OECD’s Ana Llena-Nozal on long-term care

The Care Initiative at Green Templeton hosted Dr Ana Llena-Nozal, Senior Economist, Organisation for Economic Co-operation and Development (OECD) on Thursday 31 March. Dr Llena-Nozal spoke on What Changes has the Pandemic Brought to Long-term Care Organisation in OECD Countries?

Anna Llena-Nozal headshot via webcam with OECD logos behind

Lecture report

Sunwoo Ryu (DPhil Social Policy, 2017) reports from the evening:

Dr Llena-Nozal shared the OECD’s research findings on the impact of the COVID-19 pandemic on the long-term care (LTC) sector in high-income countries. Dr Llena-Nozal approached this by describing cross-national diversity in the range of implemented policy responses for LTC residents and how they changed over time. Based on in-depth analysis of these policy responses, policy lessons for LTC were also drawn.

Recognising the severity of the pandemic in the LTC sector

Research on how the pandemic has affected LTC organisation is important because this sector has been badly hit during the pandemic. The lack of prioritisation of LTC caused a delay in introducing effective containment and mitigation measures, with early intervention crucial to limiting the spread of the virus and reducing mortality. This is illustrated by the fact that 40% of all COVID-19 deaths took place among LTC residents across the OECD member states. However, the mortality rates in LTC facilities differed greatly across countries. Dr Llena-Nozal suggested a number of potential factors contributing to the substantial cross-national differences. Above all, the cross-country disparities were related to the differences in policy responses.

Examining different policy responses

In the early phase of the pandemic, Dr Llena-Nozal and her research team found that a large number of countries attempted to reduce interpersonal transmission of the virus through the closure of care centres, as part of their containment and mitigation strategies. However, unlike day-care centres, the closure of LTC residences was uncommon in most countries. Instead, restrictions were imposed on visitors to LTC facilities and interactive activities among residents. Dr Llena-Nozal made the point that there was no hard evidence that the former measure was effective in response to a question during the Q&A on whether the ban on family members’ visits to LTC residences actually had any impact. According to the research, such restrictions were relaxed over time in different ways depending on the evolution of the pandemic in each country.

Simultaneously, countries promoted infection control through the improvement of hygiene, supply of personal protective equipment (PPE), isolation of people with symptoms, and the establishment of taskforces. However, when it comes to the LTC sector specifically, research has found that workforce knowledge of hygiene and PPE usage was limited due to a lack of staff training and clear national guidance on the need to wear PPE. Moreover, the sector’s workforce was not prioritised for the supply of PPE until the later stage of the pandemic – unlike those working in hospitals. Consequently, as of summer 2020, on average – across 17 OECD member countries – only 75% of LTC workers were wearing PPE during working hours. Although isolation of residents with symptoms was important, it was also found that most residences did not have sufficient extra spaces to do so. Further to this, in many countries, pandemic taskforces were neither specific for LTC nor had an LTC expert.

Dr Llena-Nozal’s team also observed countries’ diverse policy responses to tackle the issue of staff shortages, which ranged from the recruitment of recently retired healthcare workers and students, the deployment of volunteers, to the improvement of working conditions. These policy responses were particularly important as LTC has been historically short-staffed, another factor which made the sector generally ill-prepared to respond to increasing care needs during the pandemic. Despite some progress, policy discourses on increasing the wages of LTC workers were not as active as debates about the conditions of healthcare workers. Indeed, less than 20% of the countries introduced a permanent wage increase for LTC workers, whilst 40% provided a one-time bonus.

Drawing policy lessons moving forward

The vaccines have been a game-changer; they have been considerably effective in reducing mortality in the LTC sector. However, COVID has been proliferating around the world due to the emergence of diverse variants, which brings new uncertainty to the future fight against the virus. From this perspective, Dr Llena-Nozal emphasised the need to turn the experiences from the previous COVID waves into learning opportunities. For all those involved in care, a number of valuable lessons can be drawn.

First of all, the generation of a high-quality standardised dataset and the introduction of timely monitoring systems are a prerequisite in the LTC sector for providing an accurate picture of its status and for evidence-based policymaking. Secondly, the LTC sector should not remain short-staffed and labelled as ‘low-skilled’. To this end, Dr Llena-Nozal noted during the Q&A discussion that some countries have promoted a public campaign to change the public image of the LTC sector and its workforce. There is also a major role for the improvement of wages and other working conditions in creating better quality care.

Lastly, the current institution-based LTC system could also be fundamentally rethought given clear evidence that the bigger the LTC facility, the higher the infection and mortality rates. In fact, some countries, especially the Nordic welfare states, have increasingly de-institutionalised LTC over the past few decades by promoting home-based care services for the elderly. The question is, then, to what extent we can and should move towards a home-based model of LTC.

This does seem to be what people prefer but there are difficulties or risks associated with it, such as social isolation, and difficulties in regulating and monitoring the conditions. In light of this, Dr Llena-Nozal stressed that institutional LTC should be made safer and more people-centred, whilst a shift towards more home-based care options should be accompanied by the promotion of a community-based care system and the provision of PPE and adequate working environments for workers.

About the Care Initiative

Green Templeton’s Care Initiative explores issues associated with care of older people by bringing together people from different disciplinary and professional backgrounds.

Created: 28 April 2022