Introduction
Care demands are increasing globally due to various factors, including demographic changes, increasing lifespan, gender imbalance, and lack of support. Hence, the need for carers is also increasing. Generally, there are two main categories of carers: unpaid caregivers and paid care workers. Both categories are differentiated mainly by the benefits that they receive.
Unpaid caregivers are often relational with the recipients, i.e., spouses, family members, and relatives, and do not receive any pay. Meanwhile, paid care workers refer to those who are paid in return for the care services that they provide. In that term, paid care workers are believed to be doing better than unpaid caregivers.
However, despite getting paid, care workers are still facing challenges. Care workers around the world face issues with recognition for the important work they do and their growing importance as society ages.
Resultantly, the tireless, and at most times, thankless, work they do is inadequately compensated, inadvertently impacting care service outcomes and gender equity (as women make up most of the care workforce). Besides that, care workers also have unclear career growth and normally work in an unconducive environment. Thus, a possible solution is the implementation of regulations and policies by the governments that help to professionalise the care workforce.
Professionalisation may take many forms and may not be a one-size-fits-all solution due to the diversity of assistance and interventions needed in care provision. However, generally, four aspects need to be considered to improve professionalisation: registration, qualifications, pay, and work conditions. Thus, this article will highlight initiatives, or possibly best practices, taken by developed countries to professionalise their care workers.
Registering Care Workers
After decades of instability and the signing of the Belfast Agreement in 1998, Northern Ireland’s care system, devastated by conflict, needed to be rebuilt. A registry for Long-Term Care workers, including domiciliary care workers, care home workers and more, by the Northern Ireland Social Care Council was initiated to improve care delivery and facilitate the increasing need for quality care post-conflict. To encourage registration, practising care workers must be registered and the profession of “Social Worker” was made a protected title in 2003 and may only be used by registered workers, if using the status without registering is an offense against the law. Registering care workers has enabled the implementation of a minimum standard of care, minimum entry qualifications, and minimum 90 hours of training all workers must adhere to. Resultantly, Northern Ireland care workers have experienced an elevated social status and are perceived to provide better services after registration was enforced.
In Singapore, registration has worked to professionalise and improve the recognition of Early Child Care and Education (ECCE) workers. After being officially registered with the Early Childhood Development Authority (ECDA), an ECCE professional will have access to a framework that provides guidance on career progressions in the field, which eventually will improve access to better-paying jobs.
Generally, having a centralised registry for care workers in either Long-Term Care (LTC) or ECCE is a meaningful and effective policy mechanism to improve care worker recognition and compensation. This registry will also monitor and evaluate care workers' career growth, which shall provide better prospects and job retention for the industry.
Qualifications
Education and training programmes play a pivotal role in ensuring quality care services and elevating the status of care work. In the LTC sector, countries like Germany have set a minimum level of educational attainment for certain workers like nurses for the elderly, where prospective care workers would need to complete either a bachelor’s program or go through the vocational system. On the other hand, personal care workers do not necessarily have prior qualifications in care, but due to Germany’s extensive and accessible vocational system as most workers have related qualifications. In Australia, discussions have begun on the need for, at the very least, a certificate as a requirement for care workers. This is because a minimum level of qualification for all care workers will help increase wages in the sector and elevate job security whilst also encouraging a better career progression framework.
Similarly, all ECCE workers in Singapore are required to have at the very least, a certificate. However, due to a structured career progression framework, workers are encouraged to attain higher levels of education to achieve higher positions and wages. This has improved occupational perceptions or recognition by the public, but more importantly, it will increase the quality of the care services.
Career Progression
Globally, LTC workers face issues pertaining to the lack of a clear career pathway, forcing many workers to leave and find better opportunities in other sectors. Policymakers are still on the on-set of providing a solution, for instance, a recommendation as part of an Australian Parliamentary Committee report suggests the creation of a structured career path for care workers. It has been applied to LTC workers in Ontario, Canada, where Personal Care Workers can transition to become Practical Nurses and then to Registered Nurses, with each progression resulting in higher pay but with higher educational prerequisites.
The Singaporean model for the professional development of ECCE workers is a comprehensive and structured framework that may be worth emulating for both LTC and ECCE sectors globally. It simplifies career decisions for workers who are already in the field and provides a sense of security for prospective workers looking to join.
To supplement this effort, the Singaporean Government provides incentives for workers to progress up the ladder through subsidised and low-cost training modules and scholarships to attain higher qualifications. The outcome of this, coupled with other reforms in the ECCE sector, has resulted in higher year-on-year wages for ECCE workers.
Collective Bargaining
Poor collective bargaining power has influenced low pay and unsatisfactory working conditions among care workers. The informality of much-paid care work, in addition to the marginalisation of migrant workers, further complicates unionisation in many countries. This is apparent in developing countries where the establishment and activities of trade unions, regardless of occupation and sector, have been heavily suppressed.
Improving care collective agreements by themselves is difficult and would require a national review of trade unions. Trade unions in Australia and New Zealand have consistently won increased wage agreements and enhanced working conditions for care and support workers.
For example, in New Zealand, after years of deliberation between the courts, workers, and employers, the trade union benefited 15% to 50% salary increase. In Australia, care workers represented by national unions have actively pursued wage increments through collective action, which have resulted in a salary raise of up to 28.5%. These examples reflect the importance of trade unions and collective action in ensuring better pay for all care workers.
In conclusion, improving the professionalism of care workers has provided them with better career progression and opportunities, eventually enhancing the overall quality of care services provided. Besides that, a well-regulated care industry is key to ensuring greater benefits to attract and retain skilled talents in the care workforce. Best practices, or initiatives, taken by developed countries should be improvised to cater to the local care demands and needs.
