Who takes care of older people in Latin America and the Caribbean?

More than 8 million older people are dependent on long-term care in Latin America and the Caribbean. These people are not able, on their own, to perform at least one basic activity of daily living, such as bathing or showering, eating, using the toilet, dressing, getting around a room, or getting in and out of bed. In this region, care dependence affects 12% of people over age 60 and almost 27% of people over age 80.

Traditionally, this region’s main source of long-term care services has been unpaid, informal help, whether from families or friends. This role is primarily filled by women in families. Based on the case studies developed in the Panorama of Aging and Long-Term Care, we know that:

• In Argentina, 77% of people over age 60 who need care in order to perform basic activities of daily living regularly receive help from a family member (according to the National Survey on the Quality of Life of Older People). Only 16% of people over age 60 who need help performing basic activities of daily living receive help from a specialized caregiver (3.4%) or domestic worker/non-specialized caregiver (12.2%) (Oliveri, forthcoming).
• In Costa Rica more than 300,000 people (around 6% of the population) frequently help a family member or friend complete basic and/or instrumental activities of daily living. In most cases, the person providing the care is the child (43%) or spouse (32%) of the care-dependent person.
• In Mexico, the 2014 National Time Use Survey reports that women spend an average of 50 hours per week on unpaid housework (compared to 18 for men), and 33 hours per week on activities for the market and goods for personal consumption (compared to 52 for men). If we just look at caregiving tasks, women spend an average of 10 hours per week and men 7.
• In Uruguay, the results of the 2013 Longitudinal Social Protection Survey show that 82% of care-dependent adults who receive help to complete their daily activities receive that help from unpaid caregivers: 58.9% from a family member living in the same home, 16.8% from a family member living elsewhere, and 6.3% from somebody outside the family. Women provide the unpaid assistance over 70% of the time.

But transformations in the structure of families in recent decades have eroded their ability to directly look after care-dependent people. The main reasons for this trend are smaller family sizes and the growing participation of women in the world of work.

To lighten the emotional and financial burden on family caregivers, long term care services provided in the home are beginning to gain importance. Home care services complement those provided in an institutional setting, which are used as a last resort for severely care-dependent people. When the State provides these services—whether through subsidies for hiring caregivers, by directly providing in-home caregivers, or by providing services in an institutional setting— family caregivers have more time and there are more formal job opportunities. Care workers in the region generally have low salaries, flexible work arrangements (part-time, intermittent, or shift work), and few opportunities for training and building a career. They also face certain occupational hazards associated with the nature of the sector, and most are outside of the formal system, so they do not receive social security benefits. This makes unemployment in the sector unattractive. The spread of COVID-19 added an additional disadvantage: greater exposure to the risk of infection for caregivers.

On June 16, 2020, the Panorama of Aging and Long-Term Care webinar entitled “Who cares? How to develop human resources and social protection for long-term care” featured Ana Llena-Nozal, senior economist and head of the long-term care team at the OECD.

In her presentation, Ana spoke about the difficult working conditions and training gaps in the long-term care workforce. What can we learn from the policies implemented in OECD countries to better recruit, train, and retain long-term caregivers? According to the presenter and the experiences of OECD countries, there are four keys to developing a workforce of long-term caregivers:

• Recruit more workers. Measures include campaigns to improve the image of caregivers, especially among young people; financial support for training; and training programs for young people or the unemployed.
• Retain more workers. To keep workers from leaving the sector, working conditions need to be improved. There also needs to be a guarantee of decent salaries, more flexible hours to give caregivers a better work/life balance, more job security, and increased training. Counseling services are also included to prevent stress and burnout.
• Increase care workers’ productivity. This can be done by using technology to supplement care work. Examples include technologies for communication or monitoring patients, or assistance technologies like alarms or sensors.
• Improve coordination between workers and environments. It is important to encourage work in multidisciplinary teams that coordinate with formal and informal caregivers. This could prevent unnecessary hospitalizations and long hospital stays.

We invite you to watch the video from the event here. You will find the publications presented during the event at the same link. You can also see the first part of the presentation, where Tiago Oliveira Hashiguchi, a OECD health policy analyst, shows estimates of the suitability, quality, and efficiency of the public social protection systems for long-term care of OECD member countries and European Union members states. These estimates can be compared between countries and regions.