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This is the first in a two-part series on the worldwide problem of how to best care for our elderly.

It’s not a good time to be growing old in the developed world. And it is going to get significantly worse in coming decades.

The workforce problems that aged care faces in Australia are just as bad overseas. Indeed, you can read about the problems in aged care elsewhere in the world and they sound, note for note, exactly like those besetting us.

A Washington Post profile at the weekend looked at the huge problems America’s home senior care sector faces trying to find enough workers. There’s been a marked shift over the past decade among American seniors from residential care (nearly half of US nursing homes rank four or five stars, well above Australian levels) to homecare — a shift accelerated by the pandemic.

Governments everywhere have encouraged the shift to homecare, which costs less and accords with the lifestyle demands of baby boomers — but it comes with a price of services that are harder to regulate, an even more precarious workforce, and less government oversight.

In the US, nursing home staff requirements have fallen, and homecare staff numbers are nowhere near sufficient: even in smaller states like Minnesota, there are thousands of job vacancies. The US homecare workforce is about 2.6 million, and it will need another million workers in the next eight years to match the ageing of the population.

The stories from US aged-care providers are the same as here: the jobs — dominated by women, and women of colour — are among the lowest paid in the US workforce, and workers can earn significantly more working for Amazon or in the US fast-food industry — both of which have been forced to lift minimum pay rates dramatically due to low unemployment.

Aged care providers, like unions, have called on the federal government to fund higher pay for care workers; the Biden administration proposed a $400 billion funding increase but Republicans blocked it. The sector is pushing for a temporary three-year visa category to bring in 85,000 foreign care workers.

And as you go through the situations in aged care in other countries after the pandemic, it rapidly becomes clear that the same problems face most developed countries. And the same characteristics of aged care repeat themselves: low-paid jobs; mostly female workers; a reliance on migrant labour.

In Canada, there is an overall large shortage of health staff, and pay differentials, work precarity and COVID have caused massive shortages in the homecare workforce. The broader care workforce is also in crisis, with health agencies unable to spend emergency COVID funding due to lack of staff. Canada already relies heavily on immigration to supply care workers and health staff.

New Zealand faces a very similar aged care workforce shortage as Australia, with staff forced to undertake epically long shifts in understaffed facilities. As in Australia, nurses prefer to work for higher pay in public hospitals. The sector is calling for easier immigration requirements to encourage migrant workers.

Wherever you look it’s the same. European healthcare services more broadly have a massive shortage of workers, made much worse by the pandemic. Germany has a critical shortage of nurses and other health professionals in its health and caring services, and many Germans rely on an informal care industry that employs up to 600,000 Poles (mostly women) to provide in-home services, often in highly exploitative contracts.

In France the Macron government increased the minimum wage for care workers last year to €22 an hour to try to overcome severe shortages of carers for the elderly and expand the workforce by 10,000 (France is one of the few countries, along with Belgium and Spain, where the ratio of care workers to the elderly has increased).

In the Netherlands, aged care providers have taken to asking seniors’ families help look after them, and the government has launched an urgent plan to transform Dutch seniors care by keeping them at home and helping them digitally. In the UK, staff shortages are causing downgrades of nursing homes, with one in 10 care jobs vacant (it has increased from 8% at the end of 2021). Aged care workers in the UK earn less than café workers or Amazon warehouse workers.

In Japan, the paragon of rapidly ageing societies, growing care needs drove an insurance-based approach to aged care and the integration of health and aged care services, but the country, which faces an acute labour shortage, faces a shortfall of nearly 370,000 nurses and care workers. In Italy, another country with a rapidly ageing population, the care system relies heavily on eastern European workers — often working irregularly, as in Germany. And Chinese state media admitted in 2019 that China — where aged care is primarily provided by families — has a shortage of more than 10 million carers for disabled elderly.

Now, bear in mind that these are shortages that have developed over the past decade, exacerbated by the pandemic. In most OECD countries, there were fewer aged care workers per 100,000 elderly people in 2016 than in 2011, including in Australia. But the demand for aged care — either in residential facilities or in-home — is going to continue to increase.

Simply to keep the same ratio of care workers to the elderly as in 2016, by 2040 Australia will need more than 40% more care workers, according to the OECD — and that assumes productivity gains. Across the OECD, the figure is more like a 30% increase — and more than double that if productivity doesn’t increase — in a sector where productivity measurement alone is difficult, let alone productivity growth.

With a global shortage of care workers now threatening to become steadily worse over the next 18 years and beyond, tomorrow we’ll look at possible solutions.

Can the shortfall in aged care workers be remedied without huge pay rises? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.