Profit over people: the impact of market approaches on long-term care and its workers


(24 April 2023) EPSU, PSI and the Centre for International Corporate Tax Accountability and Research (CICTAR) have published an analysis on the impact of market approaches to long-term care. The report examines how the responsibility for long-term care has shifted to the private sector in many countries, including those within the EU, Australia, Canada, the United Kingdom, and the United States. It highlights that this shift has not necessarily led to improved quality of care, as the largely female and often migrant workforce in long-term care is subject to exploitation, resulting in high turnover and chronic staff shortages.

Private operators of long-term care facilities extract excessive revenues from public funding and private fees, prioritising profits and expansion over quality of care. This has long been a concern for EPSU, with the pandemic exposing these flaws and a series of exposes, such as the French Orpea scandal in early 2022, bringing these consequences to public attention. The report finds that these issues are present across ownership types, including private equity, private business, public company and large-scale not-for-profit.

Unfortunately, government regulation has been insufficient to maintain acceptable standards, but some reform efforts are beginning to emerge. The report proposes solutions such as greater worker involvement in decision-making processes, increased engagement with public health systems, and prioritising direct public provision to reduce profit extraction by private operators. These reforms and funding increases should be aimed at ensuring adequate standards of care and building public support for fair and transparent public funding. Addressing the exploitation of workers in the long-term care industry - particularly through collective agreements - is crucial to improving the quality of long-term care delivery.

The European Care Strategy and Long-Term Care Recommendation is only a first step in addressing these issues. The national action plans for long-term care must take concrete steps to prevent the commercialisation of care.

Read the full essay here.