LTCcovid Country Profiles

Responses to 4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science.

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.



Several countries have embarked on reforms to address working conditions, wages as well as improve attractiveness of the sector (source: EU report; Fixing Long-Term Care Act, 2021;New Legislation To Reform Ontario’s Long-Term Care Sector).

International reports and sources

EU report on LTC (2021) highlights recent reforms related to LTC workforce in Member States.

An EU report (2021) noted that a new social services law in Bulgaria established the right to training for LTC workers and the right to supervision.

Last updated: September 13th, 2021

To improve staffing levels, in November 2020, the Ontario government announced funding to increase the average daily direct care from a nurse or personal support worker  per long-term care resident to four hours a day by 2025. The Act proposes to enshrine this commitment in legislation, and to increase care provided by allied health care professionals to an average of 36 minutes per resident per day by March 31, 2023. The proposed Act provides that higher (but not lower) targets of average care may be established by regulation (source: Fixing Long-Term Care Act, 2021;New Legislation To Reform Ontario’s Long-Term Care Sector).

Last updated: December 10th, 2021

An EU report noted that Croatian government launched a programme in 2017 to encourage the employment of disadvantaged women (especially 50 years old+) to provide support and care for older people, the programme was serving around 30,000 people, and employed 6,000 women in 2020.

Last updated: September 13th, 2021

An EU report (2021) noted that the Czech government has continually and significantly increased the wages of employees in LTC sector since 2014 which is likely to have made the profession more attractive.

Last updated: September 13th, 2021

There have been attempts to attract and retain workers to the formal care sector following the action plan ‘More hands in the older person and health sector’ of the Association of Municipalities from 2018. These have not least attempted to get more young people to start training as home and health care assistants or helpers. The measures span information campaigns, higher wages, and better collaboration between relevant partners to attract, educate and retain more workers. These efforts have so far not proven successful, perhaps partly due to the poor image of the sector with the general public, including the young people who are intended to take up education and look for work in the sector (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (


Lauritzen, H.H.; Jensen, M.C.F. and Kjer, M.G. (2022) Analyse af social- og sundhedsfagenes image og imageudfordringer Rekruttering til og fastholdelse i social- og sundhedsfagene

Last updated: May 25th, 2023

The transformation funds from the Segur de la Sante will also invest into developing digital tools around ageing and disability, for instance by developing digital integrated care records.

Following the Segur de la Sante, which was a consultation of all medical and social care stakeholders over 2020 to contribute to recovery of the health and care sectors and build resilience, a number of measures were taken to revalorise health and care staff.

To increase the attractiveness of the care home sector as a route of employment, care worker pay was reviewed in 2020 and increased by 183€ per month.

Increased salary rates for domiciliary care workers in the public sector will start from October 1st 2021 and will represent a 13-15% increase in pay.

An 2,330 additional training places for nurses were also created.

Author: Alis Sopadzhiyan (LTC Covid profile pending)

Last updated: December 3rd, 2021   Contributors: Adelina Comas-Herrera  |  Camille Oung  |  

An EU report (2021) noted that jobs in the LTC sector are being made more attractive through new training opportunities at tertiary level, with the launch of certified training programmes for potential carers.

Last updated: September 13th, 2021

An EU report (2021) noted that the Netherlands implemented numerous measures in 2017, including: improved working conditions; better protected contracts (e.g. open-ended contracts, flexible working time, leave); better matching of supply and demand. The government programmes also focus on improving the attractiveness of the sector via image campaigns as well as other measures improving working conditions and training.

Last updated: December 2nd, 2021

In 2020 (partly due to pandemic) a reform was introduced in Sweden whereby LTC employees are offered paid training to become, for example, assistant nurses. Local authorities and the relevant trade union agreed to offer a permanent full-time job for those who participate in this training (source: Employment, Social Affairs & Inclusion – European Commission).

Last updated: November 30th, 2021

A Health and Social Care Levy was announced by the government on September 9, 2021. As part of this £36 billion investment to reform the NHS and social care, at least £500 million will be allocated for funding the care workforce across three years. It is reported that it represents a five-fold increase in public spending on the skills and training of care workers and registered managers. The government have committed to providing additional support for the continuous professional development of the workforce, including training places and certifications for care workers. The funding will also be directed to mental health wellbeing resources and to provide access to occupational health funding (DHSC, 2021a).

The government announced that this would be accompanied on November 3, 2021, with a new recruitment campaign to encourage people to apply for roles in the adult social care sector. ‘Made with Care’ will launch across broadcast and social media for five months and will highlight vacancies in the sector as well as showcasing the work care workers do. However, many organisations and sector leaders have raised concerns that the existing funding and measures in place are not sufficient to mitigate a deepening workforce crisis ahead of a difficult winter.

The government published its White Paper on social care reform on 1st December 2021 (DHSC, 2021b). In it were a suite of initiatives for strengthening the skills and training of the social care workforce. These include the establishment of a Knowledge and Skills Framework, portable care certificates, and support for mental health and wellbeing. However, it stopped short of enhancing pay and no new money beyond the previously announced (£500m over three years from the health and social care levy) and the £162.5m for the winter of 2021/22 was allocated to workforce initiatives (Source: Workforce Recruitment and Retention Fund for adult social care).

Visa Relaxation for Migrant Care Workers

In December 2021 , addressing unprecedented challenges prompted by the pandemic, the government announced a temporary relaxation of immigration rules for overseas care workers in an attempt to recruit and retain care staff. Care assistants and home and social care workers are to be added to the Shortage Occupation List (SOL) in early 2022 and will be eligible for a 12-month health and care visa; allowing migrants to fill gaps in workforces. It is proposed that these measures will be in place for at least 12 months (Sources: BBC News and


DHSC (2021a). Health and Social Care Levy. Department of Health and Social Care Policy Paper. Retrieved from: Health and Social Care Levy. Accessed on 28/03/2022

DHSC (2021b). People at the Heart of Care: adult social care reform white paper. Department of Health and Social Care Policy Paper. Retrieved from: ASC Reform White Paper.  Accessed on 28/03/2022

Last updated: March 28th, 2022   Contributors: William Byrd  |  Nina Hemmings  |  Natasha Curry  |  Daisy Pharoah  |  

The ‘Social Care – Making a Difference’ campaign has been developed by the Northern Ireland Social Care Council (NISCC) on behalf of the Department of Health as part of its ongoing work to reform Adult Social Care. The campaign highlights that social care staff are an integral and valued part of the health and social workforce and their work is critical to the sustainable provision of social care services now and in the future. This campaign went live on May 10, 2021 and is centred on local social care workers, whose stories are told through video and photography while highlighting the diversity, impact and importance of social care and the positive difference it makes in people’s lives (Source: Adult social care recruitment campaign launched).


Last updated: March 28th, 2022

In April 2020, the Scottish Government announced an immediate 3.3% pay increase for all social care staff in recognition of the vital work they carried out during the pandemic.

Last updated: March 28th, 2022   Contributors: Jenni Burton  |  David Henderson  |  David Bell  |  Elizabeth Lemmon  |  

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.