DESK REVIEWS | 03.03. Long-term care workforce (including unpaid/informal workers)

DESK REVIEW | 03.03. Long-term care workforce (including unpaid/informal workers)

The main source of LTC in Brazil is provided for by family/unpaid carers; however, the number of people who began providing care for older adults as ‘formal’ or ‘paid carers’ is increasing rapidly. There is no official statistic on the number of unpaid carers in Brazil. According to the Brazilian Annual Report of Social Information (Relação Anual de Informações Sociais), ‘informal care worker’ was the occupation with the largest growth rate between 2007 and 2017 (growing over 500% – from 5,263 to 34,051 registered informal carer workers) in Brazil (Brazilian Ministry of Economy, 2018). This number reflects a growing interest for the profession by Brazilians (mostly women); however, this may also mean a growing tendency of informal care workers being formally recognized as professionals.

Currently, informal care workers are hired as domestic employees and can be paid for hourly (not registered formally, without any pension or labour rights, and without a minimum payment that is set by the government), or by receiving the minimum wage or more (registered officially, with pension and labour rights as a domestic employee would). For domestic employees, everyone working more than three days a week for a family should be formally hired by law. These individuals are ‘hired’ by the family directly through their personal links, or through care agencies, and they provide from supervision through full time care, which is paid for according to the amount of care needs.

References:

Brazilian Ministry of Economy. (2018). RAIS 2018. http://www.rais.gov.br/sitio/index.jsf

An ILO report states that there are no formal long-term care workers in India. Instead, most care work is performed by informal and/or family carers (Scheil-Adlung & Xenia, 2015).

It has been reported that emphasising family responsibility in long-term care, as is the case in India, creates an unequal gender balance of unpaid family care workers. It disproportionately affects female family members who invest effort and time into unpaid care, and also lose income from employment in the process (International Labour Organization (ILO), 2015). There is no specific data available on formal and informal long-term care work in India.

References:

International Labour Organization. (2015). World Social Protection Report: Building economic recovery, inclusive development and social justice. ILO. Available from: https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/documents/publication/wcms_245201.pdf

Scheil-Adlung, & Xenia. (2015). Long-term care protection for older persons : a review of coverage deficits in 46 countries. ILO Working Papers.

 

We cannot identify the size and structure of the long-term workforce. No data has been reported on LTC workers (Scheil-Adlung, 2015, p.24).

References:

Scheil-Adlung, X. (2015). Long-term care protection for older persons: A review of coverage deficits in 46 countries. In Extension of Social Security (Issue 50). http://www.ilo.org/wcmsp5/groups/public/—ed_protect/—soc_sec/documents/publication/wcms_407620.pdf

Kenya has 20.7 doctors and 159.3 nurses (enrolled and nursing officers) per 100,000 which is below the WHO-recommended average of 21.7 doctors and 228 nurses per 100,000 people (Republic of Kenya, 2014a). Other key cadres of staff in public health facilities include public health officers, pharmacists, laboratory technologists, nutritionists, health records officers, trained health workers, social health workers, and community health extension workers (World Health Organization, 2017b). The majority of the Kenyan health workforce work in the private sector with almost 75% of the medical doctors and 66% of nurses and clinical officers (Kenya HealthCare Federation, 2016). Currently, there are a total of 65 Hospices and palliative care providers across Kenya (Kenya Hospices and Palliative Care Association (KEHPCA), 2019). However, there is no literature on how many health care workers are providing LTC services in Kenya.

References:

Kenya Healthcare Federation and Task Force Health Care. (2016). Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector. Nairobi, Kenya. http://khf.co.ke/wp-content/uploads/2018/03/2016-Kenyan-Healthcare-Sector-Report.pdf

Kenya Hospices and Palliative Care Association (KEHPCA). (2019). Hospices. https://kehpca.org

Republic of Kenya. (2014a). Kenya Health Policy 2014-2030. Nairobi, Kenya. http://publications.universalhealth2030.org/uploads/kenya_health_policy_2014_to_2030.pdf

World Health Organization. (2017b). Primary Health Care Systems (PRIMASYS): Case Study from Kenya, abridged version. Geneva, Switzerland. https://www.who.int/alliance-hpsr/projects/Alliance-PRIMASYS-Kenya-comprehensive.pdf

In terms of people working in long-term institutions for older adults (under any modality: home care, old people homes/residences, etc.), the Social Assistance Housing Census CAAS survey identified 14,582 people working in the 1,020 long-term care institutions for older adults. Of these, 86% were employed and 14% worked without payment or as volunteers. The majority were women, representing 78% of the paid workers and 63% of the unpaid workers or volunteers.

The CAAS survey also asked about different characteristics of the employment performed and if the staff was certified in different skills/competencies expected by type of activities performed. Based on these specifications, the CAAS reports that 97% of the personnel working in permanent residences for older adults do not have adequate certification of competencies in the area in which they work. Moreover, there are other individuals (mostly paid informal workers) working in services such as day centres, home care aides, domestic workers that form part of the LTC workforce, but there is no data available on their number, their labour conditions, etc.

According to the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações, CBO) (CBO 5162-10 Cuidador de Idosos), the carer occupation can be performed by anyone. There are many private skill training courses being offered for people who want to get trained to work as carer, which are provided online or face-to-face, freely or paid for by the individual, the older person’s family, or by a care agency, or other health service. Here is an example of such courses.

‘Formal caregiving’ has been recognized as an occupation since 2002 by the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações, CBO), but not as a profession (for that it would be necessary a law regulating its activities). Changing the status from occupation to profession had been approved by the Chamber of Deputies and the Senate House. However, the president of Brazil later denied this recognition justifying that the proposal had incurred conditions which restricted the free professional work. This project of law (PLC11/2016) stated that informal care workers should have completed basic education attainment (8 years or more), at least 160h of relevant training, to be aged 18 and above, to have no criminal records, and attested physical and mental capabilities. This would have been a landmark on improving the quality of the care provided for older people.

Due to the absence of a formalization of such profession, informal care workers do not have regulated set of training skills or basic professional rights. Even though the President has denied the recognition of the occupation as a profession, there is still a chance of this recognition to happen as deputies and senators plan to further discuss this in the near future (Conselho Federal de Enfermagem, 2019b). In addition, state and municipal laws have been proposed to try and systematise the care provided to older people locally, such as in Rio de Janeiro state (ALERJ, 2016). This state law states:

Art. 5º: The regular qualification, preparation, and qualification courses for Carers of Older People must have, at least, the duration of 160h (one hundred and sixty hours) of in-class training, with theoretical and practical content, being 25% (twenty-five percent) of the total number of hours dedicated to practical activities involving monitoring and supervision, and the course provider must involve professionals from professions related to the field of gerontology, such as: geriatricians, nurses, nutritionists, physiotherapists, psychologists, occupational therapists, and social workers.

Other professionals who are part of the Brazilian LTC workforce are regulated by their professional bodies, such as the Nursing Council for nurses and health assistants, Medical Council for physicians, and Physiotherapy Council for physiotherapists. However, none of these professionals need to be specialised in LTC beyond their generalist training in order to provide LTC for older people. It would depend on the employer to require such training.

References:

ALERJ. (2016). Lei Ordinária 7332.

Conselho Federal de Enfermagem. (2019b). Projeto de Lei do Cuidador é vetado Conselho Federal de Enfermagem—Brasil. http://www.cofen.gov.br/projeto-de-lei-do-cuidador-e-vetado_72314.html

 

Under the NPHCE, post-graduate training for medical doctors in geriatric medicine has been initiated in a few centres and the Medical Council of India recognised the MD course in Palliative medicine in 2012. In addition, post-graduate diploma programmes in gerontology are available for graduates from disciplines other than health (UNESCAP, 2016). While there has been progress in geriatric and gerontology training in India, training for staff engaged in other roles in care homes, such as administration and service delivery still have significant gaps (Johnson et al., 2017).

Although, the long-term care workforce system is not well organised, a few training institutions as part of the government, private sector, and universities offer programmes and coordinate employment opportunities for formal caregivers. The Ministry of Social Justice provides financial support to institutions for training geriatric workers and formal caregivers through the National Institute of Social Defence (NISD). However, there is a need to standardise the content and evaluate the quality of these courses (UNESCAP, 2016). There are other various non-governmental and private sector operators, for example Nightingales medical trust, ARDSI etc., which offer training and other innovative long-term care programmes (Nightingales Medical Trust, 2014; ARDSI, 2015).

References:

Alzheimer’s and Related Disorders Society of India (ARDSI). (2015). Alzheimer’s and Related disorders Society of India (ARDSI).

Johnson, S., Madan, S., Vo, J., Pottkett, A. (2017). A qualitative analysis of the emergence of long term care (old age home) sector for seniors care in India: Urgent call for quality and care standards. Ageing International, 43(3), 356–365. https://doi.org/10.1007/s12126-017-9302-x

Nightingales Medical Trust. (2014). TRAININGS AT NIGHTINGALES MEDICAL TRUST.

UNESCAP. (2016). Long-term Care of Older Persons in India. Available from: https://www.unescap.org/resources/long-term-care-older-persons-india

There is no professional training and qualification system specific for the national LTC workforce yet. In the LTC guideline for Puskesmas, certification or registration with a professional body is indicated for GPs, nurses, and other health care workers such as nutritionists or physiotherapists, but not for caregivers (Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat, 2018). Trainings aimed at volunteers (cadres) providing LTC services through the Posyandu Lansia have been done by local governments in collaboration with universities, such as in Malang and Depok (Kartika et al., 2019; Nugraha et al., 2019). There has been LTC training in Puskemas level too, such as in Sungailiat, Bangka District (Dinas Kesehatan Kabupaten Bangka, 2019). However, these initiatives seem to be at regional coordination level, and thus the training provision might not yet be standard nationally.

On the international level, professional training and qualification systems are managed by the National Agency for the Protection and Placement of International Migrant Workers (Badan Nasional Penempatan dan Perlindungan Tenaga Kerja Indonesia or BNP2TKI for short). This international collaboration offers training and certification on certain skills. For example, an annual placement program between Indonesia and Japan provides both skills and language training for Indonesian nurses or people undertaking diplomas and bachelor’s degrees in nursing (BNP2TKI, 2011). The Indonesia-Japan Economic Partnership Agreement (IJEPA), launched in 2008 (Ministry of Trade, 2018), established a system for ‘Indonesian health care workers to work as nurses and certified care workers in Japan’ (Nugraha et al., 2017, p.54). The length of training (6 months in Indonesia and 6 months in Japan) might not be sufficient, as it is heavily focused on nursing and language skills, while less on the use of technology and attitude in care service (Arianti, 2013).

Other sources of professional training for the LTC workforce are trainings held via third sector associations focusing on carers, people with dementia, or the provision of long-term care. Organisations providing training include Alzheimer Indonesia, Wulan 247, Indonesia Ramah Lansia or Yayasan Emong Lansia (Sabdono, 2015).

References:

Arianti, R. K. (2013). Pengaruh Profesionalisme, Pelatihan dan Motivasi terhadap Kinerja Nurse dan Caregiver Indonesia. MIX, III(2), 121–132.

BNP2TKI. (2011). Sejarah Penempatan TKI Hingga BNP2TKI. http://www.bnp2tki.go.id/frame/9003/Sejarah-Penempatan-TKI-Hingga-BNP2TKI

Dinas Kesehatan Kabupaten Bangka. (2019). Laporan Kegiatan Kesehatan Keluarga Pertemuan Perawatan Jangka Panjang (PJP Care Giver Lansia) Sungailiat 02 April 2019 http://dinkes.bangka.go.id/node/199

Kartika, A. W., Choiriyah, M., Kristianingrum, N. D., Noviyanti, L. W., & Fatma, E. P. L. (2019). Pelatihan Tugas Perawatan Kesehatan Keluarga Caregiver Lansia dalam Pogram RURAL (Rumah Ramah Lansia). Jurnal Pengabdian Kepada Masyarakat (Indonesian Journal of Community Engagement), 5(3), 448. https://doi.org/10.22146/jpkm.45139

Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat. (2018). Pedoman untuk Puskesmas dalam Perawatan Jangka Panjang bagi Lanjut Usia. Kementerian Kesehatan RI.

Ministry of Trade. (2018). Fact Sheet Indonesia-Japan Economic Partnership Agreement (IJEPA).

Nugraha, S., Agustin, D., Rahardjo, T. B. W., & Yuko, H. (2019). Pelatihan Bagi Kader Posbindu Tentang “Long Term Care” ( Perawatan Jangka Panjang ) Bagi Lanjut Usia Kota Depok. PAMAS, 3(2), 113–120.

Nugraha, S., Honda, S., & Hirano, Y. (2017). The change in mental health status of Indonesian health care migrant worker in Japan. Kesmas, 12(2), 53–89. https://doi.org/10.21109/kesmas.v0i0.1698

Sabdono, E. (2015). Commentary on Indonesia’s domain ranks in the 2015 Global AgeWatch Index.

There are no professional training and qualification systems for the long-term care workforce in Kenya. Furthermore, there is only one medical gerontologist who trained outside Kenya, working at policy level. According to the first palliative medicine specialist in Kenya, Dr. John Weru, “the duty for palliative medicine specialists is to teach other doctors and clinicians as this is a very new medical specialty practice in the country, to set up structures and processes for the growth and development of the service and to provide the much needed clinical care to patients and their families” (Star Correspondent, 2015).

References:

Star Correspondent. (2015). Meet Kenya’s first palliative medicine specialist. The Star, 23 February. Nairobi, Kenya. https://www.the-star.co.ke/sasa/2015-02-23-meet-kenyas-first-palliative-medicine-specialist/

 

While there is no formal public long-term care system in Mexico, some government institutions are working towards creating different standard competencies of care. For example, the National Institute of Geriatrics is currently working with other health and higher education institutions to develop and implement standards of care and aptitudes (skills—competencies) in cognitive stimulation for older adults for health care professionals and older adult care standard and aptitudes for social workers within the health care system. However, while these could be mandatory and applicable to all health care institutions, they would not be alike for (temporary and permanent) long-term care services since there is no agency or regulation that requires them to do so.

Care homes in Brazil are recognised by the National Health Surveillance Agency (ANVISA) as ‘living settings’ (Brasil, 2005). They have strong links to social assistance policies and come less under the ‘health-systems radar’. The offer of health services often varies according to the legal nature of the institutions, meaning that care homes do not need to have health professionals as part of the staff team by the law. Even though every care home should inform the municipal health surveillance of its operation and licensing, many institutions work in informality and clandestinely, particularly small not-for-profit and private institutions. In addition, care home workers’ profession is not secured by law, meaning that anyone could work in care homes, regardless of their preparedness to carry out that role.

Each profession involved within the LTC workforce has its own regulatory body, except for the ‘informal care workers’, as explained in the previous item. Such professional councils regulate, inspect, and establish the necessary basic training, staff/user ration, quality monitoring, etc. for the overall role of each profession within any area of care. With regards to care for older people, in specific, there is the Brazilian Society of Geriatrics and Gerontology (https://sbgg.org.br/) and the National Academy for Palliative Care (https://paliativo.org.br/) which provide specialist knowledge, training, and accreditation for those working in LTC. However, there is no national council or guidelines which are specific for the LTC workforce. Though not recognized as a profession, there are formal dedicated spaces to try and formalize, inform, and support informal care workers, such as the Association for Carers of Older People of the Metropolitan Area of Sao Paulo (ACIRMESP – https://www.acirmesp.org.br/).

The National Surveillance Agency – ANVISA regulates the minimum staff and infrastructure within care homes in Brazil, as described in the law RDC nº 283 published on 26 September 2005 (Brasil, 2005). For care workers, for example, this document states the staff/user ratio according to the older people’s level of care dependence:

Level I (low dependence): one care worker for 20 older adults per 8h/day.

Level II (medium dependence): one care worker for every10 older adults per shift.

Level III (high dependence): one care worker for every 6 older adults per shift.

This ANVISA document also details key quality monitoring and compliance variables (page 11), which can be used to fine or close down an institution for poor standards, for example (e.g., mortality rates, prevalence of dehydration and undernutrition, infection, pressure injuries, etc.) (Brasil, 2005). A single annual report detailing such variables are sent to ANVISA by the care home managers. ANVISA can make unannounced visits for inspection voluntarily or in case there is a formal complaint from anyone. However, ANVISA does not monitor the quality of the day-to-day care and interactions with older people (e.g., outside visits, person-centred care, eye contact, etc.). 

References:

Brasil. (2005). Legislação—Anvisa. http://antigo.anvisa.gov.br/legislacao/?inheritRedirect=true#/visualizar/27647

As part of the Ministry of Health and Family Welfare programmes, NPOP, the NPHCE provided operational guidelines, which support the provision of accessible, affordable, comprehensive and high quality long-term care to the elder population (MoHFW, 2011). However, there are no regulatory mechanisms in place for long-term care workers. 

References:

Ministry Of Health And Family Welfare. (2011). Operational Guidelines: National Programme For Health Care Of The Elderly (NPHCE). Available from: https://main.mohfw.gov.in/organisation/Departments-of-Health-and-Family-Welfare/national-programme-health-care-elderly-nphce

There is no regulatory body for care workers operating in Indonesia. Members of the public long-term care workforce, such as those working as volunteers for Puskesmas and Posyandu Lansia, are bound by the guidelines of their local healthcare provider. Similarly, members of the private long-term care workforce operate within the guidelines of the private sector (Pratono & Maharani, 2018). The BNP2TKI, however, operates a regulatory body for care workers working overseas (BNP2TKI, 2011).

References:

BNP2TKI. (2011). Sejarah Penempatan TKI Hingga BNP2TKI. http://www.bnp2tki.go.id/frame/9003/Sejarah-Penempatan-TKI-Hingga-BNP2TKI

Pratono, A. H., & Maharani, A. (2018). Long-Term Care in Indonesia: The Role of Integrated Service Post for Elderly. Journal of Aging and Health, 30(10), 1556–1573. https://doi.org/10.1177/0898264318794732

There are 27 Professional bodies and Associations operating in Kenya and regulate the training and conduct of their members. Some have been established under Kenyan law, while others are loose associations representing members of the profession. For instance, the Kenya Hospices and Palliative Care Association (KEHPCA) is a national association formed to represent all palliative care service providers in Kenya (Kenya Hospices and Palliative Care Association (KEHPCA), 2019). The professional bodies that regulate the health professionals include the Medical Practitioners and Dentists Board for doctors, Nursing Council of Kenya for nurses and Clinical officer council for clinical officers. The Kenya National Qualifications Authority (KNQA) is mandate to set the standards for accreditation, Quality Assurance, assessment and examination, to guide all players operating in the Country (Kenya National Qualifications Authority (KNQA), 2019).

References:

Kenya Hospices and Palliative Care Association (KEHPCA). (2019). Hospices. https://kehpca.org

Kenya National Qualifications Authority (KNQA). (2019). Professional Bodies and Associations in Kenya.

As mentioned at the beginning of Part 3., Mexico does not have a mandatory national registry of long-term care institutions, mandatory standards of care, including human resources, and no professional care/caregiver bodies exist.

No data about this have been found. However, there was a huge increase in the rate of people working as carers for older people between 2007 and 2017 (growth of more than 500% – from 5,263 to 34,051 registered informal care workers) (Brazilian Ministry of Economy, 2018). Qualitative research shows that people working in care homes are generally undervalued and underpaid (Salcher et al., 2015). However, there is a general lack of national and representative data on this topic in Brazil.

References:

Brazilian Ministry of Economy. (2018). RAIS 2018. http://www.rais.gov.br/sitio/index.jsf

Salcher, E. B. G., Portella, M. R., & Scortegagna, H. de M. (2015). Cenários de instituições de longa permanência para idosos: Retratos da realidade vivenciada por equipe multiprofissional. Revista Brasileira de Geriatria e Gerontologia, 18, 259–272. https://doi.org/10.1590/1809-9823.2015.14073

India has seen a considerable rise in the number of formal caregivers (home-based attenders) as it has turned into a commercial venture (UNESCAP, 2016). However, patterns of vacancies and workforce turnover have not been documented. 

References:

UNESCAP. (2016). Long-term Care of Older Persons in India. Available from: https://www.unescap.org/resources/long-term-care-older-persons-india

There is no specific information on staff providing LTC. Information available focuses on general health care providers.

It is not common for people to leave Brazil to work as informal care workers in other countries, and it is also rare for foreigners to come and work as informal care workers in Brazil. However, experts have indicated that, during the economic downturn, an increasing number of Brazilians (mainly women and mostly illegally) emigrated to work as professional carers in other countries (IEA USP, 2017). When the terms ‘imigração’ (immigration) and ‘cuidador de idosos’ (carers of older people) are added to the Google search engine, a plethora of agencies that help mediate the migration of Brazilians to work as informal care workers in other countries come up, specially Canada, United States and Europe. However, we could not find any official source of information detailing the number, destination, and characteristics of these individuals.

Among Brazilian people moving from one state to another within Brazil to work as informal care workers, a study suggests that this movement is generally observed from the North-eastern region, and also from the states of Minas Gerais, Parana and Santa Catarina, towards Sao Paulo and Rio de Janeiro states (Guimarães et al., 2011). No further information could be found about how many and who are these individuals. In general, the main reason for migration within Brazil is economical or ecological disasters. A study conducted by Oliveira and Jannuzzi (2005) on the distribution of migrants per sex and reasons for displacement/migration based on data from PNAD 2001 (a national demographic census conducted by the government) shows that most people migrate to other country regions to live with the family who had moved or due to the person’s job. This study also shows that within-country migration mostly occurs in the group of people aged 20-54 (Oliveira and Jannuzzi, 2005).

References:

Guimarães, N. A., Hirata, H. S., Sugita, K., Guimarães, N. A., Hirata, H. S., & Sugita, K. (2011). CUIDADO E CUIDADORAS: O TRABALHO DE CARE NO BRASIL, FRANÇA E JAPÃO. Sociologia & Antropologia, 1(1), 151–180. https://doi.org/10.1590/2238-38752011v117

IEA USP. (2017). Fenômeno da migração também tem relação com idosos—IEA USP. http://www.iea.usp.br/noticias/fenomeno-da-migracao-tambem-tem-relacao-com-idosos

Oliveira, K. F. de, & Jannuzzi, P. de M. (2005). Motivos para migração no Brasil e retorno ao nordeste: Padrões etários, por sexo e origem/destino. São Paulo em Perspectiva, 19(4), 134–143. https://doi.org/10.1590/S0102-88392005000400009

 

It is observed that due to the challenges with agriculture, many informal workers migrate to urban areas, possibly taking up carer jobs due to their high demand and comfortable pay. It has also been remarked that with increasing migration of working-age children, the availability of informal carers for older persons has decreased (Scheil-Adlung & Xenia, 2015). However, more information on the patterns relating to the migrant workforce in long-term care work is not available.

References:

Scheil-Adlung, & Xenia. (2015). Long-term care protection for older persons : a review of coverage deficits in 46 countries. ILO Working Papers.

No resource could be identified that showed an association between migration rates and the availability of the LTC workforce in Indonesia. However, there is evidence of cases, such as in Cilap city in the province of Central Java, where it was found that large numbers of women from the city work as carers and nannies overseas due to economic reasons (Raharto, 2017). These case studies are confirmed by BNP2TKI data (January 2018) that shows that considerable numbers of Indonesians contribute to the long-term care workforce in other countries (Pusat Penelitian Pengembangan dan Informasi BNP2TKI, 2019). This pattern is facilitated through bilateral agreements, such as between Indonesia and Japan, which enables Indonesian nurses to stay in Japan after the completion of their nursing training there (UNESCAP, 2014).

References:

Pusat Penelitian Pengembangan dan Informasi BNP2TKI. (2019). Data Penempatan dan Perlindungan TKI Periode Bulan Desember Tahun 2018. http://www.bnp2tki.go.id/uploads/data/data_14-01-2019_043946_Laporan_Pengolahan_Data_BNP2TKI_2018_-_DESEMBER.pdf

Raharto, A. (2017). Pengambilan Keputusan Tenaga Kerja Indonesia Perempuan untuk Bekerja di Luar Negeri: Kasus Kabupaten Cilacap (Decision making to work overseas among Indonesian women labor migrants: the case of Cilacap district). Jurnal Kependudukan Indonesia, 12(1), 39–54. http://ejurnal.kependudukan.lipi.go.id/index.php/jki/article/view/275/pdf

UNESCAP. (2014). Report of the Regional Expert Consultation on Long-term Care of Older Persons. https://www.unescap.org/sites/default/files/Report%20Reg-Consultation.pdf

There is no information specifically on LTC workers.

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).

References:

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

The LTC workforce is largely informal and unorganised, and information on their working conditions is not available.

We are unable to find information to respond to this question.

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.

References:

El trabajo doméstico en México: La gran deuda social. (2016).

People may volunteer in some care homes, such as through providing pastoral care, musicotherapy, arts therapy, writing/reading lessons, etc. An example of such initiative can be found here. There are non-profit associations and blogs where volunteer carers may subscribe themselves and can become part of a community which provides care for others (e.g. “portal da terceira idade” and “velho amigo”). Usually, volunteering schemes are set up by each institution and there are no official data about how many volunteers exist in Brazil, how these are enrolled, and what requisites they have. There are also healthcare students who practice their care and research skills in care homes which are linked through the Universities. There are also donation schemes in which churches, individuals, and large institutions donate food, clothes, and other items.

People may volunteer in some care homes, such as through providing pastoral care, musicotherapy, arts therapy, writing/reading lessons, etc. An example of such initiative can be found here. There are non-profit associations and blogs where volunteer carers may subscribe themselves and can become part of a community which provides care for others (e.g., “portal da terceira idade” and “velho amigo”). Usually, volunteering schemes are set up by each institution and there are no official data about how many volunteers exist in Brazil, how these are enrolled, and what requisites they have. There are also healthcare students who practice their care and research skills in care homes which are linked through the Universities. There are also donation schemes in which churches, individuals and large institutions donate food, clothes, and other items.

 

An example of a volunteer-led model for long-term care has been tested in the state of Kerala. The Neighbourhood Network of Palliative Care (NNPC) project is a community-owned service model for long-term and palliative care (Kumar, 2007). Volunteers undergo a structured training program and operate in groups to identify and deliver interventions to people with chronic illness in their community (Kumar, 2007). These groups are supported by trained healthcare professionals (Kumar, 2007). Another example is that of ARDSI, where of the 18 chapters of across the country, only five centres are under the national administration while the rest rely mainly on volunteers to support the activities of the organisation.

However, most formal long-term care services are often clinician-centred, and the number of volunteers involved in long-term care is negligible. Most volunteers are former family caregivers who try to help with their expertise and experience from being carers. It has been observed that volunteers are more interested in training carers (informal or formal) than in directly supporting persons with care needs. 

References:

Kumar S. K. (2007). Kerala, India: a regional community-based palliative care model. Journal of pain and symptom management, 33(5), 623–627. https://doi.org/10.1016/j.jpainsymman.2007.02.005

The organisation of the Posyandu Lansia is built mostly on volunteers. Volunteers are also involved in activities run by the Puskesmas (Departemen Kesehatan RI, 2006). We are unable to find any information about the organisation of the workforce.

References:

Departemen Kesehatan RI. (2006). Pedoman Umum Pengelolaan Posyandu. Departemen Kesehatan RI.

The National Volunteerism Policy in Kenya “recognizes the following categories of volunteers:

  1. Youth Volunteers – These are young people aged between 18-35years as enshrined in the constitution.
  2. Retired Volunteers – These are individuals retired from formal employment offering their services voluntarily.
  3. Online Volunteers – Individuals or groups of people offering volunteer services virtually.
  4. Institutional Based Volunteers– These includes individuals or groups offering volunteer services through organisations or institutions.
  5. International Volunteers – These are Kenyans and non-Kenyans offering volunteer services in Kenya and abroad.
  6. Diaspora volunteers – These are Kenyan citizens living abroad who come to Kenya to offer volunteer services.
  7. Community based volunteers – These are individuals or groups that are engaging in volunteer activities informally within their communities.
  8. Children volunteers – These include Kenyans below the age of 18years engaging in volunteer activities under guidance of an adult or institution.
  9. Government volunteer initiatives
  10. Professional volunteers – These are individuals who are in active formal employment in various sectors and offer their services voluntarily on part time basis

Different organisations have different approaches towards mobilisation, recruitment, induction, training, engagement, motivation, retention, and transition of volunteers” (Republic of Kenya, 2015b). The policy does not provide on the roles of the volunteer or the mode of shadowing. The current practice is that the roles are defined by the institution of higher learning or the host institution but are not specific to LTC.

References:

Republic of Kenya. (2015b). The National Volunteerism Policy. https://www.labourmarket.go.ke/media/resources/FINAL_VOLUNTEERISM_POLICY.pdf

Information on the support of voluntary work in health care provision (all areas/population groups) has been collected as part of the National Health Satellite Accounts generated by the national statistics institute INEGI. For the year 2017, voluntary care in health represented 1.2% of the total GDP of the health sector. Volunteer work is mostly performed in non-profit organisations at the community level, and individuals are usually not employed/contracted and/or paid. On the other hand, the 2015 Social Assistance Housing Census, CAAS, showed that of the total staff working at the interviewed long-term care institutions, 14% worked without payment as volunteers.