (hourly paid), or part time (Brazilian Ministry of Economy, 2019). When individuals are self-employed, there are no employer-employee formal guarantees (e.g., pension, benefits), although they are still required to pay taxes. Formal employment is normally established through the Workers Law Consolidation (Consolidação das Leis do Trabalho – CLT), which is a formal/registered employment scheme. Care workers (informal care workers) are often hired as domestic employees as they are included under this category of occupation as described in the laws N.5.859/72, N. 7.418/85, N. 11.354/06 and Article 7 of the Federal Constitution. Formal employment under Workers Law Consolidation or as a domestic employee guarantees workers’ rights, such as: a minimum salary (which is established for overall workers and pension), holidays, maternity, and paternity leaves, etc. There are no official data about how many carers are working under informal circumstances. As mentioned previously, the number of formally hired carers have increased dramatically in the past years (from 5,263 in 2007 to 34,051 in 2017) (Brazilian Ministry of Economy, 2018).
Brazilian Ministry of Economy. (2018). RAIS 2018. http://www.rais.gov.br/sitio/index.jsf
Brazilian Ministry of Economy. (2019). Classificação Brasileira de Ocupações—Relatório da Familia—4.0.15. http://www.mtecbo.gov.br/cbosite/pages/relatorio/relatorioTemplateWordFamilia.jsf
There is no structured LTC workforce hence exclusive reliance on informal care. There is only one medical gerontologist working at the policy level and the rest of the health care workers are based in public facilities providing basic outpatient and inpatient services.
Mexico does not have a LTC system and therefore no human resources or labour force that is registered/accredited nor their working conditions are regulated. However, there is a growing market for paid informal workers, with diverse training and competences, from specialised nurses employed to carry out very specific care activities, to domestic workers that perform personal care or supervision as part of their overall tasks.
While no studies of working conditions of care workers have been carried out, a recent report by the Ministry of Labour and Social Security (El Trabajo Doméstico En México: La Gran Deuda Social., 2016) on the conditions of domestic workers showed that 98% are not affiliated to any health care services and work 32 hours per week on average. In addition, 76% reported no affiliation to a social security institutions and therefore, have no labour related benefits such as disability or old age pension, maternity leave, paid vacation, etc. Regarding their payment, domestic workers earn less than 50% of the average salary.
El trabajo doméstico en México: La gran deuda social. (2016).
The LTC workforce is characterised by poor remuneration, lack of professional development and unfavourable working conditions in terms of workload (WHO, 2017).
WHO. (2017). Towards long-term care systems in sub_Saharan Africa: WHO series on long-term care. Available from: https://www.who.int/publications/i/item/9789241513388