This book examines recruitment and retention measures in community-based care and support services for adults with disabilities and health problems.It focuses on 10 EU Member States:Austria,Bulgaria,Denmark,France,Germany,the Netherlands,Poland,Portugal,Spain and the United Kingdom.It examines 30 case studies from these countries,analysing initiatives that were successful either in creating more jobs in the provision of health and social care for adults in the community or in improving the quality of jobs,with the aim of both attracting new recruits and retaining existing staff.

Policy context

Population ageing is generating a need and a demand for more and better jobs in long-term care.An accessible and high-quality system of health and social care provision is essential for European societies and economies.The health and social care sector is growing in nearly all EU Member States,providing opportunities for an ever greater number of jobs.This is a sector with increasing demands for quality and skills to support people with multiple chronic conditions.There are barriers to job creation in this sector,however,including a shortage of recruits,budgetary constraints and demanding working conditions.To overcome these problems and to support the creation of a strong workforce in the sector and its ongoing growth,a variety of strategies are required.Such strategies can be sustainable,however,only if workers find it worthwhile to stay in the sector,and this means that policies designed to solve labour shortages in the care sector must also ensure that they are satisfied with their working conditions and wages.

Keyfindings

（1）The balance of community-based versus institutional care for adults with disabilities varies across countries.Overall,there is an increasing trend towards more community-based care.The momentum towards home care appears to be driven by lower costs,policies promoting the greater independence of people with disabilities,the preferences of clients and the potential of assistedliving technology.

（2）It is difficult to determine the size of the workforce in community-based care for the elderly and disabled.Data are available only for Austria（20,100 jobs）,France（393,000 jobs）,the Netherlands（132,200 jobs）,Spain（115,900 jobs）and the UK（960,000 jobs）.

（3）Data available for three of the study countries show rising numbers of home-care workers:on average,in Austria by 740 yearly,in France by 19,800 yearly and in the UK by 28,000 yearly.Most likely,this rising trend also applies in other countries.The rising trend is expected to continue in the coming years.

（4）Generally,the labour market for community-based care is characterized by shortages,especially at higher qualification levels.These have been mitigated temporarily by the economic crisis.In the long term,increasing shortages are to be expected,especially for better-qualified personnel.Europe is in the midst of an economic crisis that is leading to cutbacks in care services and more emphasis on the financial argument for community-based care over institutional care.High unemployment rates are making the sector more attractive to work in,while the increasing emphasis on labour market measures may succeed in boosting recruitment.

Labour market strategies

Four labour market strategies have been identified to improve recruitment and retention in the sector:（1）targeting labour reserves in order to attract new employees to the sector,including the recruitment of unemployed people and groups such as immigrants and labour migrants;（2）promoting and facilitating the education of potential employees-by,for example,creating spe-cific learning paths,developing campaigns to encourage young people to choose a career in the sector and improving the relationship between this labour market and educational institutions;（3）improving the working conditions of current employees in order to optimise their potential and retain them in the sector-for instance,by introducing training programmes,professionalising the sector and providing more career opportunities for existing employees;（4）improving the operational management and labour productivity of organisations,for example through the use of new technologies and direct payments,or distributing tasks more effectively among staff.

Policy pointers

（1）Recruitment programmes in community-based care services can provide job opportunities for people in the migrant population,the long-term unemployed and adults who themselves have disabilities.Some migrants may already have experience in the informal care sector.Reaching each of these groups needs a targeted approach.

（2）Campaigns to encourage young people to consider a career in the care sector are more successful if targeted at specific groups.Much remains to be done to persuade boys especially that care work is a valid career choice.

（3）The content and organisation of social care education has to be attractive to students,with an emphasis on practical work and,if possible,traineeships in their own neighbourhood.

（4）For people already working in the sector,human resource and general management have to be professional.Standards in the care sector can be improved through practice-oriented training and retraining schemes for workers.Training is more successful if it is close to home,as much as possible free of charge and run during working hours;small class sizes are also recommended.

（5）Assistive technology offers much potential in this field.Workers need to be trained in the use of this technology.It is also important to gain acceptance of the technology among clients and service providers.

（6）Sustainability deserves particular attention,especially in the case of subsidised projects.This means that projects subsidised from public funds need secure finances,activities need to be coordinated effectively and one body or organisation needs to take on the lead role.

（7）The transfer of successful initiatives to other regions,countries or sectors demands a well-thought-out strategy to embed the successful innovations in regular activities and policies.This may include using the EU funding for transnational partnerships.

（8）Political willingness to address the labour market problems in home care and community-based care is an important prerequisite for successful,sustainable and transferable measures.At the moment,there is a gap between policies and political commitment.Legislation exists but sustained political support is needed to further develop the labour market for home care.

（9）Political support is essential to continue the structural funding of recruitment and retention measures by the EU and its Member States.

（10）Data gathering and use of statistics could be substantially improved to develop,monitor,evaluate and adapt the relevant labour market policies of national and European authorities.