The Covid-19 pandemic shone a stark light on existing problems in the care system. Acute staff shortages and heavy workloads are posing serious challenges for the sector. Our writer explored some ideas that are being developed to make the care system fit for the future, and looked at solutions for ensuring better working conditions and fair pay for staff.

“It’s actually disrespectful to the people we care for,” says Csilla F, a live-in carer who provides round-the-clock support for those who need it. She keeps them company, cooks for them, and helps them wash and take medication. Although Csilla loves being a carer, the working conditions make it hard to do a good job.

Csilla has no formal training and no one checks up on her. She’s on call for up to 24 hours a day, which leaves almost no time for a private life. On top of that, she’s paid an extremely low hourly wage. Her day-to-day work reveals where the problems in the care sector lie.

Csilla has spent more than 20 years commuting from Slovakia to Austria to care for her clients. “I love being there for people,” she says. But if she found a different job, she’d give this one up in an instant.

And she’s not the only one. Fewer and fewer people are choosing to work in the care system because of the conditions. Yet the need for care in Austria is projected to increase. Around 127,000 people currently work in the sector. A study by the Austrian National Public Health Institute predicts that an additional 75,700 care staff will be needed by 2030 and that demand could outstrip supply by 2024.

“There aren’t enough people who are willing to do this job under the current conditions,” says Monika Riedel, a health economist who researches financing models for the care sector. She’s well aware that today’s care staff work under heavy time pressure for wages that aren’t commensurate with the job.

Figures from the employment agency Arbeitsmarktservice Österreich show that the starting salary for live-in carers is between 1,670 euro and 1,780 euro. Qualified nurses can expect to earn between 1,570 euro and 2,260 euro. There is already a shortage of skilled workers in the sector, but demographic change will increase the pressure on the financing system in the coming years. “People are getting older. Family structures and habits are changing,” says Riedel. If things continue like this, Austria will soon have a care crisis on its hands. How can the country stop this from happening?

“There are lots of solutions,” says Richard Stern, an expert for digital innovation at Kuratorium Wiener Pensionisten-Wohnhäuser (KWP), Austria’s largest senior care provider. Stern believes that technology is crucial for the future of the care profession. His team is exploring how digitalisation can reduce the pressure on care workers and – he stresses – improve people’s lives.

Perhaps, then, the future of care will look like this: 106-year-old Martina has her usual breakfast of bread rolls and jam. A carer accompanies her to the recreation room, where she plays a few hands of cards with her friends Hildegard and Sara from next door. After a quick coffee break, she heads off for some skiing in the Alps. That might sound absurd, but it’s actually set to become a reality at Vienna’s KWP retirement homes. Every home has had its own virtual reality headset since roughly 2020. Residents might not be able to go shopping on their own, but now they can see a mountain peak up close. Those with dementia can walk old familiar paths. And 106-year-olds can go skiing. “The headsets are quality of life,” says Stern. They also make things easier for the care home staff who, as well as supporting residents with their personal hygiene, medication and many other tasks, are also responsible for filling their leisure time.

Alongside the VR headsets, another project will soon begin testing various technologies to support residents. Special mattress toppers, for instance, can detect if a person leaves their bed at an unusual time. The toppers contain a sensor that alerts care workers or family members to unusual activity.

Stern believes that this will also relieve the pressure on care staff. While carers will continue to perform the social component of their work – engaging with the people – the technology can take other tasks off their hands. “For instance, a carer would no longer have to devote ten minutes multiple times a day to taking a resident’s temperature,” says Stern. An easy-to-use automatic thermometer could perform this routine task instead. “The carer would then potentially have time for a proper conversation when they visit that same resident.”

Stern adds that these kinds of technologies can also be used at home. Thermometers, special mattress toppers, and countless other aids offer older people the chance to continue living on their own for longer, if they like. “The 65+ generation wants to live independently. Digitalisation makes this much more possible,” says Stern.

Monika Riedel also thinks that it’s important for people to receive care in their own homes as long as possible: “This is what many older people want.” But although Stern and Riedel believe it’s the future, home care is still a relatively new and unregulated field.

Live-in care is one of the most common forms of home care and it only works because people like Csilla are forced to accept exploitative conditions. Laws guaranteeing the quality of care and protection for the care workers are scarce. “In the 20 years I’ve been doing this job, hardly anyone has ever checked up on me,” says Csilla. “It’s as if the Austrians don’t mind whether their care is good or bad.” Often, neither the carer nor the family they work for know what the carer is and isn’t allowed to do. The profession isn’t regulated. The agencies that are responsible for placing and looking after the women, most of whom come from outside Austria, usually think more about the families and clients. “There are so many of us,” says Csilla. “There’s always going to be someone who will accept what I’m unwilling to.”

Csilla once cared for an old man who was a former alcoholic and very aggressive. When she tried to talk to his family about it, she was fired. “Thank goodness,” says Csilla. “I was just starting out and would have put up with it for ages otherwise.” She received no help or protection from anyone – and so found herself in a foreign country with no job and nowhere to sleep.

Simona Durisova from IG-24 is familiar with stories like Csilla’s: “Live-in carers aren’t really self-employed,” she says. IG-24 was founded during the Covid-19 pandemic as an organisation that represents the interests of live-in carers. Durisova explains that the workers are actually employees, but the model that classes them as self-employed has become entrenched for cost reasons – which is bad for the carers: “We’ve got a structural problem with bogus self-employment,” she says. The carers can hardly ever take on more than one client, which prevents them from earning more money. Women like Csilla are therefore clearly not really self-employed, which forces them into an unfair position. Durisova adds that there’s also a lack of real representation because the agencies and carers are jointly represented in the Austrian Economic Chambers, even though they have different interests. “The agencies mainly think about their clients,” says Durisova. “It’s high time that we had real representation.”

As well as seeing the value of improving and reorganising existing models, experts like Riedel also believe new approaches to care are needed: “If we’re going to manage care well in the future, we’re going to need a lot of different solutions.” This is especially true of home care, she says.

One such solution comes from Wohnbuddy, an Austrian home-sharing platform that matches young people (often students or apprentices) with older people or whole retirement or nursing homes.

Two young people living in this type of arrangement are Imad and Charlotte, both students. They’ve been living in a retirement home since October 2020 – and have learned a lot in that time. The first lesson was that TV magazines are the lifeblood of the home. On Imad’s first day, his neighbour, a man in his 80s, asked Imad to get him one with the rest of his shopping. It opened Imad’s eyes to a whole new world.

Imad had previously worked with older people through a project at a day centre. When he was looking for a flat, he read about the home-sharing scheme on social media and thought it was just the thing for him and his girlfriend. That’s how he and Charlotte came to be living here.

The home is in Vienna’s 4th district and has 180 residents. It’s a white 1970s building with green windows; two of the large ones belong to Charlotte and Imad. They have 44 square metres of space and pay 220 euro each per month in service charges. They share the kitchen with their neighbours, but the pair are usually the only ones who use it. Imad and Charlotte didn’t move in for monetary reasons, though: “Of course it’s good from a financial perspective, but we also thought that it’s the only time we’ll have this opportunity,” says Charlotte. In early 2020, she was feeling a bit lost, but moving into the retirement home has changed that: “I’m much happier now,” she says.

The first few weeks brought a lot of surprises – like the TV magazines. Charlotte and Imad are enjoying getting to know people who have a different pace of life. People who eat lunch at noon sharp, play Ludo, and seem to have all the time in the world. “It does me good to spend time with them, especially when I’m stressed,“ says Charlotte. Imad agrees: “It helps you slow down.”

They both volunteer five hours a week in the home. Most of that time is spent in “day families,” groups for people who can no longer manage day-to-day living alone. Many of them have dementia. Imad and Charlotte regularly accompany them to a nearby park, where they watch children playing. The care staff don’t have time for these kinds of group excursions.

Young people like Charlotte and Imad, and technology like the VR headsets, can brighten up life in retirement homes and make life easier for staff. But they can’t solve one particular problem in the care sector – and it’s perhaps the most important problem of all. Care staff who work in hospitals and care homes earn very little. “The low pay isn’t a question of supply and demand,” says Riedel. “The profession needs to be valued more highly.”

It’s also a feminist issue: As sociologist Paula-Irene Villa Braslavsky notes in an essay on the Covid-19 pandemic, care work in general is either badly paid or not paid at all. She says that the pandemic intensified a long-running crisis in care. The sector is already at the heart of our economic system.^{Paula-Irene Villa Braslavsky: Corona-Krise meets Care-Krise – Ist das systemrelevant? In: Leviathan, issue 48 (2020), p. 433–450.} Reports by the OECD show that unpaid care work accounts for between 30 and 50 percent of GDP. And this work is primarily done by women. A time-use survey from 2008/2009 found that people in Austria do more unpaid work than paid, and women do twice as much as men.

It’s estimated that 80 percent of people in need of care receive it at home from family members – mostly women. And even when this important work is paid, the wages are usually low. Villa Braslavsky blames patriarchal structures for this and says we need to rethink the way we look at care: “Care staff are critical workers,” she writes.

In Austria, the individual states and municipalities are responsible for financing care services. However, because they have little tax revenue of their own, they also get a fixed share of federal tax revenues. The national government allots this money more or less on a per capita basis – irrespective of the level of demand for care in a municipality, or whether the local population is largely old or young. “The allocation should be needs-based,” says Riedel.

This is one reason why many families or people in need of care fund the services themselves. The team at IG-24 see this as a problem: “We’re calling for government-organised employment,” says Durisova. IG-24 wants a solution that will give carers better pay and ensure that the families who need care don’t have to shoulder too great a financial burden. “Families can’t afford to employ the carers themselves. The situation in the care sector will only improve if the government steps in. And it mustn’t scrimp and save.”

For IG-24, the long-term goal is a state-run system for live-in care. Right now, it’s calling for better working conditions and is developing a new organisational model: “We’re just starting to work out a cooperative framework that would offer employment for the carers,” says Durisova. “It’s very early days but this type of work is so important. There has to be some sort of body that organises the care.” The idea is that carers and the families using their services will be members of the cooperative. Both parties will pay into it and receive shares. “We want to raise awareness among the carers and their clients that there are better ways of organising things,” says Durisova. In the long term, though, the state needs to take over – both Durisova and Csilla agree on that.

But Csilla isn’t interested in waiting for politicians to catch up. She’s planning to sue the Austrian state over bogus self-employment in the care sector. “Someone has to bring a test case,” she says, “something needs to happen.” Of the law firms she has approached so far, none have agreed to take the case.

Original in German. First published in the #01/2022 issue of period.
Translated into English by Jen Metcalf.

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