Global
Coalition
on Aging

GCoA

Text

Global Coalition on Aging

Building
The Caregiving
Workforce
OutlineOur Aging World Needs

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Building The Caregiving Workforce Our Aging World Needs

The COVID-19 pandemic has highlighted three essential truths which must
begin to shape the actions of governments, the healthcare communityand other private, public and non-profit stakeholders for years to come:1. The world’s rapidly growing aging population is highly vulnerable
to serious public health risks but is often isolated and marginalizedin our societies.
2. Because of modernization, urbanization and mobility, families today
in most areas around the globe are smaller and more physically distant
than ever before, heightening the need for more elder caregiving skills,
training and talent.
3. The two points above shine a bright spotlight on the irrefutable factthat the world is experiencing an acute–and expanding–shortage ofprofessional care workers.
The world is getting older. Human labor is at a premium. And technology,
despite its manifest benefits, will never entirely replace the role playedby professional caregivers in ensuring the mental, emotional and physicalhealth of the world’s aging population. These realities reveal gaps acrossall institutions that touch humanity, and these gaps must be addressed
urgently–starting with developing the caregiving workforce of the future.

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The Global Coalition on Aging’s (GCOA) 2018 report,

care and integrated care, which must be transformed

Relationship-Based Home Care: A Sustainable Solution

to align with today’s and future aging realities and thefor Europe’s Elder Care Crisis, articulated the value

goal of maintaining functional ability as we age.

provided by skilled professional caregivers. These
trained and paid professionals deliver care defined

For years, Home Instead has been a partner with GCOA

by and tailored to the needs of older individuals,

on a mission to make society a better place in which

focused on care outcomes instead of a predetermined

to grow older. With this mission comes the recognition

checklist of tasks.

that one’s home is the preferred and safest place toage and the understanding that our living rooms are

The report called for integrating this relationship-based

the hospitals of the future. However, this care model

home care model into health and social care ecosystems

cannot succeed without a skilled, vibrant, respectedworldwide. An example of such progress is in Australia,

and growing caregiving workforce.

where the Royal Commission Into Aged Care Quality
and Safety Counsel issued its report following a

To achieve this, we need to elevate caregiving as

two-year inquiry into the future of care in Australia.

a career of choice, with high standards set for worker

Its final submission states:

training and the delivery of care. We recognize that
supplementing professional care with technology,
properly deployed, has great potential to improve
care outcomes. Professionalizing and creating

Support and care in the home will be
the norm for aged care, through to theend of life. Wherever care is delivered,it should be personal and relationshipbased rather than transactional andinstitutional. All aged care will be well
adapted to providing safe, high quality
and empathetic dementia care.1

a career path for the caregiving workforce will beessential for providing the high-touch and high-techcare needed to foster a sustainable and innovative
society that supports our rapidly aging populationand fuels the growing silver economy, currently
valued at more than $USD 15 trillion.
Now, in Building the Caregiving Workforce Our Aging
World Needs, we zero in on the urgency and necessityof expanding and professionalizing the caregiving
workforce. First, we highlight the exploding global
demand for elder care—especially home care—in the2021 marks the start of the Decade of Healthy Ageing as

face of growing shortages of caregivers and the special

declared by the United Nations and World Health Organi-challenges of COVID-19. Second, we examine barriers

zation. At the top of the Decade’s agenda are long-term

to building the caregiving workforce the world needs.

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Building The Caregiving Workforce Our Aging World Needs

Third, we explore caregiving as a job creation engine

private sector, NGOs, and stakeholders across all insti-

in a world where automation and artificial intelligencetutions of society. As the largest provider of home care

(AI) are putting millions out of work and millions more

services around the world and the leading global busi-

jobs are transitioning. Finally, we recommend practicalness voice on the opportunities of aging, Home Insteadsolutions for seizing the opportunity to build a highly

and GCOA are committed to elevating the dialogue andrespected workforce of professional caregivers on

taking actions that lead to a caregiving workforce that is

the scale needed to serve today’s—and tomorrow’s—

rewarded and respected for the skilled, professional andaging population.

essential work provided. We wrote this report because
the demand for care is undeniable, but it is up to us to

The increasing demand for elder caregiving represents

lead the charge by living up to the principles shareda challenge never before experienced until the 21st

within this report. Together we can build the caregiving

century. The solutions must be multi-faceted, requiring

workforce of the future—the caregiving workforce ourcollaboration between and among governments, theaging world needs.

Jeff Huber

Michael W. Hodin

CEO

CEO

Home Instead

Global Coalition on Aging5

Contents
Wanted: More Caregivers

7

Closing the Care Gap:
More Than a Numbers Game

14

What the World Needs Now:
A New Engine of Job Creation

18

Building a Professional Caregiving
Workforce: A Roadmap

25

Looking Ahead

41

Endnotes42

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Building The Caregiving Workforce Our Aging World Needs

CAREGIVER TERMINOLOGY
We recognize the term “caregiver” is quite broad. There is not one narrow, universally accepted definitionof this term. For instance, a caregiver can be a family member, loved one, friend or neighbor. A caregiver can also be a trained professional that is hired or provided to assist with the needs of an individual
without the capability to do so for himself or herself. Caregivers can also be identified by the care recipient, as they can provide care to a child, a person with disabilities, or an aging adult. For the purposes ofour report, when we refer to the “caregiving workforce,” we are speaking specifically about those whose
job it is to care for older adults. We may also refer to them as paid caregivers, professional caregivers
or home care workers.

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CHAPTER 1:

Wanted: More Caregivers
The single most powerful demographic fact of our time is the agingof the world’s population. The data is clear and compelling.
•   For the first time in human history, there are more

the tasks of everyday life—or else their health will fall

old than young—a trend that will only grow as longevity

victim to various chronic conditions, such as dementias

continues to increase and birth rates decrease.

and frailty, which will require even more intensive and•   The world’s 703 million people aged 65 and older as

expensive care.

of 2019 will more than double to 1.5 billion by 2050.2•   In China, two-thirds of older adults have at least one•   Even the relatively young region of Latin America ischronic condition, such as diabetes, cardiovascular

rapidly aging. In 2050, individuals over the age of 65 will

disease, cancer or chronic respiratory disease.4 Nearlymake up nearly one-fourth of the total population.3

one quarter of older adults in China need assistance

The miracle of longevity means hundreds of millions ofeating and personal hygiene.5

with activities of daily living, such as bathing, dressing,people around the world are living longer, healthier andmore productive lives. Yet, longevity also increases thelikelihood individuals will someday need assistance with

1.5B

1B

703M

1.5B

113%

65 AND OLDERWORLD POPULATIONGROWTH

250K

2019

2050

25%

OF LATIN AMERICA
POPULATION WILL
BE 65+ BY 2050

66%

OF CHINESE OLDER
ADULTS HAS AT
LEAST ONE CHRONICCONDITION

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Building The Caregiving Workforce Our Aging World Needs

70%

2050

204%
PROJECTED GROWTHIN NUMBER OF PEOPLE
LIVING WITH DEMENTIAWORLDWIDEAMERICAN OLDER ADULTS
NEED LONG-TERM
SERVICES & SUPPORT

1 IN 6

OLDER ADULTS GLOBALLYEXPERIENCE FRAILTYOR PRE-FRAILTY

2020•   In the United States, 70% of Americans who reach•   The global incidence of frailty and pre-frailty amongage 65 have severe needs for long-term services

independently living older adults is approximately 1 inand support.

6, and frailty is often associated with adverse health6

As care needs increase with the aging of the population, how and where care is provided is also changing.

outcomes, including falls, disability, and increased useof health care resources.9

According to a recent report from the Organization for
Economic Development and Cooperation (OECD), there
is a major shift in care settings--from nursing homes
and residential care to home care and support for living
independently for as long as possible.7•   Worldwide, about 50 million people are living withsome form of dementia (such as Alzheimer’s disease)—a figure that is projected to reach 82 million by 2030
and 152 million by 2050.8

There’s always that moment on that first day,when you open the door to walk out and you
turn around to look at your client, and they’resitting there clean, fed, content, and looking
forward to seeing you again. That moment
is worth the whole thing to me.
James, Vietnam Veteran and professional caregiverfor 15 years, United States

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FOCUS ON FRAILTY

Frailty is a clinical syndrome prevalent in older adults and commonly
associated with risk for poor health outcomes including falls,
hospitalization and mortality.
Frailty is characterized by vulnerability resulting from aging-associated decline in reserve and function—physical and cognitive. Epidemiologists point out that the clinical characteristics of frailty include negative energy balance, sarcopenia, and diminished strength and tolerance for exertion. Some indicators offrailty include low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss—all of which can be identified, prevented and/or treated in a pre-frail stage with theright type of person-centered care.10 According to the World Health Organization (WHO), “Active casefinding of older people with frailty is essential for the reorientation of health services to these people’s
needs.”11 With more awareness, education and training, a focus on frailty can help mitigate healthcare
costs and improve quality of life.

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Building The Caregiving Workforce Our Aging World Needs

The Growing Caregiver Gap
Unalterable demographic certainties are driving a surge in demand for caregivers.
However, at this very moment of growing need, the world is experiencing an acute—and expanding—shortage of professional care workers.
•   Across OECD countries, the number of elder care•   Singapore needs to grow its direct care workforce byworkers will need to increase by 60% by 2040 to maintain130% over the next 10 years in order to serve its rapidly

the current ratio of caregivers to older people. That isaging population.15

equal to a needed supply of 13.5 million new workers.12•   In Germany, need for care increased 34% between
2015 and 2018, with 76% of care taking place in the home.13
These needs will continue to grow, and one study projects
a current shortfall of 120,000 care workers.14

2040

13.5M
NEW CARE WORKERS
NEEDED BY 2040 IN
OECD COUNTRIES•   Hong Kong projects it will need an additional 240,000
workers to provide care over the next three decades.16•   In the United States, a national shortage of 151,000
care workers will exist by 2030, and a 355,000-caregiver
shortfall by 2040.17

2031

130%
SINGAPORE CAREWORKFORCE NEED

2040

235%
UNITED STATESCAREGIVER
SHORTAGE GROWTH

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AN UNFAIR BURDENFOR UNPAID CAREGIVERS

Without a robust professional caregiving workforce, theburden of caring for aging adults will inevitably fall on unpaid,
untrained family caregivers.
→ An Australian study found→ In the United Kingdom,→ In the United States,

1.9 billion hours of unpaid

approximately £5.3 billion is60% of family caregivers

care is provided every year,

lost due to people dropping

work full- or part-time invalued at A$60.3 billion.

out of the workforce to care for

addition to their caregiving

older or disabled loved ones.

responsibilities.20

18

19

UNITED
KINGDOM:

£5.3B
LOST

AUSTRALIA:

1.9B

UNITED STATES:

60%

HOURS OFUNPAID CARE

AUSTRALIA:

A$60.3B
IN UNPAIDCARE

OF FAMILY CAREGIVERSWORK FULLOR PART-TIME

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Building The Caregiving Workforce Our Aging World Needs

There Is No Place Like Home
While the surging demand for caregivers is being driven by rising longevity, alltypes of care are not created equal. Evidence indicates that home care is thepreferred model of caregiving across a range of indicators.
People want to age in place: Survey data

Home care is less expensive than insti-

consistently shows that the vast majority oftutional care: For all but the sickest andolder adults around the world are vocalizing

most frail older people, home care is nottheir desire to age at home, rather than

only the most desirable choice, but also themove to institutional care or live with family members.

best financial option. In 2019, the average cost of home

An AARP study found that nearly 80% of adults age 50

care in the United States was less than half the cost ofand older want to remain in their homes as they age­—a private room in a nursing home ($USD 52,000 for 44

but only about half expect to do so. In Australia, 75% ofhours per week of home care versus $USD 102,204).23

older people want to stay in their current home as longIn the European Union (EU), the average unit cost ofas possible, even if they need help to stay at home.

institutional care is 106% of gross domestic product2122(GDP) per capita, compared to 36% for formal homecare.24 Institutional care is the largest public long-termcare expenditure in most European countries—a hugecost that is driving unsustainable debt levels. For these

Institutional care is the largest public
long-term care expenditure in most
European countries—a huge cost thatis driving unsustainable debt levels.

reasons and others highlighted in this section, transforming long-term care is a core action area of theDecade of Healthy Ageing.

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Home care is safer than institutional care:

Governments worldwide are turning to

Across OECD countries, nearly half of allhome care as a solution: Recognizing

COVID-19 deaths happened in care andthat home care offers a more sustainablenursing homes, although less than 1% of

and cost-effective solution, the Chinese

people live in those facilities. A recent World Economic

government has embraced a goal of delivering 90% ofForum report, COVID and Longer Lives: Combating ageism

all senior care in the home.27 Similarly, the Irish govern-

and creating solutions, emphasizes that home care has

ment’s Sláintecare policy framework seeks to integrate

long played a critical role within the broader healthcare

health and social care services, providing the majority

system, but that “the COVID-19 period has shown thatof care at or closer to home.28 Yet, like most countries,

these settings have the potential to significantly buttress

China and Ireland currently lack the home care work-

healthcare delivery…by ensuring that care can continue

force needed to achieve these goals.

25

while institutional health facilities threaten to be overwhelmed.”26 Home care workers have played a criticalrole assisting seniors during the pandemic by protecting
vulnerable elderly populations from exposure at theseoverwhelmed hospitals and nursing homes. And further,caregivers who work in individuals’ homes, rather than ininstitutions, have been better protected from the virus
due to the one-on-one—as opposed to one-to-many—
nature of home care work.

More home care is possible: A recent
analysis estimates that 25-60% of caregiven to older people in the Netherlands
could be provided at home.29 In Canada,
roughly 40% of institutional care residents could go
home—if given the right support.30 One study in the
United States found that increasing the availabilityof home care could generate significant Medicare
savings, since $USD 4 billion in Medicare costs result
from a lack of non-medical support.31

It is the clients who bring joy to my life.
My clients are so appreciative that I’m
helping them stay in their homes.
It’s heartwarming to know you’re helping
provide extra meaning to their lives.
Kristin, professional caregiver, Canada

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Building The Caregiving Workforce Our Aging World Needs

CHAPTER 2:

Closing the Care Gap:
More Than a Numbers Game
Closing the gap between supply and demand for home care workers will not be
achieved by simply recruiting and training more people. It will also require a dramatic
shift in societal understanding of and attitudes toward the caregiving profession.
Providing professional home care requires a special

This is more than an injustice to the millions of dedi-

kind of talent, as well as a unique combination of skills.

cated home care workers across the globe—it is also

A caregiving career centers on a passion to serve othersa major barrier to building the professional, skilled—accompanied by patience, empathy and trustworthi-

caregiving workforce the world desperately needs

ness. High-performing caregivers also exhibit depend-

to support its rapidly aging societies.

ability, flexibility and enthusiasm. They need exceptional
communication skills to build rapport with the people
they care for—to break down the loneliness and social
isolation so many older people feel and to lend a sympathetic ear to the unique challenges that older people
face. In fact, the OECD points out that psychologicalsupport that is achieved through conversations is oneof the top roles that a caregiver plays.32
In far too many countries, however, the caregivers weneed most are the ones we tend to value least. A profession that deserves society’s respect and appreciation isoften overlooked and devalued.

Hidden in Plain Sight
Bioethicist Nancy Berlinger has referred to home care
workers as “an overlooked population…in plain sight.”34
This perceived invisibility was made evident during the
COVID-19 pandemic.
Despite serving on the front lines of care for the mostvulnerable populations—and being deemed “essential”
workers in many countries—home care workers were
often marginalized and forgotten.
In a qualitative analysis of home care workers in New

When researchers in the United States
asked caregivers what drew them tothe profession, more than 88% cited their
desire to serve people.33

York City during the COVID-19 pandemic, workers
commented that “we are definitely a forgotten field…
You hear people clapping, thanking doctors andnurses,…the hospital cleaning staff….I am not doing
this because I want praise; I love what I do. But it would
be nice for people to show us gratitude.”35

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I know it sounds like a cliché, but you feelthat you can really make a difference topeople in their daily lives, and that’s whatmakes me happiest. I go home knowing that
I have done a worthwhile job. Above all, it’s
the opportunity to provide comfort and care
to people in their greatest hour of need.
Emma, professional caregiver, Ireland

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Building The Caregiving Workforce Our Aging World Needs

While older people and their families recognize theBridging the gender gap: Today’s care-value professional caregivers provide, caregiving isgiving workforce is comprised largely of

still too often considered low-status work. A variety

women, which perpetuates an image ofof factors contribute to this lack of respect for care-

low-respect domestic work. In the United

giving, each of which makes it difficult to recruit andStates, women account for 87% of professional homeretain skilled professionals around the world. It is timecare workers.38 In Argentina, one-third of all employed

for universally accepted ideas about the caregiving

women—but only 3% of all employed men—are care

workforce to correspond with the shifts in supply

workers.39 As modernization upends traditional maleand demand—and the increasing need of this workand female gender roles within households, and aswithin society. All stakeholders can help remove

workplaces strive to achieve gender equality, caregiving

these obstacles by:should be no exception.

Combatting ageism: Too often older

Linking wages and value: Wages for home

adults are marginalized across society,care workers are typically on par with jobs

an ageist attitude that influences therequiring a minimum level of skills andpeople who care for them. Recent social

training, similar to retail and food service.

media trends—like nicknaming COVID-19 the “Boomer

Many factors, including high rates of part-time employ-

Remover” in reference to the high mortality rates inment contribute to suboptimal wages across the sector.

older people—only serve to legitimize this prejudice.

Median annual earnings in the United States are $USD

According to the World Health Organization (WHO),

20,20040—which is below the United States poverty line

ageism “can take many forms, including prejudicial

for a family of four.41 In England, 73% of independent

attitudes, discriminatory practices, or institutional

sector care workers are paid less than the country’s

policies and practices that perpetuate stereotypicalreal living wage.42 And in Japan, average caregiverbeliefs.”37 To address this widespread injustice,salaries are between $USD 23,000 and $USD 35,000.43

WHO has launched a global report and campaign

Industry standards, training and skills development

to combat ageism.

must and will increase with rising demand for quality

36

care. As a result, so too will the cost of quality homecare services, which directly correlates with a higher
earning potential of the workforce.

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Retaining workers: The aforementioned

Reframing aging as the rule, rather than the exception,

factors all contribute to high turnover rates

does not come easily. Without a societal shift in ourfor caregivers, reinforcing the field’s repu-

perceptions of aging, how can we change perceptions

tation as undesirable. In Singapore, theto appreciate the value these essential care workers

average tenure of home care workers with their current

bring, while also building recognition and respect for

employers is just 2.6 years, lower than nursing homes

caregiving as a profession?

or elder day care. In the United States, turnover rates
44

run between 40% and 60% for home care workers.45
Working environments and benefits, as well as recruitment of the workers best suited to caregiving, will be
important considerations for employers as the talentpool grows more competitive with the rising need forhome care. Unfortunately, only half of OECD countries
have made any efforts to recruit workers to the carefield since 2011.46

Defining a career path: Skills developedin caregiving can be vital in other healthcare
and social work professions and within the
broader business community. A clearly
defined path for trained caregiving professionals thatoffers access to greater career opportunities is lacking.
Caregiving can be a promising job opportunity for thoseat the beginning, in the middle, and/or at the end of theircareers. Yet, these career paths in the aging field areneither well-defined nor promoted.

Only by addressing these intersecting
challenges can we close the supplydemand gap in caregiving—and, more
importantly, build a robust, thriving
workforce of professional caregivers.

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Building The Caregiving Workforce Our Aging World Needs

CHAPTER 3:

What the World Needs Now:
A New Engine of Job Creation
Even before the arrival of COVID-19, the global labor market was in the midstof an intense disruption.
Over the last 50-plus years, both Europe and the United

COVID-19 only added to the uncertainty. In China,

States have seen a massive shift away from manu-

roughly 5 million people lost their jobs due to COVID-19

facturing jobs to service-sector employment. In thein January and February of 2020.51 In March 2020 alone,

EU, manufacturing has fallen from 20% of GDP in 1991

701,000 American jobs were lost—the largest monthly

to under 15% as of 2018. Today manufacturing jobs

decline since the financial crisis in 2009.52

47

account for just 8.5% of the workforce in the UnitedStates, down from nearly a third in the early 1950s.48

Service sector jobs were particularly hard hit. The
pandemic has put more than 120 million jobs at risk in

As manufacturing jobs dried up, service-sector jobs

the global travel and tourism industry,53 and retail trade

took their place. Prior to COVID-19’s labor market shocks,

lost 2.1 million jobs.54

about three out of four workers in both Europe49 and theUnited States50 were employed in the service sector.

25%

PRIOR TO COVID-19

3 OUT OF 4
UNITED STATES & EUROPEAN
WORKERS WERE EMPLOYEDIN THE SERVICE SECTOR

20%
15%
10%

33%

8.5%

UNITED STATESWORKERS EMPLOYED IN
MANUFACTURING

5%

1950

2020

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120M

61%

WORKERS IN WORLD’SLARGEST ECONOMIESTO BE RETRAINEDJOBS AT RISKIN THE UNITEDSTATES

57%

57% OF JOBS UNDER THREATACROSS 37 OECD COUNTRIESInterestingly, however, the workforce shifts createdAccording to IBM, these innovations will require retraining

new opportunities in the care field. For example, in

120 million workers in the world’s 12 largest economies.56

Sweden, over 1,000 laid-off SAS airline workers were

Across the 37 OECD countries, an average of 57% ofoffered the opportunity for fast-track healthcarejobs are under threat.57 Researchers have concluded

training as hospital and nursing home assistants.55

that 25% of United States jobs are at “high-risk” of automation, while another 36% face “medium-risk” of being

Many in the program simply wanted to help others

taken over by technology.58

in their time of need, demonstrating how the natureof service and purpose are increasingly desired

Even before COVID-19, the need for alternative job-

job characteristics.

creation engines capable of employing millions ofpeople displaced by AI, automation and other technologies was critical. COVID-19 has dramatically accelerated

AI, Automation and Technology
Put Jobs at Risk
Beyond the pandemic, many of today’s service sector
jobs were already at risk from automation, artificial
intelligence (AI) and other advances in technology.

this imperative, as millions of businesses around theworld seek contactless solutions that replace people
with machines.

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Building The Caregiving Workforce Our Aging World Needs

Caregiving Is a Job Creation Engine That Can Be Enhanced(but Not Replaced) By Technology
Caring for the world’s rapidly aging population is—and

A Rapidly Growing Industry: The global market forwill remain—a vibrant growth industry. While technology

home care is projected to increase from $USD 304

has made the future of work within all sectors uncertain,

billion in 2020 to $USD 516 billion by 202759—a nearly

there will always be enormous opportunities in caregiving.

70% increase.

In fact, caregiving stands at the leading edge of a newwave of employment demand and job creation that can

A Powerful Job Creation Engine: In Brazil, it is predicted

offer rewarding work to individuals displaced by tech-that up to 25% of the population needs home care to

nology, the COVID-19 pandemic and other global shifts.

assist with the activities of daily living.60 As of 2018,
roughly one-quarter of China’s 249 million 60-plus population required care, but there were only an estimated300,000 certified caregivers to meet that demand.61 In
the United States, personal care aides and home health

Clients are scared—and rightfully so.
With the pandemic, you’re the only
person ever seen besides their families.
Their age and health conditions makethem more vulnerable.

When it comes to caregiving, technology should be

Max, professional caregiver, United Statesembraced—by older people, by their families, byaides are among the 10 fastest-growing occupations.
By 2028, a combined 1.2 million new jobs will be createdin these sectors.62

employers of caregivers and by caregivers themselves.
However, machines will likely never replace the humantouch. Nor will machines replace the intensely humancapabilities of compassion, empathy, patience andtrustworthiness that define home care workers. Instead,in the future, it will be the human workforce, aided bytechnology innovations to create efficiencies, that will
deliver the best care in the home.

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Opportunities for All Ages and Stages
Caregiving offers rewarding opportunities for a broadcross-section of workers—from Millennials (those born
between 1980 and 1996) seeking meaning and purpose in
their careers, to older adults looking to earn additional
income, give back, and stay engaged during retirement.
In fact, according to Aegon’s 2020 Retirement Readiness Survey, 57% of workers globally expect a phasedtransition into retirement and envision working in some
capacity while in retirement. Fifty-one percent say theywant to continue working in retirement in order to keep
active physically and mentally.63
A Flexible Encore Career: Many people in their 50s, 60s,
70s and beyond have gained valuable experience caring
for children and aging loved ones. Home care provides a
rewarding option to employ these vital skills. In addition
to bringing practical experience and empathy to the job,these mature workers are able to forge trusted relationships
with the individuals, families and loved ones they serve.
Providing Meaning for Millennials: Younger people insearch of purpose-driven work are finding that caregiving can offer a satisfying and meaningful career.
Research shows that Millennials struggle to find jobs
they find meaningful. Nine out of 10 Millennials said it was
important for their work to have a positive impact on theworld, half would take less money, and two-thirds would
work longer hours in order to do more meaningful work.64

Millennials don’t just see their job as a job;
they see it as a representation of their life,
and they want that life to have meaning.
How Millennials Want to Work and Live, Gallup, 2016

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Building The Caregiving Workforce Our Aging World Needs

Millions of people around the world will be looking for

For all of these groups and many others, home care—in

new jobs as AI, automation and technology continue

particular, relationship-based home care—offers oppor-

displacing humans in more and more sectors. Millions

tunities for meaningful work that can not only fulfill themore are looking to leave their current positions ingoals of individual workers, but also meet the caregiving

search of work that offers meaning and purpose. Others

needs of the world’s aging population.

feel dissatisfied in retirement and want an encore
career where they have both flexibility and the chance
to make a difference.

The key question: How can we elevatecaregiving as a globally admired,valued and respected profession?

HOME CARE SPOTLIGHT

23

Helping Families Make Memories
Kristina
P R O F E S S I O N A L C A R E G I V E R , C A N A DA

As a young adult, I worked as a care aide at the local
hospital and found it a rewarding experience. After
getting married and having children, I spent 12 years
as a stay-at-home mom.
During this time, my mother was diagnosed withbrain cancer, and I became her primary family caregiver. For five months, I drove to her house every
week, returning to my home on the weekends. I was
so tired, I couldn’t soak up those final moments withmy mother because I was so focused on her care. If
there was a professional caregiving agency at thattime, I would have hired them on the spot.
When my children became more independent,
I wanted a job that would allow me to be homefor dinner with my family, but also make use of mycaregiving skills, and make a difference. Working fora home care agency allowed me to do all of this.

One of my first clients was Beryl, a 96-year-old
great-grandmother who needed help a few times a
week. I’m still working with her two years later. Just
thinking about Beryl makes me smile. We clicked
immediately. She was a teacher, so if I use thewrong word, she corrects me. When she’s having a
super day, I’m literally running to keep up with her.
I put my heart and soul into this job. Clients like
Beryl bring so much joy into my life. Given myexperience caring for my mother, I want my clients’families to be able to enjoy time with their loved
ones without worrying about caregiving responsibilities. They can focus on listening to stories, having
conversations and making memories they will holdclose to their hearts for a lifetime.

24

HOME CARE SPOTLIGHT

Building The Caregiving Workforce Our Aging World Needs

From Packages to People
Max
PROFESSIONAL CAREGIVER, USA

After studying music production in college, I had atough time finding a job in that field. All my previous
jobs had been in food service—from fast food togrocery stores to catering—so I wanted to steer
clear of that. So, I looked for a job with the highest
hourly wage, which turned out to be as a package
handler at a large distribution center.
My job paid $14.86 an hour to unload packages fromtrucks and transfer them to a maze of conveyor beltsrunning throughout the facility. It was back-breaking
work—but what turned me off wasn’t working hard;
it was the apathy of my fellow workers. Too many
people wanted to get away with doing as little aspossible. It was not cool to care about doing a goodjob, and I didn’t like that environment.
I lasted four months—and then tried a few gig-economy
jobs, but the work was unreliable. Then a friend working
in home care suggested I give it a try.
Caregiving was a new experience. I was immediately
impressed by the company’s professionalism andeagerness to get me working by providing me withthe training I needed. Going into my first client’s
home for the first time was a little nerve-wracking.

I didn’t know them; they didn’t know me. But the
moment I arrived, I realized the importance of mytraining. I was dealing with a real person with real
health conditions, who needed real help. I couldn’t
let him down.
That first client was a 92-year-old World War II
veteran with advanced dementia who struggled tocomplete his sentences. But I could see the person
inside trying to get out, and I soon learned how tofigure out what he was trying to tell me. Every day,I’d make him coffee and food and try to get him totalk a little more—sometimes successfully, sometimes not. We’d talk about his memories of the war
and watch old Westerns on TV. One day he put his
arm around me and said, “You know, we’re really
good buddies, aren’t we?” That’s when I knew I was
having an impact.
I’ve been a caregiver for over a year—and I love myjob. At times, it doesn’t even feel like I’m working.
When you’re with someone three or four days aweek, you meet their kids and grandkids and get
absorbed into their family. I feel truly valued andnot like I’m just one of many.

25

CHAPTER 4:

Building a Professional Caregiving
Workforce: A Roadmap
The challenges facing society today are complex, but clear:
We do not have enough caregivers
to provide care for the world’s
rapidly aging population.
Millions of workers—displacedby technology, downsized by
COVID-19, or searching for greater
meaning and purpose—deservewell-paying, rewarding jobs with
opportunities for advancement.

Technology can enhance caregiving—especially with routine tasks likeorganizing appointments andmedication reminders—but it will
never entirely replace human touchand person-centered care.
Professional care companies are
already struggling to recruitand retain caregivers.

Innovative solutions are needed to address theseand the healthcare community; insurance companies

challenges. It is tempting to assume that simply raisingand labor groups; advocates for older people andwages or allowing more migrant workers into a country

individual families—everyone has a critical stake in thiswill solve these problems. But these levers are compli-

outcome and a vital role to play in making it happen.

cated, and alone they do not constitute long-term,
systemic solutions to the challenge of caring for theworld’s aging population.
Multi-faceted, long-term, scalable solutions are needed.
All key stakeholders—public, private, non-profit—must
engage in an effort that focuses on building the robust,
thriving caregiving workforce of the future. Government

In that collaborative spirit, thefollowing recommendations are aimed
at elevating caregiving as a profession
and building a robust workforce thatcan meet the needs of society, aging
individuals and their loved ones.

26

Building The Caregiving Workforce Our Aging World Needs

27

RECOMMENDATION 1:

Change the Global
Perception of the
Caregiving Profession
so It is Appreciatedfor Its Value to Society
Shifting society’s perceptions of caregiving jobs is a critical first step
toward attracting more people. The process starts with campaigns
that transform mindsets about caregiving—from a low-skilled job of lastresort to a valued, professional career of the future.

28

Building The Caregiving Workforce Our Aging World Needs

What will it take to reposition caregiving? A new publiccaregiving. Unfortunately, over the last 10 years, only

narrative that will change perceptions on a massive

half of OECD countries have implemented policies orscale. Clear messages about the rewards of caregiving—

programs to attract workers to the care field.65

the expertise and specialized training caregivers bringto the role, the exceptional service and value theyIn May 2020, the United Kingdom Department of Healthprovide to care recipients, and the professional andand Social Care (DHSC) launched a national recruitment

ethical standards they uphold in their everyday work.

drive. The “Care for others. Make a difference” campaigncelebrates the extraordinary work of caregivers andGovernments, non-profits and business leaders all haveaims to inspire people with the right values and attri-a stake in ensuring a robust, well-trained, committed

butes to consider a paid career in elder care. Ads ran

pipeline of caregivers to alleviate strains on individuals,

across traditional and social media, linking to a website,families, healthcare systems and economies.

www.everydayisdifferent.com, where people canread career stories, learn about different caregiving
roles, download resources and search for jobs. To help

National Campaigns Can Createa Movement and Draw Talentconnect qualified people with caregiving jobs, DHSC

The nursing and teaching professions have been

National campaigns involving other professions—in

successfully re-framed by thoughtful campaigns that

healthcare and other sectors—have also provenchanged public perceptions. There is no reason why asuccessful in elevating respect for these careerssimilar broad-scale effort cannot achieve the same forand attracting new recruits.

has partnered with five national job boards that offer
support in filling vacancies.66

In Germany, government and care industry associations

We breathe easier knowing our grandmother’s care is in the capable hands ofa caregiver. I can honestly say my grandmother might not be here today, talking
about celebrating her 100th birthday in lessthan two years, without this support.
Family caregiver, Canada

joined forces to launch a campaign to attract nursing
trainees. Launched in January 2020, the “Make a Career
as a Human” campaign is led by the Federal Ministry
for Family, Seniors, Women and Youth. It grew out of
the Nursing Training Offensive Plan, which called forincreasing nursing apprentices by at least 10%. The planand campaign are supported by other federal ministries,
local governments and many associations in the healthcare sector.67

29

In the United States, the American Physical Therapy

and/or people living with dementia. These scholarships

Association has a campaign under the umbrella ofgive nurses a platform to discuss innovations in care

“Choose PT.” First launched in 2016 to educate the publicand highlight the value of the profession.

on physical therapy as an effective non-opioid andnon-drug option for treating chronic pain, the campaign

CarersUK hosts an annual Carers Week and Carers Rights

serves as a powerful tool for raising awareness of the

Day to raise awareness of caregiving and highlight thebenefits of physical therapy and the role of physicalchallenges carers face. These events not only focus

therapists as “movement experts.”68

attention on the contributions caregivers make tofamilies and communities across the United Kingdom,
they also enlist people who may not think of themselves

Enlist Public Advocatesand Create Recognition
Opportunities

as having caring responsibilities to identify with theprofession and access much-needed support.

Associating a well-known public figure with an issue

BOTTOM LINEor cause has proven effective at driving interest andGovernments, non-profit umbrellagroups and other healthcare
stakeholders will need to pool theirresources and expertise to create
and organize a movement that brings
global recognition to the value of the
caregiving workforce. A movement
needs ambassadors to become
the “face” of the cause. As part ofany campaign, well-known andrespected celebrities stepping out
as ambassadors and sharing theirpersonal stories will help shine a lighton the value of caregiving.

raising awareness. By recruiting celebrities or otherpublic figures whose loved ones are benefitting, or
have benefitted, from home care, for example, could
encourage policymakers and the general public to adopt
the need for caregiving for older adults as a cause to beaddressed. These efforts will also help showcase caregivers as heroes and elevate respect for the profession
as a whole.
Creating annual milestones—such as professional awards
and high-profile events—can also help elevate caregiving.
Queen Silvia of Sweden has a longstanding commitment
to the quality of care for older people, particularly thosewith dementia. The Queen Silvia Nursing Award is ascholarship granted each year in Her honor, to nurses
in Sweden, Finland, Germany, Poland and Lithuania who
submit creative ideas for improving care of older adults

30

Building The Caregiving Workforce Our Aging World Needs

RECOMMENDATION 2:

Bolster Training
and Education
Standards to Ensure
Consistent Quality
and Accountability
In the early days of nursing, anyone could claim the label “nurse.”
There were no standards for nursing care. Most people relied onfamily members or friends to provide care or, on occasion, would
rely on word of mouth to find others who had built a reputation in
the community.
Similarly, today’s prevailing view of home care is likely related
to the lack of uniform training and educational standards for
professional caregivers.

31

As a 2017 EU CARE/EIT Health report stated: “Today, theFor instance, in England, care workers can seek

European Union and its Member States do not have acontinuing education opportunities, including training

standard definition or measurement of quality care, letand courses that culminate in a care certificate. This

alone a monitoring mechanism to ensure care stan-is one step toward helping the care workforce map adards are being met, an overall caregiving strategy, orEU-led caregiving education, training or curriculum.”

career path.

69

The Australian Royal Commission into Aged Care Quality
The story is much the same in the United States. Thereand Safety recently recommended defining high-quality

are currently no federal training standards for personalcare as care that “puts older people first. It means acare aides, i.e., home care workers. And in fact, only

standard of care designed to meet the particular needs

five states require more than one week of instruction toand aspirations of the people receiving aged care...

take on the job.70

delivered with compassion and respect...designed torespond to the person’s expressed personal needs,

Some national authorities and advocacy groups haveaspirations, and...preferences.”71 In Ireland, Home &begun to elevate the interconnected issues of high-Community Care Ireland (HCCI), the representative bodyquality care, caregiving training requirements, and more

for private home care providers, is calling for a number ofstructured career pathways in the care field.

changes, including:72• Designating “Health Care Assistant” and “Home Help”

One of my clients underwent such a transformation after I started working with himthat his friends hardly recognized him.
He hadn’t been taking care of himself, sothat was my first challenge. Once weformed a bond, he allowed me to cut hishair and trim his beard, as well as pressa suit for him. Now he sits by the front
door every morning to await my arrival.
Sophia, professional caregiver, United Kingdom

as protected titles to ensure the development ofthese roles as key health occupations;• Developing care worker grades and career progression paths that reflect skills and experience;• Encouraging new graduates to enter home care;• Promoting ongoing professional development andlife-long learning among care professionals andmaking this a requirement of any future registration
process for careers; and• Creating a broad range of training and skills development programs to build capacity.

32

Building The Caregiving Workforce Our Aging World Needs

The Irish government’s Health Services Executive (HSE)

Basic training on conditions that increase in prevalenceis the main employer of caregivers, with HCCI member

with age—such as dementia, heart failure, osteoporosis,

companies employing the second largest group offragility fractures and vision loss—will go a long way

caregivers. To effectively ensure quality home care, any

toward skill development in many elder care situations

efforts to professionalize the industry in Ireland andand standardization across the profession. It is impera-change perceptions must be a joint public/private effort.

tive that home care agencies and government agencies
work together to provide professional caregivers thehands-on learning experiences—including the use oftechnology, mentorship and career support—that carers
need to advance in the field.

BOTTOM LINE

Governments must acknowledge
the value of the caregiving workforce
to public and private healthcare
systems in order to meet the needsof their growing aging populations.
Legitimizing the value of this workforce will require care providers
and governments alike to work toestablish quality standards.

33

THE EVOLUTION OF NURSING: 73,74,75
POTENTIAL LESSONS FOR CAREGIVINGLESSON 1

with funding from the Rockefeller Foundation. Ten

Formal training shapes how caregivers are perceived.

years later, China’s nationalist government funded

Prior to the late 1800s, nursing was not a well-its first secondary-level nursing school.76 There

respected profession and the quality of care in

were 216 secondary nursing programs establishedhospitals varied greatly. Then, in 1859, Florencein China by 1949, when the communist government

Nightingale published “Notes on Nursing”—thecame into power. During the national educational

first instruction manual of any kind for nurses. The

reforms initiated by the new government, nursing

Nightingale Training School for nurses at St. Thomas’s

education beyond the secondary level was abolished,

Hospital in England opened the following year. The

and nursing education only regained its academic

next two decades saw the opening of the firstcontext in the 1980s.77 In an effort to build not only anursing schools in the United States. Professional-

larger but more competent and qualified workforce,ized training according to accepted best practices

China has joined the international movement tostarted the process of transforming nursing into

implement a national licensure examination for nurses.

the respected position it holds today.

In 1995, China established the National Nursing
Licensure Examination (NNLE). Prior to the estab-

LESSON 2

lishment of the licensure examination for nurses,

Shifting from on-the-job training to more formal

nurse registration and management in China had

education takes decades. By 1900, the United

been unregulated, lacking any national standards.78

States had over 400 hospital-based nursing schools.
However, there was little or no standardization

LESSON 3

of training as each hospital determined its own

Governments need to play a role in setting stan-requirements. Hospital-based diploma programs

dards. In Japan, modernized nursing professional

remained the norm until the latter half of the 20th

qualifications were established by Midwives Rules ofcentury. In 1952, Columbia University introduced

1899, Nurses Rules of 1915, and Public Health Nurses

the concept of a two-year associate nursing degree,

Rules of 1941, respectively. Then, in 1942, it was thewith a curriculum combining half nursing classes

National Healthcare Act that bolstered public healthand half general education classes, plus clinicalnurses, midwives and nurses to the level of health-experience gained in the community. These asso-care professionals including medical doctors andciate degree programs took off in the 1960s anddentists.79 The first United States nurse registration

beyond, largely replacing hospital-based diplomas.

law, written to protect the title of nurse and improve

China’s early development of modern nursing

one state. It took until 1955 for all states to develop

education was influenced by western policy reforms.

standards of educational training, regulations and

The first college-level nursing program was estab-laws governing both licensed practical nurses andlished in 1920 at the Peking Union Medical College

registered nurses.

the practice of nursing, was enacted in 1903, in just34

Building The Caregiving Workforce Our Aging World Needs

RECOMMENDATION 3:

Support and Reward
Caregivers
Commensuratewith the Demandsof the Job and theValue They Provide
For all the reasons cited in this report, the need for caregivers willcontinue to grow—and the workforce of caregivers must grow if
we are to care for the world’s aging population, reduce the strain
on loved ones and families and lower the financial burden on overstrained public and private healthcare systems.

35

The field of caregiving cannot achieve sustained growth
unless the profession as a whole takes care of its own
workers. According to the OECD, the most important
policy changes needed are those that focus on
improving working conditions and employee training.80
Over time, wages will rise with the quality of the
caregiving workforce, with training and with growing
demand. But employers must pay more attention to theemotional and financial needs of caregivers—especially

The key to engaging more older adult
employees is by helping them focus on
their caregiving job, not as a part-timewage filler, but as a second career thatthey can really develop.
Seiko Adachi, Founder & Executive Headof Social Welfare Corporation, Shinko Fukushikai, Japan81

if they are to attract young, purpose-driven talent.
Building a robust, growing, sustainable workforce

A study from Stanford University explains that countriesof caregiving professionals requires a comprehensivewith the highest performing education systems havesystem of support and rewards that are fully aligned

one very important feature in common: they treat theirwith the extraordinary demands of caregiving

teachers as professionals. Investing in opportunities forand the incredible value caregivers provide to care

professional training and career development before

recipients--their clients--and their loved ones. The

and on the job, as well as mentorship for ongoing career

foundations of this system must include:

support, has resulted in high performance of students

Competitive compensation that recognizes
the expertise, training and intangible qualities needed to be a caregiving professional.
Comprehensive employee benefits that are

and education systems overall.82 Similar investments
should be made in the caregiving workforce, which willcontinue to grow in demand and in value to society.

a staple of other respected professions and

BOTTOM LINE

will help attract and retain long-term talent.

To grow a qualified talent pool, homecare agencies, national governments
and others that employ caregivers
must focus on needs of the incoming
workforce and provide workplaces
that will attract dependable, flexible
and enthusiastic individuals to join
the caregiving workforce.

Career development in the form of learning
experiences that demonstrate to caregivers
that they will have opportunities to enhancetheir skills, advance in their careers andfulfill their passion to serve.

36

Building The Caregiving Workforce Our Aging World Needs

RECOMMENDATION 4:

Fully Integrate theHome Care Workforce
Into the 21st-Century
Health and Social
Care Ecosystem
At a time when the essential need for home care in the health and social
care ecosystem is increasing, the professional status of home care workers
within these ecosystems has not kept pace. This must change. After all,these are the frontline care professionals who are critical to the deliveryof value-based care, play a crucial role across the care spectrum, andprovide much-needed assistance to millions of older people worldwide.

37.While keeping older adults safe at home is a recognized

Reducing Hospital Readmissions inpriority for healthy aging, the value of the multitude ofGermany: A pilot program in Naumburg/

benefits it provides is simply not appreciated. Home

Saale, Germany showed that collabora-care plays an important part in early detection andtion across the full range of professional

prevention of disease and decline. Home care stream-

care providers, hospitals, rehabilitation facilities andlines transitions from hospital care to skilled nursing orhome care workers reduced hospital readmissions forrehabilitation facilities to the home. Home care maxi-senior patients by more than 30%.83 The program will

mizes choices for older people, allowing them to follow

be expanded to improve upon these results using a new

their clear preferences to age in place. Home careinnovative app.

reduces hospital readmissions, lowers overall healthcare costs and alleviates the burden on family members.
But, the status of home care workers remains low.
Some successful examples demonstrate how collaboration between home care providers and other membersof the healthcare ecosystem leads to better healthoutcomes for older adults, thereby demonstrating thevalue of the home care workforce.

Providing Better Care to Seniors in the UK:
A joint initiative between the Home Instead
franchise in Exeter and East Devon and
the South West Ambulance Service Trusttrained care teams in using a “traffic light system” forassessing injuries from a fall—a common but dreaded
occurrence for older adults. The assessment used red/amber/green indicators to determine whether an ambulance was needed or if it was safe to help the client
up from the fall using a Raizer Chair. Since 2017, thisinnovative initiative has helped lead to a 79% reduction
in hospital admission rates from falls and a savings ofmore than £210,000 for the National Health Service
from one location alone.84

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Building The Caregiving Workforce Our Aging World Needs

The potential for improving care and quality of life while

During COVID-19, every state in the United States

reducing costs is enormous. The barrier continues

deemed home care services as essential—providing

to be antiquated attitudes toward home care fromlife-saving and life-sustaining support for the physical,

the medical profession and across the healthcare

mental, emotional and social well-being of older adults.

ecosystem, which have permeated across broader

This fact alone demonstrates the critical role homesociety. While these attitudes persist, the essential

care workers play in the lives of millions of older adults

value of home care within the healthcare ecosystem

the world over.

can neither be recognized nor realized. These attitudes will be hard pressed to change without a robust,engaged and capable caregiving workforce.
BOTTOM LINE
In Australia, the care industry has successfully advocated for the creation of a new role: Aged Care Navigator.
Currently in the trial phase, Navigators will assist older
Australians who need care with learning about available
aged care services and how to access them. Navigators
will guide care recipients along their lifetime journeys
through the aged care system and provide a “go-to”
source of knowledge that begins with discussing thecare process.85

Healthcare systems—whether public
or private—must better understandand formally recognize the vital rolethat home care workers play in thecare ecosystem. To grow a qualified,talented workforce--and elevate itin the process--home care agencies,
national governments and others that
employ caregivers must focus on andtruly meet the needs of caregivers.

HOME CARE SPOTLIGHT

39

Providing Care With Love
Jin
PROFESSIONAL CAREGIVER, SHENZHEN, CHINA

One of my first clients, Aunt Xu, suffered fromsymptoms of Alzheimer’s. She was so frightened
and felt powerless about stopping the progressionof the disease. Her husband didn’t know much about
it either, and he felt helpless and depressed. This
lack of knowledge is not unusual among Chinesefamilies, so education is an important part of ourwork as caregivers.
To relieve the pressure on their relationship, I started
to take daily notes on how Aunt Xu was doing, andwhat activities she could manage on her own. I kept
her husband updated on her progress and also tried
to educate him about the disease so he could understand what was causing her symptoms. I encouraged
them to spend time exercising together, which I
knew would have physical and emotional benefits
for both of them.

It’s only been a few months since we started working
together, but recently I was thrilled to see the couple
holding hands. I later learned that it was the firsttime in many years they had done so. Walking handin hand—a tiny but difficult step forward and a goodreason to celebrate!
Aunt Xu is making progress, slowly but surely. I’mworking with her to ensure she maintains the ability
to do basic self-care activities, like taking a shower,brushing her teeth, as well as household tasks likefolding clothes and preparing meals. We also docreative activities, such as gardening, painting andhandicrafts. Each of these small steps goes a longway in helping to enhance her quality of life.

40

Building The Caregiving Workforce Our Aging World Needs

41

Looking Ahead
As this report demonstrates, the urgent need to build a robust, thriving
workforce of professional caregivers is paramount. An aging society
demands this solution. Families and loved ones desperately call for help.
Older people speak with a clear voice on their preference to age at home.
Governments and healthcare systems face unsustainable financial
burdens unless new solutions are found.
The caregiving industry, governments, NGOs, patient advocacy organizations, family support groups and other stakeholders must come together
to shape the needed solutions for creating the home care workforce
our aging world requires. This report’s recommendations aim to serve
as a catalyst for change to foster collaboration and action.
It is time to build a global workforce of professional caregivers that is highly
valued, deeply respected and sustainably growing—a workforce capableof satisfying the demands of older people to age at home; providing
peace of mind to family members and loved ones who want the best carefor their loved ones; and strongly integrated into the overall healthcare
ecosystem in ways that lower costs and create a dynamic continuum ofcare across the entire aging journey for people everywhere.

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Building The Caregiving Workforce Our Aging World Needs

Endnotes
1. Royal Commission into Aged Care Quality and
Safety Counsel Assisting’s Final Submissions.
Available at: https://agedcare.royalcommission.gov.au/sites/default/files/2021-02/
RCD.9999.0541.0001.pdf, page 472.
2. World Population Aging: Highlights. United
Nations. 2019. Available at: https://www.un.org/
en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf, page 7.
3. Frayssinet, Fabiana. Latin America Must
Address Its Caregiving Crisis. Inter Press
Service. May 19, 2015. Available at: http://www.
ipsnews.net/2015/05/latin-america-must-address-its-caregiving-crisis/
4. Burden of chronic noncommunicablediseases increases in China. China Daily.
February 7, 2019. Available at: http://www.
chinadaily.com.cn/a/201902/07/WS5c5bf3c2a3106c65c34e8538.html
5. Challenges of Population Aging in China:
Evidence from the National Baseline Survey.
CHARLS. May 2013. Available at: https://online.wsj.com/public/resources/documents/
charls0530.pdf, page 5.
6. What is the lifetime risk of needing andreceiving long-term services and supports? Office of the Assistant Secretary for Planning and
Evaluation. April 4, 2019. Available at: https://
aspe.hhs.gov/basic-report/what-lifetime-riskneeding-and-receiving-long-term-servicesand-supports
7. de Bienassis, Katherine, Ana Llena-Nozal,
Nicolaas S. Klazinga. OECD Health Working
Papers No. 121: The economics of patient
safety Part III: Long-term care: Valuing safety
for the long haul. September 2020. Available
at: https://www.oecd-ilibrary.org/docserver/
be07475c-en.pdf?expires=1618238280&id=id&accname=guest&checksum=E36DB300C406CF0A5C35B8DED54781F8, page 7.

8. Dementia Fact Sheet, WHO. Available at:https://www.who.int/news-room/fact-sheets/
detail/dementia
9. Ofori-Asenso, Richard, et al, Global Incidenceof Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review
and Meta-analysis. JAMA Network Open.
August 2, 2019. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2740784
10. Xue, Qian-Li. The Frailty Syndrome: Definition and Natural History. Clin Geriatr Med. 2011.
Feb; 27(1): 1–15. Available at: https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC3028599/
11. WHO Clinical Consortium on Healthy Ageing,
Topic focus: frailty and intrinsic capacity.
December 2016. Available at: https://apps.who.
int/iris/bitstream/handle/10665/272437/WHOFWC-ALC-17.2-eng.pdf, page 23.
12. OECD, Who Cares? Attracting and Retaining
Care Workers for the Elderly. 2020. Available at:https://www.oecd-ilibrary.org/sites/92c0ef68en/index.html?itemId=/content/publication/92c0ef68-en
13. Bundesministerium fur Wirtschaft undEnergie (Federal Ministry for Economic Affairs
and Energy (BMWi)), Care Industry Overview.
Available at: https://www.bmwi.de/Redaktion/DE/Artikel/Branchenfokus/Wirtschaft/branchenfokus-pflegewirtschaft.html
14. Germany’s caregiver shortage means lesstime for patients. Deutsche Welle. February
26, 2020. Available at: https://www.dw.com/
en/germanys-caregiver-shortage-means-lesstime-for-patients/a-52549043
15. Long Term Care Manpower Study. Lien
Foundation. July 2018. Available at: http://www.
lienfoundation.org/sites/default/files/Long%20
Term%20Care%20Manpower%20Study%20
FINAL_0.pdf, page 7.

16. Elder-care shortage needs early remedy.
China Daily. October 2018. Available at: http://
www.chinadaily.com.cn/hkedition/2018-10/02/
content_37015233.htm
17. Miller, Mark. The future of U.S. caregiving:High demand, scarce workers. Reuters. August
2017. Available at: https://www.reuters.com/
article/us-column-miller-caregivers-idUSKBN1AJ1JQ
18. All About Carers. Carers Australia. 2017.
Available at: https://www.aihw.gov.au/getmedia/affa1332-0df7-4865-9590-0c60a8aad9e0/
aihw-australias-welfare-2017-chapter8-3.pdf.
aspx
19. Embracing the Critical Role of Caregivers
Around the World. Merck KGaA. 2017. Available
at: https://www.embracingcarers.com/content/dam/web/healthcare/corporate/embracing-carers/media/infographics/us/Merck%20
KGaA%20Embracing%20Carers_White%20
Paper%20Flattened.pdf
20. Valuing the invaluable. AARP. 2019.
Available at: https://www.aarp.org/content/
dam/aarp/ppi/2019/11/valuing-the-invaluable-2019-update-charting-a-path-forward.
doi.10.26419-2Fppi.00082.001.pdf
21. 2018 Home and Community Preferences
Survey: A National Survey of Adults Age 18Plus. AARP. August 2018. Available at: https://www.aarp.org/content/dam/aarp/research/
surveys_statistics/liv-com/2018/home-community-preferences-survey.doi.10.264192Fres.00231.001.pdf, page 4.
22. Ageing in the Right Place—An Australian
Perspective. Global Centre for Modern Ageing.
2020. Available at: https://www.gcma.net.au/
new-blog/2020/2/7/ageing-in-the-right-placean-australian-perspective
23. O’Leary, David. Cost of care survey. Genworth. November 2019. Available at: https://www.genworth.com/aging-and-you/finances/cost-of-care.html

43

24. Lipszyc, Sail and Xavier. Long-term care:need, use and expenditure in the EU-27. November 2012. Available at: https://ec.europa.
eu/economy_finance/publications/economic_paper/2012/pdf/ecp469_en.pdf, page 15, 26.
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Building The Caregiving Workforce Our Aging World Needs

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GlobalCoalition
on Aging

GCoA

Text

About the Global Coalition on Aging
About Home Instead
GlobalCoalition on Aging
The Global Coalition on Aging aims to reshape

The Home Instead® franchise network provides

how global leaders approach and prepare for

personalized care, support and education to

the 21st century’s profound shift in popula-enhance the lives of aging adults and theirtion aging. GCOA uniquely brings together

loved ones. Today, the Home Instead network

global corporations across industry sectors

is the world’s leading provider of in-home carewith common strategic interests in aging

services for older adults, with more than 1,200

populations, a comprehensive and systemic

independently owned and operated franchises

understanding of aging and an optimistic viewthat provide more than 90 million hours of careof its impact. Through research, public policy

annually across 14 countries.

analysis, advocacy and strategic communications, GCOA is advancing innovative solutions

To learn more, visit HomeInstead.com

and working to ensure global aging is a path toor connect with us on Facebook and Twitter.

health, productivity and economic growth.
Learn more about GCOA at

Outlinevisit www.globalcoalitiononaging.com.

For more information contact
Melissa Gong Mitchell

Jisella Dolan

mmitchell@globalcoalitiononaging.com

catalystforchange@homeinsteadinc.com

globalcoalitiononaging.com

July 2021