Public Policy for Protection and Improved Working Conditions of Long-term Care Workers

Abstract

With an increased life expectancy and population aging, numbers and proportions of older persons, especially those aged 80 or older, are rapidly increasing. In Korea, the proportion of older persons aged 65 or older has increased from 7.3% in 2000 to 16.4% in 2020. Number of the persons aged 80 or older is reportedly greater than two million in 2020. In line with the increased aging population, the need and number of care workers for older adults with functional limitations steadily increased as well. According to the National Long Term Care Insurance Statistical Yearbook, the number of social workers at long-term care institutions has doubled between 2016 and 2020, and that of nurses, nurse aids, and personal care helpers also increased by more than 30% during the same period. Although our society is in need of the increased care workers and their contribution is critical for the quality of life and health of older care recipients and their family, unfavorable working conditions and physical, sexual, and verbal threat toward long-term care workers have been continuously reported over the past decades. Moreover, under the COVID-19 pandemic situation, care workers are known to face multiple physical and psychological hardships while carrying out their duties, such as fear of infection, social stigma, stress from the intensified, newly added work duties, and under-staffing. The objectives of this study were (1) to examine the hardships of the care workers experienced while carrying out their duties, and (2) to identify policy options for the improvement of their working experiences and protect their rights. We defined our main study population as long-term care workers (including social workers, personal care helpers, and nursing or other health care personnel) who are working either at long-term care facilities or at in-home care centers. By restricting our study population to care workers at the long-term care sector, we intended to focus on the care workers providing more intensive care for older persons with certain levels of disabilities and to identify policy implications directly related to the National Long Term Care Insurance. We focused on four human right domains which are theoretically-driven and closely related to the care workers’ working experiences: (1) rights to labor (favorable working conditions), (2) rights to safety (protection from physical, verbal, and sexual threat/assault/attack), (3) rights to health (physical and mental health), and (4) rights to informational self-determination (installation and use of CCTV). By conducting a nationwide survey and focused group interviews(FGIs) of long-term care workers and reviewing the current policies on the protection of long-term care workers in Korea and other developed countries, the study could confirm that many care workers are experiencing threats to their rights in all four domains. This study further expanded our understanding of the long-term care workers that unfavorable working conditions are experienced regardless of the care workers’ occupational type, geographic area, age, and the size of institutions. Study participants also reported that the threats to labor rights were intensified during the COVID-19 such as unpaid vacation, unemployment, and income declines. Based on the findings, this study would propose multiple policy recommendations to protect the rights of long-term care workers. To protect their labor rights, more workers, especially personal care helpers, should be hired on a regular, full-time basis with adequate income. For their rights to safety, appropriate interventions need to be provided such as counseling, group therapies, and paid vacations or sick leaves by individual long-term care institutions and Public Agencies for Social Services (PASS). Finally, to protect the rights to health, annual physical examinations should be conducted specifically designed for the care workers and use of assistive devices should be promoted.