Improving care means addressing the situation of women

This article is based on Eurofound’s note for the European Parliament, prepared in March 2022 by Hans Dubois, Agnès Parent-Thirion and Eleonora Peruffo, Eurofound.

The European Social Services Conference 2022 calls for rethinking recovery and seeking new tools and modernisation of social services. In particular, the momentum should be used to improve care services that have some persistent challenges – all of which have implications to situation of women. Care is a key sector to consider in perspective of gender equality for three reasons: most care workers are women, most informal carers are women, and most recipients of long-term care are women.

Working conditions in care therefore impact women disproportionally, both on the workers concerned and on the quality of care. Similarly, improving access to care services is necessary to provide relief for informal carers and to benefit those with care needs – a majority of whom, again, are women.

Residential and non-residential long-term care services are a key part of the care sector, but most care is provided by family and friends. In the EU, 44 million adults provide frequent informal long-term care to family or friends (12% of people aged 18 years or over who care for one or more disabled or infirm family member, neighbour or friend, of any age, more than twice a week). The formal long-term care sector employs 6.3 million people in the EU. In just one decade, the sector has expanded by one-third. Amidst this rapid change, some some features persist:

  • The proportion of female workers in long-term care has remained largely stable over the past decade (81%)
  • Older workers are overrepresented (around 38% are 50+). Moreover, the proportion of workers aged 50+ in health and long-term care increased faster than on average.
  • Wages lie consistently below average in all Member States: the pay of social service workers (69.3% of them working in long-term care) is 21% below average pay in the EU Member States (almost equal for residential long-term care and non-residential care). The difference is less than 10% only in three Member States: Austria, Luxembourg and the Netherlands – where almost 100% of long-term care workers are covered by collective agreements.

Some policy responses begin emerging: the COVID-19 pandemic drove, for instance, Germany to further facilitate working beyond the pensionable age (in particular, to stimulate employment among care workers), by increasing the income people can earn without facing pension deductions. However, such measures have a limited impact if working conditions are not improved simultaneously, as many care workers across Europe report heavy workload and do not believe they can stay in work until retirement age. They suffer from the perils of the shift work and twice as frequently encounter adverse behaviour at work.

The European Care Strategy in the making is a major opportunity to address the aforementioned challenges systemically – so that care workers are enabled to provide quality care, which they are motivated to do, as reflected by high proportion of care workers having “the feeling of doing useful work’ (71% in social services sector as a whole). However, there are chronic staff shortages in long-term care in many countries that encourage looking to improve arrangements for those who currently are informal carers or domestic workers.

Overall, for making the care systems reset for the future, a broad understanding of “access’ is needed so that preventing or postponing dependency on care is advanced. To effectively implement the right to accessing care as outlined in the European Pillar of Social Rights, access has to be promoted throughout the whole range from someone’s perception of care needs to satisfying those needs. In a broader social policy perspective, access to care can be improved by also addressing some apparent “non-care’ circumstances:

  • Improving mental health support to care workers and carers, not least to prevent burnout,
  • Developing measures to balance care and non-care commitments,
  • Reconsidering the “voluntary’ non-use or postponement of getting care services (in cases when people want to wait and see if their condition improves): a low barrier phone or online consultation could be a way to ensure a professional assessment or referral,
  • Reducing the dependence of access to care on current income has to be considered to make it less affected by the economic crises (since as soon as there is fall in income, access to healthcare and long-term care get affected). Policy makers seeking to address this may need to look into structural improvements of the situation of the lowest income groups – not the least, in relation to the gender gaps in wages and old-age income.
  • Improving living conditions and neighbourhoods for people with care needs can help people maintain physical activity, social interaction and self-care such as basic shopping. Improvement of living conditions may well go along the objectives of the green transition.

All that would not only help to prevent health problems and care needs, but also would enable social inclusion and enable people to work longer.


Eurofound (2020), Long-term care workforce: Employment and working conditions, Publications Office of the European Union, Luxembourg,

Eurofound (2020), Working conditions in sectors

Eurofound (2021), Wages in long-term care and other social services 21% below average

Eurofound (2022), COVID-19 and older people: Impact on their lives, support and care

European Working Conditions Survey – 2021 extraordinary edition (publication forthcoming – follow Eurofound website).