Twenty-one percent of the German population is 65 or older, and 2.5 million people above the age of 60 are in need of long-term care (2015). While the majority of the elderly are cared for at home, the system is not designed to provide decent care to those in retirement homes. Even for patients cared for by their relatives, there is not enough support from outpatient care services.
The health minister recently claimed to fully finance 13,000 new positions.That would, on average, correspond to about one additional position per care facility, which, of course, is only a drop in the ocean, given the urgent need in many care institutions.
One additional position per care facility: a drop in the ocean.
Understaffed units struggle to hire new care workers to provide basic care. As open positions cannot be filled over several months or not at all, working conditions worsen and the time spent per patient declines. In German hospitals, the share of patients to nurses is well below the overall average in Europe. On average, a nurse in Germany is responsible for 13 patients per shift, compared to 8.6 in England and 5.4 in Norway in 2012.
There are no comparable numbers specific to elder care, but personal accounts of care workers paint a dire picture. For instance, home residents, especially those suffering from dementia, miss out on meals because staff members do not have enough time to help them eat.
There are simply not enough skilled personnel to fill the positions. For every 100 job openings in care work, there are only 21 qualified people on average at the national level. Low pay, frequent overtime and strenuous working conditions are the primary reasons for which people choose not to enter, or continue in the profession. A skilled full-time elder care worker (for context, a skilled worker has completed three years of vocational training in the German dual education system) earns 19 per cent less on average than a health care worker, and far less than employees in other recognized trades. Low income also affects pensions – so much so that many care workers live in poverty after retirement.
Hiring from abroad: a promising strategy to mitigate?
Clearly, working conditions need to be improved for current care workers by lowering the patient-to-nurse ratio, for example, through realistic needs assessments based on geographic differences. More targeted recruiting and awareness-raising initiatives in schools and job centers, such as the ones for STEM (Science, Technology, Engineering, and Mathematics) subjects, should be augmented. Vocational training in elder care needs to improve, and its reputation as a job prospect in the market made more attractive.
Leveraging existing programs to attract and hire care workers from abroad would complement the above strategies. An ongoing program by the Federal Employment Agency and the German Development Cooperation has focused on care workers from Serbia, Bosnia and Herzegovina, the Philippines and Tunisia – countries where skilled care staff are in abundance and local jobs matching their skills in the vicinity are fewer.
The recognition of qualifications held by foreign care staff needs to accelerate as some applicants still wait years before being admitted to practice their profession. Once admitted, it might take another nine months for them to catch up on specific skills required by their new employer and to be fully acknowledged as a skilled professional.
These initiatives could provide long-term prospects to foreign care workers in Germany. The situation is potentially win-win: while alleviating the labor shortages in Germany, remittances of care workers to their families can contribute to welfare gains in the countries of origin. For those returning to their countries, language skills and foreign work experience could pave the way to higher-paying jobs. The support to tackle migration bureaucracy provided by the participating agencies lowers barriers for care workers and provides a channel for regular, documented migration.
If labour market needs in both sending and receiving economies are taken into account, opportunities for migrant workers increase and quality in elder care improves. Designing meaningful migrant worker programs is essential, and a strong collaboration with participating countries’ employment agencies is a must.