This chapter provides new insights on the contribution of labour migration to addressing labour shortages in long-term care. The chapter starts by comparing countries’ approaches to admitting labour migrants, including the use of dedicated channels, shortage lists, bilateral labour agreements and quotas. It then compares the regulation of care occupations across countries, what skills, training and qualifications are required and how they are assessed. Finally, it looks at available data and evidence on retention of migrant workers in long-term care and what trade‑offs need to be considered when designing or assessing labour migration channels for this sector.
International Migration Outlook 2026
50th Edition
Abstract
Key Findings
Ageing populations are increasing long-term care (LTC) demand, while shrinking working age cohorts reduce the availability of resident care workers, creating looming increasing labour shortages in most OECD countries.
Migrant labour is one way to address labour shortages, alongside bolstering domestic workforces, improvements to technology and productivity, skills development and education. It is for countries to decide how much emphasis to put on each of these factors, understanding that short term responses may affect longer-term equilibrium.
Migrant workers already make up a substantial share of the LTC workforce in Luxembourg, Sweden, Ireland and Switzerland. Many entered via non-labour migration channels such as humanitarian or family.
OECD countries vary widely in their labour migration pathways for care workers, with only a handful operating dedicated care worker visas. Most countries rely on general work permits, with some using shortage occupation lists, quotas or bilateral labour agreements to facilitate the admission of care workers.
Skill, qualification, and regulation requirements for care roles vary based on occupation and country, ranging from no formal requirements (e.g. Israel, Italy, for personal care workers) to high standards for qualification recognition and language proficiency (e.g. Germany, for registered nurses). This variation and inconsistency in requirements complicates cross country mobility and recognition, notably within free mobility areas such as the European Union (EU).
Retention is a key policy priority for countries, however, evidence specifically on migrant retention is limited, as few countries track whether migrants admitted for care roles remain in the sector over time. Limited data available points to high turnover rates and challenges retaining staff in the sector, including migrant workers.
Although improving job quality and training will make the biggest impact to retention, migration levers, such as employer/sector mobility restrictions, family reunification rules, and pathways to permanent residence can impact migrant retention, although not always in the sector. Soft measures, such as thorough onboarding, mentoring, and ongoing language and cultural support for migrants also play a role.
Designing successful migration channels is complex and requires consideration of factors such as eligibility, mobility between employers within the sector, path to permanent residence. There is no one‑fits-all model and trade‑offs need to be made, such as balancing faster access to permanent residence to support recruitment with potential exits from the sector once full labour market mobility is gained. Similarly, facilitating international recruitment may, if badly designed, weaken efforts to train, activate and retain resident workers in the sector.
Population ageing presents the challenge of an increasing proportion of older people in the population, some of whom require assistance with daily living activities over an extended period of time due to physical or mental frailty or disability (referred to as long-term care or LTC), coupled with a shrinking working age population. Although the LTC workforce has been increasing, it is not keeping pace with increased demand for LTC. Labour shortages in the LTC sector are becoming a growing structural challenge in a number of OECD countries. This, combined with difficulty attracting and retaining local or domestic workers has led to an increasing role for migrant workers in the LTC workforce – sometimes this is the result of a national workforce strategy while in other cases it is a market-led phenomenon.
Foreign-born workers1 already account for a significant share of the LTC workforce in some countries (OECD, 2025[1]). Most of these migrants were not admitted through labour migration channels, but rather through free mobility provisions in the European Union (EU) and in Australia/New Zealand (to some degree), or through other migration pathways – as dependents, students or humanitarian migrants.
When addressing skills shortages there are four pillars: technology and productivity; mobilising domestic labour supply through improved working conditions and career prospects; skills development and training; as well as international recruitment. It is a decision for countries themselves how much emphasis to put on each pillar, including the role of migration in their workforce strategies. As shortages become more acute, however, it is valuable to examine the role of migrant workers and migration channels in the LTC sector within the context of wider reforms to address labour shortages. This is the main objective of this chapter.
Several countries have opened labour migration programmes for care workers, such as Canada and Japan. Other OECD countries have tailored their existing labour migration pathways to better support the admission of migrant care workers, whether through quotas and shortage lists within general work permits/visas or Bilateral Labour Migration Agreements (BLAs).
Another challenge in addressing the LTC workforce needs is retention over time to not only ensure continuity and quality of care for care recipients but also to reduce the costs and disruptions associated with frequent turnover of staff. Previous work by the OCED finds that improvements in job quality and training are most important for improving retention of all care workers (OECD, 2023[2]). However, when it comes to migrant care workers, most OECD countries have limited data on whether they stay in the sector over time due to the difficulty in tracking them and lack of evidence on how to best retain them in the sector.
This chapter examines labour migration channels for care workers within this policy context. Building on previous work by the OECD Health Division (OECD, 2023[2]; OECD, 2020[3]; Llena-Nozal, Barszczewski and Rauet-Tejeda, 2025[4]; Llena-Nozal, Araki and Killmeier, 2025[5]), and the chapter on migrant doctors and nurses in the International Migration Outlook 2025 (OECD, 2025[6]), it focusses on how countries structure their labour migration channels to contribute to addressing skill shortages. It reviews: current labour migration channels for care work across the OECD and their characteristics (e.g. ability to get permanent residence, bring dependents, work for a different employer, skill/salary thresholds, as well as magnitude and trend); the level of training, qualifications and occupational regulation for care sector roles; and assesses available retention data, and policy levers for improving retention in the sector, with a focus on what governments, the sector and employers can do to improve the retention of migrant care workers in the LTC sector.
LTC refers to the provision of a range of services to enable people to live as independently and safely as possible and support activities of daily living (ADLs), such as dressing, bathing, eating and maintaining mobility and instrumental ADLs, such as managing finances and doing the laundry. In countries where LTC occupations are largely unregulated,2 in most cases it does not include medical treatment or services which are predominantly provided by doctors and nurses. In countries where LTC occupations are regulated, the range of tasks involved is quite different and may include provision of medical services. This is the case, for example, in Germany, where registered nurses play an important role in LTC.
The purpose of LTC is to maintain functional ability, autonomy and dignity rather than cure disease or illness. It is provided in two main settings: institutional (such as hospitals, a nursing home or residential facilities) or home and community-based care (including day care for older people). The balance between these settings varies across OECD countries, reflecting differences in policy design, funding and cultural preferences (Llena-Nozal, Barszczewski and Rauet-Tejeda, 2025[4]). The proportion of LTC recipients who received care at home across 23 OECD countries3 increased slightly from 2013 to 2023, from 66% to 70% (OECD, 2025[1]). This reflects the desire of many care recipients to remain in their homes for as long as possible (“aging in place”), and the development of services to support home‑based care by OECD countries.
Most care recipients are older people experiencing loss of functional capacity and require assistance with daily activities. They face multiple chronic conditions that can make their care complex and require support from qualified personnel. One in four older people (i.e. aged 65 and over) require LTC, underlining the scale of care needs associated with population ageing across OECD countries (OECD, 2024[7]). The share of older people receiving formal LTC rises steeply with age – among people aged 80 and over, up to 30% receive some form of formal care, depending on the country and the availability of family or informal support (OECD, 2020[3]).
The LTC workforce is predominantly female, and characterised by persistent poor pay and conditions. In most countries, it comprises three key occupations: personal care workers (the bulk of the workforce), assistant/practical nurses and registered nurses. The tasks performed by workers are often physically and emotionally demanding, involving support with mobility, monitoring health conditions and maintaining communication with family and health professionals.
Care work can be formal (i.e. workers are paid) or informal (e.g. family caregivers). Workers in informal settings, such as their employer’s home, are particularly vulnerable as they often find themselves in a “grey” area in terms of regulation and worker rights – particularly when performing “live‑in” or “24 hour” care. The adoption of ILO Convention No. 189 on Decent Work for Domestic Workers in 2011 marked an important milestone in the recognition of domestic work as a form of employment entitled to the same fundamental labour rights and protections as other occupations. The Convention established a framework for ensuring decent working conditions for domestic workers, including clear terms of employment, limits on working time, weekly rest, minimum wage coverage where applicable, occupational safety and health protections, and access to social protection. It also contains specific provisions addressing the vulnerabilities of migrant domestic workers and workers in live‑in arrangements. By promoting the formalisation and regulation of domestic employment, Convention No. 189 has served as an important international reference point for labour market reforms affecting household-based care and domestic work.
While informal care continues to play an important role in many countries, this analysis focusses on migrants that are employed to work in the formal LTC sector, for which there is more reliable data.
Population ageing affects all OECD countries to varying degrees, driven by declining fertility rates and rising life expectancy. In 2023, 18.5% of the population across OECD countries were aged over 65, including 4.9% who were aged over 80. By 2050, the share of older people is projected to increase to 26.4%, with those aged 80 and over doubling to almost one in ten people (OECD, 2025[1]).
As people age the prevalence of disability, frailty and sickness increases, particularly among those aged 80 and over. As a result, some individuals require assistance with everyday activities. While much of this support is provided by informal carers, such as family or friends, a proportion of older people will need formal LTC services. This reflects both the severity of their needs – typically classified as low, moderate or severe limitations in daily activities4 – and the absence or limited availability of informal caregivers.
Understanding the extent and severity of needs is central to anticipating future LTC demand. On average across OECD countries, approximately a quarter of older people have LTC needs, half of which are low (12% or 31 million), followed by moderate (8% or 20.6 million) and severe needs (4% or 10.3 million) (OECD, 2024[7]).5 Cross-country variation is substantial, however, reflecting differences in population age structures and the number of years older people spend in good health. For example, Japan has a relatively high share of older people with severe needs, while in Hungary, this proportion is close to zero, partly because a large share of its older people are aged 65‑74 so are more likely to have low or moderate needs (OECD, 2024[7]). Unmet need for LTC, nevertheless, remains substantial, reflecting gaps in coverage, affordability and service capacity. Across OECD countries, just over a quarter (27%) of people with care needs receive any formal care (OECD, 2024[7]).
Rising demand for LTC is further compounded by a shrinking available working age population, reduced availability of informal carers due to changes in familial structures and increased female participation in the labour market, and the ageing of the health workforce itself. In 2023, for example, a quarter of nurses were due to retire within the next ten years (OECD, 2024[8]). Informal care is also falling; for example, in France, the number of informal carers fell by 6% between 2008 and 2022, while the number of informal carers providing more than 35 hours a week rose from 8% to 13% (Verhagen, 2026[9]).
The LTC workforce is not growing at the pace of demand
The growth in the LTC workforce is not keeping pace with the needs of older people. Across OECD countries, the number of LTC workers increased by around 20% between 2011 and 2021, yet the population aged 80 and over – the group most likely to require intensive care – grew faster over the same period. As a result, workforce expansion has not been sufficient to meet rising care needs.
In 2021, LTC workers made up 1.9% of total employment in OECD countries, ranging from less than 0.3% of total employment in Greece, Lithuania and Poland to more than 4.0% in Norway and Sweden (OECD, 2023[2]). This illustrates substantial cross‑country differences in LTC workforce supply. On average across OECD countries, there are five care workers for every hundred people aged 65 and over, ranging from 0.2 workers in Greece to 13 workers in Norway (OECD, 2024[7]). Countries with lower workforce density tend to rely more heavily on informal care and experience higher levels of unmet need for formal LTC services, particularly among people with moderate care needs. Without significant improvements in recruitment, retention and productivity, workforce shortages are likely to intensify as population ageing advances.
To meet the projected increase in demand for care, the share of LTC workers in total employment would need to increase by 0.6 percentage points (p.p.) annually between 2023 and 2033 (without gains in productivity or change in needs by age group). Even with an increase in labour-productivity the percentage of total workforce in LTC would need to increase by 0.5 p.p., amounting to millions of additional workers (OECD, 2023[2]). The European Commission has estimated that an additional 1.6 million care workers will be needed by 2050 in the EU to maintain current levels of coverage (European Commission, 2025[10]). There is some uncertainty around the estimates of increased demand for LTC workers as they do not consider future policy changes, technological shifts or the increasing reliance on formal care due to fewer informal carers.6
Care work vacancies are among the hardest to fill in many OECD countries
The reason why the LTC workforce is not increasing at the pace of demand is partly due to recruitment and retention challenges; this section focusses on the former. Depending on the skill level of the workforce and national circumstances, the difficulty in filling care worker vacancies reflects a combination of rapidly rising demand and persistent job-quality challenges. Recent OECD analysis shows that many countries report chronic recruitment difficulties in LTC and related care occupations, with shortages already evident and projected to worsen as population ageing accelerates (OECD, 2023[2]). Employer surveys and administrative data indicate that personal care workers and nurses in LTC face higher vacancy and turnover rates than comparable occupations, contributing to longer vacancy durations and unmet care needs in several OECD Members (OECD, 2023[2]).
These recruitment bottlenecks are closely linked to structural factors. When LTC occupations are regulated, training capacity and difficulties for migrant workers to get their qualifications recognised may be the most significant bottlenecks (OECD, 2017[11]).
Complementary evidence from vacancy and job‑posting analyses shows that health and care roles typically take longer to fill than other jobs across most countries, underscoring that labour shortages in care are not cyclical but reflect long‑standing mismatches between working conditions and growing care needs in ageing societies. While international recruitment can assist in filling vacancies, high and persistent vacancy rates in many countries indicate structural shortages that may not be addressed fully by international recruitment.
Recent data from OECD countries regarding recruitment challenges
The Australian Government’s 2023 Aged Care Provider Workforce Survey asked about the main challenges in recruitment across home‑care providers, and asked providers about the number of vacancies for personal care workers and nurses. The findings highlighted the difficulty of recruiting sufficient staff, competition for staff with other providers or industries, remuneration and applicants not having the right skills and qualifications (Welfare, 2023[12]). Aged and Disabled Carers are an occupation group under continued workforce pressure, with high vacancy rates persisting despite overall labour‑market cooling (Jobs and Skills Australia, 2025[13]). Similarly, New Zealand’s Aged Care Association reports ongoing recruitment challenges and staff shortages as factors limiting providers’ ability to maintain services and plan for future capacity. The occupation of caregiver and registered nurse were highlighted as having particularly high vacancy rates, driven by high turnover in the case of caregivers (31% annual turnover rate) (New Zealand Aged Care Association, 2024[14]).
In Canada, official data and provider evidence show that LTC vacancies are persistent and difficult to fill. The Canadian Institute for Health Information reports that LTC homes continue to experience staffing shortages that translate into high vacancy levels and reliance on overtime, with overtime accounting for 8% of total direct care hours in LTC in 2023‑2024 (Canadian Institute for Health Information, 2025[15]). Provider‑side evidence reinforces this picture: the Canadian Association for Long Term Care reports that there were over 38 000 vacant positions in long-term care homes as of late 2022, more than double pre‑pandemic levels, and describes recruitment and retention challenges as an acute and ongoing sector‑wide staffing crisis affecting nurses, personal support workers, and support staff (Canadian Association for Long Term Care, 2023[16]). Labour‑market statistics further confirm that these vacancies are difficult to fill: Statistics Canada finds that job vacancies in health‑related occupations, including nurses and personal support workers central to LTC, more than doubled between 2019 and 2023, with vacancies increasingly long‑duration in several regions – evidence of sustained unmet demand rather than short-term turnover.
Both Japan and the Republic of Korea face persistent difficulties filling vacancies in LTC, reflecting structural labour shortages rather than short-term mismatches. In Japan, nursing and LTC are among the occupations with the most severe shortages, with public employment service data showing very high job openings to applicants ratios, which may signal vacancies are hard to fill. It is estimated that approximately 570 000 additional care workers will be required by 2040, implying that a large share of anticipated positions will remain unfilled under current recruitment and retention patterns (The Straits Times, 2024[17]). In Korea, where demand for LTC has expanded rapidly since the introduction of public LTC insurance in 2008, government and government-funded research indicate that workforce supply is already insufficient: official projections suggest a gap of around 110 000 care workers by 2028, with shortages driven in part by an ageing workforce, as around two‑thirds of current carers are aged 60 or over (Korea Immigration Service Foundation, 2026[18]). Longer-term government forecasts point to much larger unmet staffing needs over the next two decades if current trends persist, reinforcing concerns that vacancies in LTC will become increasingly difficult to fill without significant policy action.
The EU is experiencing severe recruitment challenges in both the public and private care sectors, especially for highly skilled care professionals. Several countries (including Austria, Belgium, Denmark, France) place care workers on shortage occupation lists to accelerate or facilitate the recruitment of foreign workers. Shortages are reflected in vacancy rates, which peaked between 2019 and 2021 when approximately 421 000 residential care workers across the EU left the sector. The replacement of the workforce is seen as a key challenge as job openings predominantly reflect the replacement of health and care workers that are retiring rather than growth in employment (CEDEFOP, 2023[19]).
Retention issues exacerbate pressures
Persistent difficulties in recruiting and retaining workers further exacerbate these pressures. Improving job quality, training and wages are key to attracting and retaining care workers in LTC over the medium and long term, which will help address labour shortages in the sector. Beyond Applause? Improving Working Conditions in Long-Term Care (OECD, 2023[2]) emphasises that these persistent structural weaknesses contribute to high turnover and difficulties in retaining experienced staff (see Box 4.1). The publication highlights the need for sustainable workforce strategies that go beyond symbolic recognition and focus on better staffing levels, clearer career pathways, stronger access to continuous training, and improved working environments. Strengthening job quality is essential not only for retention, but also for ensuring quality and resilience in long-term care systems.
Available data on retention show that the LTC sector is characterised by high turnover rates and short job tenure, with many workers leaving the sector within a few years. Average job tenure in LTC is two years less than in the general health workforce (OECD, 2023[2]). This is partly due to a higher share of part-time and temporary contracts, and poorer working conditions compared with hospital and acute settings.
To improve retention in the LTC workforce, the OECD publication Beyond Applause? Improving Working Conditions in Long Term Care, recommends:
Raising wages and improving financial recognition to better reflect skills, responsibilities and working conditions, supported by adequate public funding.
Reducing workload pressures through improved staffing ratios, limits on excessive overtime, and more predictable schedules.
Strengthening occupational health and mental health protections, including prevention of work-related injuries, stress and burnout.
Expanding training and career pathways to enhance professional recognition, skills development and progression opportunities.
Promoting job security and stable contracts by reducing reliance on casual and insecure employment arrangements.
Reinforcing social dialogue and collective bargaining to improve working conditions and workforce voice.
Linking funding reforms to workforce outcomes, ensuring that increased investment translates into better jobs and lower turnover.
Source: OECD (2023[2]), Beyond Applause? Improving Working Conditions in Long-Term Care, https://doi.org/10.1787/27d33ab3-en.
Official strategies and plans can play a role in supporting retention. Several actions are in place to support these policy goals at the EU level: the European Care Strategy and the Council Recommendation on access to high-quality long-term care provide a comprehensive framework for reforms and investments at EU and national levels to improve provision of care services, and urge Member States to support quality employment, ensure fair working conditions, improve the professionalisation of care, and address skills needs.
Aligning with this, several OECD countries (including Australia, Austria, Belgium, Chile, Denmark, Finland, France, Germany, Ireland and Norway) have official strategies or plans that cover the retention of care workers or healthcare workers in general, indicating that retention is a priority. Strategies generally contain the following elements: improving wages, stable contracts, access to training, and professional development.
While official strategies and plans can play a role in directing the efforts of government and the sector to support retention, implementation is key if outcomes are to be achieved. For example, New Zealand’s 2017 Care and Support Workers (Pay Equity) Settlement was intended to permanently raise wages but ultimately failed to deliver long-term improvements as continued funding was not provided after the expiry of the Settlement in June 2022, leaving many workers effectively back at minimum wage (Health New Zealand, 2024[20]). Retention of migrant LTC workers adds other considerations and is discussed at the end of this chapter.
To introduce the discussion of migrant workers in LTC, first it is important to identify the major structural factors that influence the approaches OECD countries take: the funding model, predominant care setting (institutional or home care) and regulation of care worker occupations.7 The following taxonomy (Figure 4.1) provides a framework for understanding the variety of approaches OECD countries take to care worker labour migration. It builds on a typology of LTC systems done by the OECD health division (Llena-Nozal, Barszczewski and Rauet-Tejeda, 2025[4]). Four clusters were identified, with some countries partially belonging to a cluster.
Cluster 1: Long-term care insurance model is represented by Japan, Germany and Korea. Entitlements guaranteed by mandatory LTC insurance expand demand for both home and institutional services; providers and occupations are regulated/accredited. These countries have mixed home/institutional settings and care work occupations are subject to certification regulations in Japan and Germany (but only semi-regulated in the case of Korea). Labour migration channels are an important complement to domestic training capacity. Structured, labour migration channels are available aligned to certification (language and skills), often via bespoke categories or bilateral agreement routes (e.g. Japan’s EPA – Economic Partnership Agreement – and “Specified Skilled Worker” visas).
Cluster 2: Universal tax-funded systems with broad access to formal LTC are present in Denmark and Finland. These systems are highly regulated with emphasis on care provided at home. There are limited labour migration channels for personal care workers as the domestic workforce and existing pools of migrants fill most workforce gaps. As the population ages, selective international recruitment is likely if domestic supply lags.
Cluster 3:Limited public funding, selective access to formal LTC, mixed home/institutional care and semi-regulated/unregulated workforce is seen in Australia, Canada, New Zealand and the United Kingdom. Persistent staff vacancies/shortages make migration an attractive lever, with exceptions made to existing labour migration channels usually made to facilitate recruitment of personal care workers.
Cluster 4: Limited formal LTC and regulation, emphasis on home care combined with cash/ in-kind benefits, seen in Italy, Greece and Spain (and in France and Israel to some extent), is generally correlated with a lack of accessible labour migration channels and reliance on either migrants already present or informal carers. The exception is Israel, which combines cash/in-kind benefits, home care and a labour migration channel.
A framework for understanding variety of approaches to care worker migration
Understanding how many people work in LTC, and how many of them are foreign-born, is important but not simple. The definitions of LTC workers (provided above) do not map easily to categories used to identify workers in administrative or survey data. Even when consensus is reached on the definition of LTC workers, these do not always map clearly to classifications. For example, in the EU, the Council Recommendation of 8 December 2022 on access to affordable high-quality long-term care (https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv:OJ.C_.2022.476.01.0001.01.ENG) contains several definitions relevant for LTC workforce, separating “formal” long-term care, “informal” care, domestic long-term care worker, who may be a live‑in care worker. “Formal” in this Recommendation is based on professional status, rather than contractual status.
Labour Force Surveys (LFS) can be used to gain an understanding of employment in the LTC sector but have serious limitations due to the occupation and industry classifications. Sector and occupation classifications often do not correspond exactly to long-term care activities. Within the health sector, for example, there are sector classifications that cover residential nursing care activities, but these might not capture care work provided in the home or hospital setting or provided through visiting care workers. Using broad occupation codes can miss LTC workers who are only one part of wider categories, such as “health professionals, personal care workers and social work”. Persons identified as nurses or nursing assistants may be working in care if employed in hospitals or through agencies, but this is not necessarily captured by occupation or sector definition. For workers providing care in the home, it can be difficult to separate LTC work from childcare or private household duties. As a result, home‑based carers, live-in carers and mixed-task workers (which is where migrant LTC workers are overrepresented) can be misclassified or invisible, even though they are a significant proportion of the workforce as 70% of recipients of LTC receive care in the home on average in the OECD. See Annex 4.A, for an overview of occupation codes used in LTC in different countries.
When labour force surveys are referenced, LTC workers are defined under the scope of the International Standard Classification of Occupations 2008 (ISCO‑08) and the statistical classification of economic activities in the European Community (NACE, rev. 2) as follows:
ISCO‑08: Nursing professionals (221), Nursing associate professionals (3 221), Healthcare assistants (5 321), Home‑based personal care workers (5 322);
NACE rev.2: Residential care activities (87), Social work activities without accommodation (88).
It does not include activities of households as employers of domestic personnel, including live‑in care workers, which may be relevant for countries where LTC workers are employed as domestic workers.
Source: OECD (2023[2]), Beyond Applause? Improving Working Conditions in Long-Term Care, https://doi.org/10.1787/27d33ab3-en.
The other challenge to using LFS to estimate the size of the care workforce and the share of foreign-born is related to the sampling method. Most surveys use a household sampling method. This may miss live‑in carers employed by the household due to the grey nature of their work as well as cross-border workers who are not usually resident (particularly important in countries like Luxembourg or Switzerland). Identifying the LTC workforce as an aggregate of smaller categories may have specific challenges when the sample size is too small or the target group tiny. Recent immigrants are less frequently captured in survey samples than long-standing immigrants. Further, labour force surveys do not usually capture the visa or permit status and therefore cannot generally be used to identify international recruitment from abroad.
Using LFS data to compare countries overall is far from perfect, however, since the extent to which the care workforce is captured depends in part on the share of care workers who work in sectors and occupations which are well-covered by the LFS, such as institutional nursing homes (sector) or home health and personal care aides (occupation). For smaller countries, such as Australia, the sample size is not sufficiently large to enable accurate analysis of the contribution of migrant care workers to the sector.
LFS, with the above caveats, nonetheless provide an indication of the proportion of migrants in a certain occupation or sector across OECD countries, and the trend (i.e. whether the proportion is increasing or decreasing).
Other surveys are conducted which may capture care workers, although they may also face the same issues of definition and sample design.8 Administrative data provides a unique alternative source. Social security contributions provide a picture of employed workers, often by sector and occupation, although subject to the same classification challenges as survey data. In some OECD countries, specific pension funds for domestic workers may allow identification of migrant workers. In Italy, for example, a separate pension fund allows identification of workers (Box 4.3). This covers only workers who are declaring their employment, however. The number of workers paying social contributions for home‑based care work may be well below the total, due to undeclared work, which is particularly rife in the home care sector. For example, in Poland, the total number of foreign individuals paying social contributions in the entire health and social sector is below most estimates of the number of just Ukrainians working in care (Box 4.4).
In Italy, mandatory pension contributions by domestic workers allow the pension institute INPS to identify and monitor home‑based care workers, separating “badanti” (caregivers) from other domestic workers. An Observatory publishes data on workers by sex, age, nationality, hours worked, and reported wages, for all workers who have made at least one pension contribution payment. In 2025, “badanti” represented 51.3% of all domestic workers, confirming the predominance of this occupation. The care workforce is dominated by foreigners, even if the share of foreigners has fallen from 80% to about 72% in the past decade (Table 4.1), although this may reflect, to some extent, naturalisations. In 2024, in terms of origin, 43% of all care workers recorded were nationals of countries in Central and Eastern Europe, and 9% of countries in South America.
Individuals paying at least one pension contribution as domestic care workers, by nationality, 2015-2024
Note: The number of workers paying social contributions for home‑based care work may be well below the total, due to undeclared work.
Source: INPS Osservatorio sui lavoratori domestici.
In addition to LSF data and administrative data on the care workforce, there are limitations in capturing the flows and stocks of migrant care workers in migration data sets. For those countries where there is a specific permit or visa channel for care workers, it is possible to refer to programme data, which is presented below for Israel, the United Kingdom, Canada and Japan. For countries where occupation codes are reported for labour migration channels, it is possible to identify the number of migrants admitted for employment in care occupations. This is possible, for example, for Australia for the temporary skilled visa programmes. Countries which conduct labour market testing may also have data on care work occupations which are approved through the labour market test, although positive decisions on labour market tests may not lead to actual admission.
EU LFS data on migrant care workers provide a partial picture
The portrait emerging from the EU LFS is that foreign-born working in LTC – excluding domestic workers who may do LTC tasks – make a substantial share of the LTC workforce in several of the countries covered. Across 26 European OECD countries, the share of foreign-born workers increased by 7 p.p. over ten years – from 14% in 2014 to 21% in 2024. However, this varies between countries. In Luxembourg, Sweden, Ireland and Switzerland this trend was particularly strong with four out of every ten long-term care workers being foreign-born but in Türkiye, Lithuania and Poland foreign-born workers represented less than 2% of the workforce (OECD, 2025[1]). Note, that this figure is likely underreported for Luxembourg as the LFS may not capture non-resident cross-border workers, a significant component of the workforce. See Figure 4.2 below.
Note: EU 26 is an unweighted average. “All workers” refers to share of migrants in total employed population.
Source: OECD (2025[1]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en (originally from EU Labour Force Survey).
Within the category of foreign-born, the proportion of non-EU nationals working in LTC across the 26 EU countries has increased more than for EU nationals – going from 8% in 2014 to 19% in 2024 (an increase of 11 p.p.), while that for EU national increased from 3% to 6% over the same period. For a breakdown of the country by country change please see Annex Table 4.A.1.
The United States and the United Kingdom also have a high presence of foreign-born care workers
In the United States, immigrants constituted 30% of the overall direct care workforce in 2024 (defined as individuals 18 and older who earned at least USD 1 000 during the year and indicated that their job was in both the long-term care industry and their occupation fell under the category of either aide or nurse) (Chidambaram, 2026[21]). This includes 18% who were naturalised citizens and 12% who were non-citizen migrants. The proportion of foreign-born varies by setting – in home care settings they made up a third of all workers and in residential care a quarter. Immigrants play a large and growing role in long-term care – increasing from 24% of direct care workers in 2018 (Pillai, 2025[22]).
In England (United Kingdom), of the 1.6 million posts in care in 2025/26, an estimated 33% were filled by non-British workers (Skills for Care, 2026[23]). The number of EU nationals has been declining, in both absolute terms and as a share of workers in care posts, falling from 100 000 to 90 000 and from 7.1% to 5.5% of workers between 2020/21 and 2025/26. The number of non-EU workers has risen from 8.4% to 27% over the same period, reflecting the expansion in international recruitment, even as the number of British workers fell.
In Korea, migrant workers comprised only 0.9% of the employed nursing assistants in care work in 2023 (Kwon, 2026[24]), while migrant workers – overseas Koreans of Chinese origin, of whom more than half are over age 60 – comprised 90% of the “caregiver” workforce.
The extent and type of migrant employment in the care sector varies across OECD countries depending on factors, including the LTC sector, the labour market regulations, the culture of care (including informal versus formal care), and the migration system itself (Desiderio, 2021[25]). LTC systems also differ widely among OECD countries, with a general evolution from a reliance on informal care provided by family and friends to more formal long-term care systems, which increase the scope for formal employment, over time.
All countries predominantly rely on women for work in the care sector, a factor which contributes to low pay, irregular working hours, poor working conditions and workplace harassment and abuse. Where workers are female and migrant, they are likely to face additional disadvantages.
Temporary migrants and labour migrants
Like many Asian non-OECD countries, Israel relies almost exclusively on temporary labour migrants for the provision of LTC, mainly in the care recipient’s home (known as live‑in care). More information on Israel’s migration channel is in the next section. The migrant care workforce in New Zealand and Australia comprises a mix of temporary visa holders on work, student, partner and working holiday visas. In Australia, students appear to be an important group: a Department of Health survey in 2024 found that 43% of aged care workers were foreign-born, and the non-citizen foreign-born holding temporary visas (about 10% of all aged care workers) most were either student (45%) or graduate (20%) visa holders (Australian Government, Department of Health, Disability and Ageing, 2024[26]). In New Zealand, by contrast, temporary work visas appear more important; a 2023 industry survey of residential aged care facilities found that 45% of the workforce was on visas, of which 32% were accredited employer visas or other temporary work visas, with most of the others holding permanent residence (Aged care Association New Zealand, 2024[27]).
Free movement provisions
In free mobility areas, regional mobility usually contributes significantly to meeting countries’ LTC needs, sometimes exacerbating unmet needs in countries of origin. In Europe, countries such as Italy, Germany and Austria have largely depended on free movement of workers from Central and Eastern Europe, attracted by higher wages and job opportunities. For example, following EU accession, there were high numbers of Polish and other central and eastern European workers working in care in the United Kingdom. However, following the United Kingdom’s exit from the EU and the end of free movement, EU migration to the United Kingdom declined, while rising EU inflows were seen in Germany (Turnpenny and Hussein, 2021[28]; OECD/European Commission, 2024[29]). Free movement of healthcare workers also occurs between New Zealand and Australia, with a large proportion of Australia’s foreign born healthcare workforce coming from New Zealand under the Trans-Tasman Mutual Recognition arrangement (Australian Government, Department of Health, Disability and Ageing, 2025[30]). Cross border movements are common, notably in Luxembourg and Switzerland.
Regularisation programmes
When legal migration channels are not available or difficult to access, undocumented migrants may play a role in meeting unmet LTC needs. In such situations, notably when continuous regularisation schemes are not available, large‑scale regularisation may be needed. Spain and Italy, for example, have undertaken large regularisation programmes targeted at the LTC sector. Italy has conducted several regularisation programmes over the last four decades. In 2002, it regularised approximately 350 000 people for the mixed category “domestic work/LTC in home” and in 2009, approximately 100 000 of the 295 000 applicants were “badanti” (live‑in domestic care workers that provide daily assistance in private households) or care workers. In 2012, a further regularisation saw 116 000 applications in “domestic work”, which again included care work (OECD, 2025[6]). In 2020, a further regularisation programme was introduced targeted at essential sectors – namely domestic, care, agricultural and fishing work. In Spain, the 2005 regularisation included applications for “domestic work” (almost a third of all applications), which includes LTC but also other roles. Currently, Spain has five categories for continuous regularisation through “arraigo” (rootedness) permits, including on the basis of providing live‑in care to a Spanish national. These permits have recently been simplified, with reduced residence requirements for applying. France has a mechanism for regularisation for persons employed in sectors where recruitment is difficult; this may include care work, allowing care workers, under certain conditions, to acquire regular status as workers.
Family and humanitarian migrants
In most of Latin America, the LTC workforce is largely informal, and care is provided by family members rather than migrant workers (Stampini et al., 2025[31]). In the United States, many foreign-born employed in care have entered through family channels (due to foreign care workers not meeting salary and skills thresholds on labour migration channels). In many OECD countries, including France, the Netherlands, the Nordic countries and Poland, migrants who entered through family reunification and humanitarian channels have increasingly contributed to employment in the long-term care sector, thereby helping to ease shortages. Box 4.4 below illustrates this with the example of Ukrainian workers and beneficiaries of temporary protection in the Polish domestic sector.
Two waves of migration brought different types of migrants
Poland experienced two distinct waves of Ukrainian migration: one from 2014 and one following full-scale war with Russia from 2022, which triggered the largest displacement in Europe since World War II, primarily to neighbouring countries. The two groups show different characteristics: the first group were primarily labour migrants, consisting of working-age men engaged in circular migration; while the second group were mainly women and children who were forced to migrate/flee (i.e. beneficiaries of temporary protection). Skill levels varied between the groups, with the former tending to be medium-skilled and the post-2022 group having higher education on average compared with the Ukrainian population.
Estimates of Ukrainian migrants in the care sector
The provisions of the Temporary Protection Directorate, launched in March 2022, provided beneficiaries of temporary protection from Ukraine with a right of residence and access to the labour market in Poland, as in other EU Member States. OECD analysis, drawing on Eurostat and national sources, indicates that Poland hosted approximately 1 million Ukrainian citizens under temporary protection in 2023-2024. Just over half were of working age, corresponding to roughly half a million potential workers. The labour market inclusion of Ukrainian beneficiaries of temporary protection has been relatively fast but as much of the employment is concentrated in low skilled jobs, this may suggest a skills mismatch as well as beneficiaries of temporary protection prioritising quick entry into the labour market.
The care and service work sector is one sector where Ukrainian migrants are concentrated, partially because it is only semi-regulated in Poland with few barriers to entry (this sector includes LTC but also occupations such as child carers and cleaners). Care International estimates that approximately 100 000 Ukrainian women work as domestic workers in Polish homes. Poland depends on these workers due to a rapidly ageing population and to compensate for emigration of Polish care workers, who often move abroad for work.
Labour migration has lost importance since 2022, probably largely replaced by the employment of beneficiaries of temporary protection (see Table 4.2). The two channels to enter Poland for employment – the declaration system and the standard work permit route – indicate relatively low numbers of workers using these channels. Prior to the arrival of beneficiaries of temporary protection, employers filed 5 900 declarations to home personal care workers, of which 94% were for Ukrainians. The numbers fell dramatically in the following years. Work permits granted for “Personal care workers in healthcare and related occupations”, which includes care workers, also fell sharply since 2022, responding to the sudden availability of Ukrainian beneficiaries of temporary protection (who did not require work permits).
Note: Occupational groups 5 321, 5 322, 5 329 included in declaration statistics until June 2025. 2025 data are estimates based on the first six months. For full year 2025, only “health and social care” was reported, of which Ukrainians comprised 62% of the 5 200 declarations.
Source: Polish Public Employment Service (declarations and work permits) and Social Insurance Institution (number of insured foreigners).
Klakla (2023[32]), In the shadows: Ukrainian Domestic Workers in Poland, Care International Poland; Polish Development Bank (2025[33]), The impact of Ukrainian migrant inflow on the Polish economy: a contemporary analysis, https://www.bgk.pl/files/public/user_upload/The_Impact_of_Ukrainian_Migrant_Inflow_on_the_Polish_Economy.pdf; OECD (2023[34]), “What we know about the skills and early labour market outcomes of refugees from Ukraine”, OECD Policy Responses on the Impacts of the War in Ukraine, https://doi.org/10.1787/c7e694aa-en; OECD (2023[35]), International Migration Outlook 2023, https://doi.org/10.1787/b0f40584-en; Eurostat (2025[36]), Temporary protection statistics (Ukrainian beneficiaries by country and age group).
Using existing pools of migrant workers, including strengthening pathways into the care sector, can be effective for addressing workforce shortages. Measures such as accelerated skills recognition, targeted language training, bridging programmes and facilitated labour market access for family and humanitarian migrants can expand the available workforce while reducing reliance on overseas recruitment, as part of a multi-modal approach.
The gap between LTC demand and supply has led some governments to consider international recruitment as a key component of their workforce strategies. In some countries, migrants are playing an increasing role even without dedicated migration channels through market-led phenomena. Countries differ significantly in the magnitude of the contribution expected from migrant care workers (both those in the country and those who are recruited from outside), and how they organise their labour migration channels for employment in the care sector.
This section outlines the approach taken by countries that have specific migration channels for care workers, followed by countries that facilitate migrant care workers to enter through general work permits, supplemented by shortage lists, quotas or bilateral labour agreements.
Comparing pathways for care workers is not simple, since the occupation comprises different occupations, and multiple migration channels may be possible. In comparing channels, key design features include occupational mobility (whether migrants can change employer within the sector, or leave the sector), ancillary conditions (e.g. whether family reunification is allowed), and long-term prospects (i.e. whether a pathway to permanent residence exists and how long it takes). While permit cost and processing times also influence accessibility of the pathway we have not included this in the analysis. Table 4.3 below provides an overview of how countries that have specific migration channels compare on these considerations. Countries where care workers enter through general labour migration channels are covered in Annex Table 4.A.2.
Note: For countries with multiple pathways, such as Japan and Canada, the table refers to the specific pathway cited.
Canada has been piloting care worker channels for decades
The Canadian Government identified structural shortages in the care sector and developed four programmes/pilots over the years to address these. These include the Live‑in Caregiver programme from 1992 to 2014, the Caring for People with High Medical Needs pilot from 2014 to 2019, and the Home Support Worker Pilot from 2019 to 2024 (Desiderio, 2021[25]). In March 2025, Canada opened a new Permanent Residence pathway, the Home Care Worker Immigration Pilot (HCWIP) (with both a childcare and home support pathway – HCWIP: HS – and an onshore and offshore stream). By December 2025, however, the Canadian Government paused the intake of applications until further notice due to high demand and interest exceeding the number of admission spaces available (Government of Canada, 2025[37]).
The current pilot (HCWIP: HS) offers permanent residence on arrival for home support workers and their dependents without the need for prior Canadian work experience. Relative to other occupations, it has lower language and education requirements (a minimum level of Canadian Language Benchmarks 4 in English or French and a secondary school diploma), but applicants need at least six months work experience gained within or outside Canada or to have completed caregiving training. A Labour Market Impact Assessment is not required – simplifying the procedure and increasing accessibility. However, intake for the HCWIP: HS is capped at 2 750 applications per year (including, in 2025, 140 spaces for undocumented or unauthorised home support workers) (Government of Canada, 2025[37]). An overview of how the current pilot compares to the previous caregiver programmes is in Table 4.4 below.
Changes from one pilot to another reflect lessons learnt identified by government, and in particular, issues that arose when temporary migration channels were used to meet structural shortages. Across the years, reforms were driven by four reoccurring problems: worker vulnerability and abuse, administrative backlogs, misaligned pathways to permanent residence and poor labour-market matching. The Live‑in Caregiver Programme required workers to live in their employer’s household and work for 24 months in Canada to apply for permanent residence. It was replaced following government gender‑based analyses, parliamentary reporting and peer‑reviewed studies of live‑in arrangements, and delayed access to permanent residence, which identified some vulnerabilities for the cohort including social isolation, excessive working hours, and heightened risks of abuse. Further, large application backlogs undermined the programme’s policy objective of providing permanent residence to participating foreign caregivers once they meet the prescribed Canadian work experience requirements.
The 2014 Caring for People with High Medical Needs pilot removed the live‑in requirement but was subsequently replaced in June 2019, after department assessments showed low uptake, widespread misunderstanding of eligibility and continued precariousness due to narrow occupational criteria and uncertain pathways to permanent residence. These concerns led to the 2019 Home Support Worker pilot, which aimed to clarify eligibility ex ante, introduced occupation-based work permits (not linked to single employers) and enable earlier family reunification. This pilot had two streams, one for newly arriving care workers, and one for care workers with 12 months of Canadian work experience. However, official data and academic evaluations later showed that complex processing rules and capacity constraints left most applicants in prolonged temporary status, well below stated admissions targets for permanent residence. In 2025, Canada moved toward new pilots granting permanent residence on arrival (Oklikah, Abada and Arku, 2024[38]; Government of Canada, 2020[39]). Table 4.5 gives an overview of admissions under the previous programmes/pilots.
Note: Data are preliminary estimates and are subject to change. All values between 0 and 5 are shown as “–”. This is done to prevent individuals from being identified when IRCC data is compiled and compared to other publicly available statistics. All other values are rounded to the closest multiple of 5 for the same reason; as a result of rounding, data may not sum to the totals indicated.
Source: Canadian Government. IRCC (31 January 2026).
Other Canadian care worker migration channels
Alongside the HCWIP, Canada uses several other pathways to attract and retain care workers. These include: options to work temporarily through the federal Temporary Foreign Worker programme; permanent immigration through the federal Express Entry programmes, such as the Canadian Experience Class and the Federal Skilled Worker programme, including targeted draws under category-based selection, which has regularly included healthcare in recent years, or the Provincial Nominee Programme and Atlantic Immigration Programme.
The Temporary Foreign Worker Programme allows families to hire home support workers to care for older persons or individuals with disabilities, chronic conditions, or terminal illnesses. It is a general pathway that offers priority processing for in‑home caregivers caring for people with high medical needs. Eligible positions include attendant for persons with disabilities, home support worker, live‑in caregiver, and personal attendant (NOC 44101: home support workers, caregivers and related occupations) (Government of Canada, 2025[40]). The Temporary Foreign Worker Programme is subject to a labour market test. Labour market test data show that 1 351 tests were approved in 2024 for employment in NOC 44101 and 33102 (nurse aides, orderlies and patient service associates) (this equates to 2 889 positions).
Through the federal Express Entry system, high‑skilled workers, including care providers (Nurse aides, orderlies, and patient service associates) in NOC 33102, can apply for permanent residence based on human capital factors such as language proficiency, education, and work experience. In addition to general Express Entry draws, the federal government prioritises occupations facing long-term labour shortages, including, in recent years, healthcare. Healthcare category‑based draws include, among other occupations, NOC 33102 occupations; if selected through the healthcare category they are prioritised over other Express Entry candidates (Government of Canada, 2026[41]). Total healthcare category selections in 2024, the first full year the category was used, were over 10 000; there is no breakdown, however, of the specific occupations of the applicants drawn. Care workers may also qualify for the Canadian Experience Class or the Federal Skilled Worker programme within Express Entry. NOC 33102 occupations are eligible for both programmes, subject to meeting requirements related to language ability, education, and work experience.
At the provincial and territorial level, the Provincial Nominee Programme allows provinces and territories to nominate candidates to obtain permanent residence. Each province and territory operates its own PNP streams and eligibility criteria (Government of Canada, 2025[42]). Several explicitly prioritise caregiving occupations.9
Finally, the Atlantic Immigration Programme provides a pathway to permanent residence for skilled foreign workers and international graduates who wish to live and work in one of Canada’s four Atlantic provinces. The programme supports employers struggling to fill local labour shortages and allows recruitment at most skill levels, including occupations in NOC 33102 (Government of Canada, 2025[43]).
Japan has four care worker migration schemes
Japan has the highest proportion of elderly citizens globally, with 29.4% of its population aged 65 and over (Japan Cabinet Office, 2024[44]). Approximately 2.72 million caregivers will be needed by 2040, bringing the projected shortage to approximately 570 000 additional caregivers, compared to 2020. Enrolment in care training institutions is low, reflecting the challenges in developing the local workforce. Japan has increasingly turned to foreign care labour to address workforce shortages and now has four schemes to facilitate entry of migrants into the care sector (outlined below in Table 4.6).
Source: OECD (2024[45]), Recruiting Immigrant Workers: Japan 2024, https://doi.org/10.1787/0e5a10e3-en.
The Economic Partnership Agreements were the first scheme to be implemented, applying to candidates from the Philippines, Indonesia and Viet Nam. Under the agreements, Japan recruits candidates, primarily nurses and certified care workers via a government-to-government framework. It is capped in the number of annual participants from each partner country and involves a subsidised support and training programme.
The “nursing care” status of residence scheme, implemented in 2017, allows foreign nationals with Japan’s national care qualification to remain long-term. In the same year, the already established Technical Intern Training Program was extended to include training in care work. There is a pathway for the trainees that successfully completed TITP Type 2 to transition to Specified Skilled Worker (SSW) status without passing language/skills tests which are required in SSW. The Specified Skilled Worker System was introduced in 2019 to mitigate skills shortages by admitting work-ready foreign nationals who have a certain degree of expertise and skills. As shown below in Table 4.7, the number of workers in Japan under SSW (stocks) increased more than ten‑fold between 2021 and 2025.
Source: OECD Secretariat based on data from the Ministry of Justice of Japan.
Israel’s long running programme provides live‑in foreign caregivers in people’s homes
Israel has the largest proportion of foreign-born workers in its social care workforce (70%) among OECD countries (OECD, 2020[3]). As of 2024, Israel hosted a total of 77 762 foreign care workers (61 776 there lawfully and 15 986 that were not in compliance with their visa conditions10), up from 75 378 in 2023. This category of workers has been increasing over time and outpacing other groups of temporary migrant workers, such as construction workers. Between 2014 and 2024 the total number of foreign care workers in Israel rose by 42% (below forecasts that the workforce would double between 2010 and 2025 (OECD, 2010[46])). Table 4.8 below outlines the increase in the foreign care workforce from 2014 to 2024.
Source: Population, Immigration and Border Authority, Israel.
Israel’s programme, established in 1991, allows individuals or families to employ foreign caregivers for elderly or disabled care (in the home) upon receiving a permit to hire a foreign care worker from Israel’s Population and Immigration Authority (OECD, 2010[46]). Workers are issued with a one‑year work visa, which can be renewed up to a total of 63 months (5 years and 3 months). In rare cases, it may be extended beyond this length upon approval by the Population and Immigration Authority to continue care for the same care recipient. Subject to approval, caregivers may change to another care recipient who holds a permit to employ a foreign worker within their region. The permit is restricted to the care sector and there is no pathway to permanent residence or the ability to bring dependents.
Although the permit is restrictive in terms of worker mobility and path to permanent residence, it is liberal in terms of admission requirements, with no requirement to have specific qualifications, professional experience or language skills to work in Israel. Recruitment is currently allowed through private intermediaries or BLAs, however, the government plans to shift recruitment to government-to-government channels, governed by BLAs with sending countries (OECD, 2024[47]). Israel has agreements with several countries for the recruitment of caregivers, including Nepal for institutional care, the Philippines for home‑based care and Sri Lanka in both home‑based and institutional caregiving.
The United Kingdom’s Health and Care Worker visa route led to a spike in migration
The United Kingdom introduced the Health and Care Worker visa (HCWV) in August 2020 as a special route or category under its Skilled Worker visa. Shortly after, it was extended to the social care workforce to address shortages in the LTC sector. Senior care workers became eligible for the visa in January 2021 and care workers (who were allowed to bring their dependents) were added in February 2022. Care providers offering employment were required to have a certificate of sponsorship, as for any other Skilled Worker, but applicants did not have to have any particular qualifications or experience. By March 2023, the number of migrant workers entering on the HCWV ballooned (a total of 57 693 visas granted in the year ending March 2023, more than 34% of the Skilled Worker route). Along with this increase, reports of exploitation by care providers increased.
In 2024, a tightening up of the ability to bring dependents and an increase in the salary requirement and skill level led to falling numbers of visa grants. In July 2025, the United Kingdom Government announced the closure of the HCWV to overseas recruitment of care workers and that they would focus on training local workers. In-country recruitment is still allowed and migrant care workers already in the United Kingdom are able to extend their visas, switch employers, and apply for settlement under the existing rules until 2028. The government has proposed extending the qualifying period for settlement from five to ten years under a new “earned settlement” model, with longer periods, potentially up to 15 years, for some lower paid or medium-skilled workers, such as care workers. The proposal remains under consultation at the time of writing. If the changes come into effect, it is proposed they be applied retroactively, which would affect migrant care workers who entered the United Kingdom in 2021/22 and would have been eligible to apply for settlement from 2026. Figure 4.3 below illustrates the change in visa volumes between 2021 and 2025 (for main applicants and their dependents).
Source: UK Home Office (2025[48]), Restoring Control over the Immigration System, http://www.gov.uk/government/publications/restoring-control-over-the-immigration-system-white-paper.
These figures refer to visas issued to care workers arriving from abroad. An additional important channel for care workers in the United Kingdom is change of status, as international students. Just under 45% of international students who graduated and switched directly from study visas to Skilled Worker visas between 2021 and 2025 went into care work (Brindle and Sumption, 2026[49]). This amounted to more than 50 000 care worker visa recipients over this period.
In most OECD countries, recruitment of a migrant care workers is possible, at least in theory, through a general work permit/visa. In practice, however, many countries’ salary and skill thresholds for such channels make it difficult for personal care workers, and sometimes assistant/practical nurses, to be admitted. This is the case, for example, in the United States, where the many foreign-born employed in care have come through non-economic channels. In some countries, such as New Zealand, the high salary and qualification thresholds in the general skilled channel have been addressed – due to the importance of guaranteeing a care workforce – by exemptions or occupation-specific concessions (such as lower formal skill and language requirements or fast-track processing). In other countries, the employment of care workers is facilitated through their inclusion on shortage occupation lists and the use of occupational quotas. This section provides more detail on the variety of mechanisms OECD countries use to facilitate the admission of migrant care workers.
Occupational quotas and shortage lists
Shortage occupation lists function as a selectivity and signalling tool, identifying occupations where international recruitment is considered justified on economic or social grounds. They typically allow employers to bypass or simplify the labour market test. In points-based systems, shortage occupation lists provide additional points and therefore the opportunity to be selected from the migrant pool. Quota based occupation lists are used to ensure international recruitment has a limited impact on the domestic labour market. Different tools aim to address different types of shortages but when they cover LTC occupations they act as a signal for facilitating recruitment. Despite the absence of a dedicated pathway, shortage occupation lists can therefore play a decisive role in enabling employers to recruit care workers from abroad, particularly where employers face persistent recruitment difficulties from the local labour force.
However, the efficacy of this approach depends on several factors. First, designation as a shortage occupation only improves access to migrant labour where the labour market test is the major constraint, not other requirements, such as salary thresholds, credential recognition or processing times. Second, the credibility and usefulness of shortage lists hinge on whether they reflect genuine and current shortages (supported by up-to-date data). Lists that are updated infrequently or based on weak evidence risk either excluding occupations where shortages are acute or allowing access to migration where shortages have eased.
Finally, shortage lists need to be underpinned by a robust understanding of how LTC occupations are defined, classified and segmented within national labour markets. Care work often spans multiple occupational categories, employment relationships and skill levels, and shortages may be concentrated in specific roles, settings or regions rather than across the occupation as a whole. Without sufficiently granular occupational definitions, shortage lists may be poorly targeted, limiting their effectiveness as a tool for improving recruitment outcomes through international migration.
Several OECD countries have care workers on shortage lists, including Austria, Belgium, Canada and France (regional shortage lists), Denmark (the “positive lists”, which use quotas for certain care workers), Finland and Slovenia. Three OECD countries use quotas for care workers (Denmark, Italy and Ireland) although the experience so far indicates that quotas may be set below the level of need for the occupation, or, on the contrary, be undersubscribed for various reasons. In both Italy and Ireland the quota for care workers has not been met in recent years. Box 4.5 below outlines how the care worker quota is used in Ireland.
Quotas aim to meet labour shortages while protecting local workers
In December 2022, following a report by a cross-departmental advisory group on long-term care workforce and in response to recognised shortages in long-term care, the government introduced a quota of 1 000 General Employment Permits (GEPs) for non-EEA care workers. In March 2025, the quota was expanded to a total of 2 000 GEPs. This measure forms part of Ireland’s approach to addressing labour shortages in long-term care while maintaining protections for the domestic workforce. It also aims to ensure continuity of care for recipients of long-term care where domestic supply is insufficient.
The quota has not been fully used so far
In 2023, 441 new GEPs were issued for care workers and home carers (SOC 6145), in 2024, 835 GEPs were issued, and in 2025, 757 GEPs were issued. In addition, 163 GEPs were renewed in 2025, along with 9 new Reactivation Employment Permits for SOC 6145, which do not count towards the quota. This brings the total number of permits issued under the quota in 2025 to 929. In the first half of 2026, 518 GEPs were issued, and 313 renewed.
Allowing recruitment in the care sector has had limited impact so far
Aside from the quota, the government made Health Care Assistants (HCA) (who work in institutional care settings) eligible for GEPs in June 2021, in response to rising demand and limited supply. The report, the Labour Market Impact of Health Care Assistant (HCA) Employment Permits, published in December 2024, examines the effect of granting GEP access to non-EEA HCAs.
The report finds that at current permit levels the labour market impact has been limited. Permit-holders accounted for a small share – about 10% – of the overall workforce, and shortages persist. However, the report projects significant growth in demand for care workers in the coming decades, suggesting the scheme may become more important over time. It also identifies structural challenges, including low pay, demanding working conditions, work-life balance issues, visa and family-reunification restraints and qualification recognition barriers, which need to be addressed to support longer-term effectiveness.
Sources: Report on the Labour Market Impact of Health Care Assistant Employment Permits (Department of Enterprise, Tourism and Employment, Ireland). December 2024. Response to Parliamentary question 193 on Thursday 10 April 2025.
In Italy, the entry of foreign workers for employment purposes is regulated by the Flow Decree (Decreto Flussi), a mechanism through which the government determines annually or on a multi-year basis the number of foreign nationals who may legally enter the country for employment. The system is based on numerical quotas for specific occupations and economic sectors.
Under the 2026 Flow Decree, a significant share of the quotas have been allocated to domestic and family care services, covering highly demanded occupations such as:
Caregivers (badanti)
Domestic workers/housekeepers (colf)
Babysitters
For this sector, a total of 13 600 entries have been authorised for foreign workers to be employed under non-seasonal subordinate employment contracts. This allocation reflects the growing demand for care and support services among Italian households, driven largely by population ageing and the increasing need for continuous assistance for elderly and dependent individuals.
The 13 600 quotas are not distributed uniformly across the country. Instead, they are allocated geographically according to the number of applications submitted by employers in different regions (Flussi, 2026[50]).
Alongside the Flow Decree (Decreto Flussi), there is also an out-of-quota channel that allows employers to hire caregivers and babysitters without being subject to the annual entry limits. This measure provides for 10 000 entries per year between 2025 and 2028 for foreign workers employed in the care of people aged over 80, persons with disabilities, and children up to six years of age. Unlike the Flow Decree procedure, applications are not submitted directly by employers through the click day system. Instead, employers must apply through authorised employment agencies or employers’ associations, which submit requests via the Ministry’s online portal using dedicated application forms.
An analysis of data by sector shows that domestic work and health and social care services recorded the highest success rate: in 2023, 29.7% of allocated quotas resulted in the signing of an employment contract. This outcome is likely linked to the stronger commitment of employers and the more personal nature of the employment relationship. At the same time, it may also suggest the use of the mechanism as a de facto regularisation channel for workers already present in Italy.
Bilateral Labour Agreements or Skills Mobility Partnerships
Eight OECD countries (Austria, Belgium, Germany, Israel, Italy, Japan, Slovenia and the United Kingdom) have Bilateral Labour Agreements that include a focus on care workers. Bilateral Labour Agreements create government to government frameworks that formalise recruitment standards, protect workers’ rights and align labour supply with destination country labour needs, helping to reduce irregular migration and exploitative recruitment practices. They are particularly suited to migration where supply of workers outstrips demand, and where job requirements, such as training or qualification requirements, are less specific (OECD, 2014[51]).
Skills mobility partnerships are a type of Bilateral Labour Agreements that go a step further by integrating skills development, credential recognition, and circular mobility into migration pathways, ideally enabling origin countries to enhance their workforce and destination countries to address workforce shortages. Although they are often limited in their scale – admitting hundreds of workers over several years – and so not appropriate for addressing structural shortages, they have become popular in recent years, particularly in the EU.
Italy has introduced pre‑departure labour mobility schemes under Article 23 of the Italian Immigration Law. These programmes allow employers to recruit workers selected abroad through structured pathways combining job matching, vocational training and Italian language training before departure, with the objective of improving labour market integration and supporting fair and demand-driven international recruitment.
Foreign workers who have completed vocational and civic-language training programmes abroad approved by the Italian Ministry of Labour and Social Policies may enter Italy and be hired at any time of the year, irrespective of the work-entry quotas established under the government’s Flow Decrees (Decreti Flussi).
The health and social care sector involves small scale training initiatives across several countries. In Peru, as of June 2026, 180 people have attended programmes for basic social care workers, healthcare assistants, and care service integration. In Sri Lanka and India (Kerala), 20 healthcare assistants have been trained in each country, while in Ecuador 50 professionals have taken part in training and placement programmes in the healthcare sector. Brazil, with 50 participants, is also involved through social and healthcare training initiatives. In addition, 8 participants in Tunisia have been trained for care services, along with 20 participants in Albania, who have also followed healthcare and social care training pathways.
Germany is another example of a country that uses a combination of general skilled migration pathways with BLAs and skill mobility partnerships to facilitate international recruitment into the LTC sector. More information is in the section below.
Germany’s system focusses on highly qualified migration for LTC
Germany’s migration system relies on qualified workers in regulated professions, principally registered nurses and nursing assistants to address shortages in LTC. Admission is restricted to skilled migrants who already hold relevant vocational or tertiary nursing qualifications, with stringent requirements for qualification recognition and language proficiency. The channels for international recruitment are the general skilled worker channel (Visa for Qualified Professionals), rather than a specific channel for care workers or health professionals, and, in some cases, the EU Blue Card. Assistant nurses and registered nurses are primarily admitted through the skilled migration channel.
The skilled worker channel in Germany is open to candidates with a recognised university degree or vocational qualification (with a minimum number of years of training). There is no labour market test; the application is reviewed by the Federal Employment Agency to check that the salary and working conditions in the contract are comparable to German conditions. Recognition of qualifications or training is required. Nursing assistants with recognised vocational training may also use the skilled worker channel, as long as they hold a formal nursing assistant/care assistant qualification that has been recognised as equivalent to a German state‑recognised vocational training. Access to the skilled worker channel requires a minimum B1 level in German, however, to gain recognition and practice as Registered Nurses migrants must attain a B2 level of German. This is not specified in the Skilled Worker regulations, but reflects standardised administrative thresholds applied across German regions for recognition.
The EU Blue Card is an alternative channel to the skilled worker channel, for highly qualified employment Nurses may be eligible for the EU Blue Card in Germany, but not necessarily in other EU countries as eligibility depends on meeting the requirements of the Blue Card Directive (art. 5) and national implementation rules. For the purposes of the Blue Card, Germany defines ISCO 222 occupations, including registered nurses, as shortage occupations, which allows for facilitated admission conditions, including a lower salary threshold, of about EUR 45 934 in 2026. A Labour Market Test does not apply. The Blue Card is thus a possible, but unlikely, pathway for nurses from abroad who intend to work in the care sector. The EU has also developed Talent Partnerships with partner countries to support skills development and mutually beneficial mobility. In 2026 the EU Talent Pool Regulation (2026/1047) was adopted, which aims to facilitate recruitment of third-country nationals for occupations facing shortages through an EU-wide matching platform.
Germany also introduced an “Opportunity Card”, a job-search visa, which is also available to nurses and nursing assistants based, for example, on the number of years of academic or vocational training. This may allow foreign nurses to enter Germany and seek work, but they would have to receive recognition to work, and at that point be eligible for the Skilled Worker pathway.
Recent reforms to the Skilled Immigration Act, which were passed in November 2023 and fully implemented in June 2024, have introduced additional flexibility into the migration system. One example of this is the “recognition partnership” route, which allows migrants to enter and work in Germany (in regulated occupations such as nursing this is typically only possible at a lower occupational level) while completing the recognition of their qualifications, thereby accelerating labour market access. For more information on Germany’s skill mobility partnerships see Box 4.6.
Germany has developed a Global Skills Partnerships Nursing training programme that provides training in an individual’s country of origin and offers a curriculum which aligns with both the standards of the individual’s home country and those of Germany. The approach includes language classes to level B1‑B2 in German and skills trainings to bridge any differences. Global Skills Partnerships aim to support faster recognition and adaption to the destination country’s labour market (Global Skills Partnerships nursing professionals can benefit from immediate recognition).
The Philippines-Germany Global Skills Partnership was established in 2019 as the first partnership in the nursing sector. This has been followed by nursing Global Skills Partnerships in several other countries: Mexico, Brazil, India, Uzbekistan and Indonesia. So far, more than 100 graduates from Mexico and the Philippines are working in Germany.
The partnerships aim to create structured, mutually beneficial pathways for skilled nursing professionals. The approach (commissioned and funded by the German Federal Ministry of Health) involves a partnership between nursing facilities in origin countries and German healthcare facilities. The Global Skills Partnership addresses the key challenges associated with the labour migration of qualified nursing staff and offers new approaches to mitigate negative consequences. Targeted strategies within the Global Skills Partnership help to empower nursing staff and partner countries, and assist in capacity building and the further development of healthcare systems.
Source: The German Federal Ministry of Health; Global Skills Partnership (2026[52]).
Other mechanisms: Industry agreements and expanding pathways to work in care for foreigners already in the country
Australia’s labour agreement with the aged care sector
In May 2023, Australia introduced an aged care industry labour agreement, which allows providers to directly recruit migrants for the following care sector roles under the Skills in Demand (subclass 482) visa (temporary) and the Employer Nomination Scheme (subclass 186) visa (permanent): aged or disabled carer; nursing support worker; and personal care assistant. The settings of the agreement were informed by the findings of the Royal Commission into Aged Care Quality and Safety, which pointed to ongoing aged care workforce shortages, as well as attraction and retention challenges. The settings were also informed by consultation with the government, including the Departments of Health, Prime Minister and Cabinet, and Employment and Workplace Relations. Employers must enter into and maintain a memorandum of understanding with relevant industry union(s) to be able to access the agreement (Australian Government, Department of Home Affairs, 2026[53]). The agreement provides access to visa concessions, including a pathway to permanent residence after two years working in the care sector (in Australia), and priority processing.
As shown in Table 4.9. below, between 30 June 2022 and 30 June 2025, as the agreement was moving to full speed, grants for care worker occupations increased by more than nine‑fold. The increase was particularly strong for personal care assistants, the occupation that constitutes the bulk of the care workforce and following the 2023 introduction of the aged care industry agreement.
Note: This data is at a national level and based on occupational codes where captured in the visa issuing process.
Source: Australian Government: Department of Home Office.
As the agreement is relatively new the Home Office does not yet have data on retention (whether and how long people stay in the care sector upon getting PR). One trend visible so far is that most participants were already onshore (i.e. in Australia) and international recruitment is almost absent – 90% of visas granted are to onshore visa holders, particularly student visa holders. This may reflect the interest of students in employment in the care sector, that providers are trying to retain existing part time employees or that student visa holders see this as an accessible and fast pathway to PR. Further, it indicates that either there is sufficient supply of foreigners available in the local workforce or barriers to international recruitment (e.g. lack of recruitment intermediaries who can affordably, effectively and efficiently match employees with providers).
Overall, Australia’s labour agreement for the aged care sector offers a balanced model by giving employers a regulated pathway to recruit foreign workers where shortages are acute, while embedding safeguards such as minimum pay rates, skills requirements, and oversight mechanisms that help protect migrant workers from exploitation and ensure fair treatment.
Expanding the eligibility of foreign nationals to work in the Korean care sector
In Korea, admission of foreign care workers under the general non-professional temporary work permit stream, the employer permit system, has not been allowed. Historically, female overseas Koreans holding the H‑2 (Work and Visit) visa have served as the main source of labour for the care sector. H‑2 visa holders are free to take up employment in most sectors, including care, provided they take a three‑day course in language and culture. The private caregiving sector (often in hospital settings but sometimes live‑in care) particularly attracts female overseas Koreans, many of whom are H‑2 visa holders, as it is unregulated with no required qualifications (Park, Choi and Lee, 2020[54]). The care sector, however, cannot continue to rely on this pool as the pool of candidates eligible is rapidly ageing and diminishing.
More recently, a sub-category under the E‑7 (professional or specialised occupations) visa was introduced to attract mid-skilled workers in various sectors such as social welfare, services, and manufacturing. In 2024, “certified care worker” was added to the list of eligible occupations under the E‑7‑2 category, enabling foreign nationals with the required credentials and Korean-language proficiency to work in the care sector. Under this policy, international students who graduate from Korean universities and obtain a certified care worker qualification may transfer to an E‑7 visa upon securing employment at a care facility.
This scheme is currently implemented on a pilot basis with an annual quota of approximately 400 persons. Following an evaluation of its performance, the government will consider whether to implement it as a regular program.
In addition, to facilitate the implementation of the certified foreign care worker program, the Korean Government designated 21 high-performing universities in each metropolitan/provincial area as “certified foreign care-worker training universities” in August 2025. As of March 2026, 505 international students had enrolled in and were studying at these universities. These universities operate formal degree programmes for certified foreign care workers to ensure they meet Korean care‑quality standards.
A key issue regarding the international mobility of health professionals, and a major focus of the political attention in recent decades, is the impact on countries of origin. In 2023, the World Health Organization (WHO) established a health workforce support and safeguards list (SSL) comprising 55 countries as part of the revision of the WHO Global Code of Practice on the International Recruitment of Health Personnel (outlined in Box 4.7 below). These countries face particularly acute health‑workforce constraints in achieving universal health coverage, as reflected in both a below‑median density of doctors, nurses and midwives (less than 49 per 10 000 population) and a universal health coverage service coverage index below a specified benchmark. The WHO recommends that active international recruitment from these countries be avoided in the absence of appropriate compensatory measures and calls instead for strengthened international support to reinforce their health systems (OECD, 2025[6]).
While the WHO Support and Safeguards List provides an important global benchmark for ethical recruitment, it does not capture all situations in which international recruitment may place pressure on source‑country health systems. Countries such as the Philippines illustrate how high levels of health worker production and international mobility can coexist with domestic shortages and significant geographic and sectoral maldistribution.
The implications of international recruitment for countries of origin also depend on the occupational outcomes of migrant workers abroad. When qualified nurses are recruited into lower-skilled LTC roles, the result may be a double loss: source countries lose scarce health professionals in whom substantial training investments have been made, while destination countries do not fully utilise migrants’ qualifications and skills. This highlights the importance of recognition pathways, skills-matching policies, and approaches that support circular migration, diaspora engagement and return mobility, helping to reconcile destination-country workforce needs with source‑country workforce retention objectives.
The WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted by the World Health Assembly in 2010, provides an overarching global framework to improve global governance and minimise the negative consequences of health worker migration, particularly from developing countries. It promotes ethical recruitment and helps countries develop systems that balance the interests of both sending and receiving countries, while safeguarding the rights of migrant health workers.
As part of the revision of the WHO Global Code of Practice on the International Recruitment of Health Personnel, the WHO established in 2023 a health workforce support and safeguards list (SSL) comprising 55 countries. These countries face the most pressing health workforce challenges in relation to universal health coverage. These countries have: 1) a density of doctors, nurses and midwives below the global median (49 per 10 000 population); and 2) a universal health coverage service coverage index below a defined threshold. Active recruitment from these countries, unless accompanied by compensatory measures, should be avoided and, instead, increasing international support for the strengthening of health system in these countries is recommended. The list will be updated every three years.
The third review of the WHO Code of Practice by the Expert Advisory Group concluded to the continued relevant and effectiveness of the Code. The group however stated that the code and its implementation needed to be strengthened and recommended additional elements to be included. On that a draft resolution was adopted by the 79th World Health Assembly (May 2026) that agreed to publish an updated version of the WHO Code of Practice that includes additional text stating notably that “the provisions of the code also apply to health personnel who migrate and take up employment positions as care workers in destination countries”. This makes the code fully relevant to ensure a fair management of migrant care workers.
There is variation in how countries regulate care worker occupations
As outlined earlier in this chapter, in most countries LTC work encompasses three main occupations: personal support workers, assistant/practical nurse and registered nurses. These occupations are regulated in different ways, with most OECD countries not regulating personal support workers at all, partially regulating assistant/practical nurses and fully regulating registered nurses. Full regulation means that candidates need to go through licensing or registration and qualification recognition, all of which take time, sometimes including extra study and examinations, and the navigation of processes that can vary by jurisdiction. In most OECD countries, registered nurses require a tertiary level education (typically a bachelor’s degree), as well as licensing or registration. For assistant/practical nurses there is more variation across countries and training can range from short courses to one to two‑year certificate programmes and upper secondary or post-secondary diplomas. Regulation of these roles is also inconsistent with some countries not regulating them at all and others requiring registration and/or licensing.
Variation in training and experience requirements across countries is especially large for personal support workers. While the low barrier to entry for personal support workers has historically facilitated the entry of migrant care workers to the labour market in many OECD countries, there is a growing trend for countries to introduce some training or experience requirements to access the migration pathway for this occupation. Australia has introduced a skills/experience requirement specifically for labour migrants, who either need to have an Australian Qualifications Framework certificate III in relevant care/health services or 12 months full-time experience in a care role. Similarly, in Estonia migrant personal care workers must meet both formal qualification and experience requirements (Estonian Qualifications Framework Level 3) or a Social and Health Care Specialist (Level 4). In Korea, foreign candidates must complete 320 hours of training and pass an examination to work in care. Table 4.10 below outlines the minimum qualifications for migrants be admitted for work in the care sector in 18 OECD countries that require credentials and/or experience.
Note: Countries that do not require qualifications, training or experience for caregiver roles are omitted from the table. Requirements for domestic/local workers may be different to what is in the table, which is specific to the requirements for the migration pathway.
As described earlier, Germany has higher human capital requirements for the admission of care workers, where internationally recruited care workers must already be trained registered nurses or nurse assistants in their home country. Another country with higher requirements is Japan, where passing the national certified care worker exam – currently administered only in Japan – is the prerequisite to obtain the “nursing care” status of residence. Box 4.8 gives an overview of Japan’s certified care worker qualification, which is available to both national and foreign candidates. However, other care worker channels in Japan have their own specific skills thresholds (for example, for Specified Skilled Worker, candidates need to undertake verification of skill and language level).
The significant differences in national frameworks for what qualifications and experience care sector occupations require can pose challenges for international recruitment and intra-regional portability of skills (particularly in the EU). This is because foreign qualifications may not map neatly to domestic occupational standards, and someone who is eligible to perform a role in one country is not necessarily able to do so in another without further evidence of meeting the skills or qualification threshold.
Japan’s Certified Care qualification is the country’s nationally recognised credential for professional caregivers in the long-term care. It confirms that the holder has the specialised skills and knowledge required to provide care tailored to individuals who experience difficulties in daily life due to physical or mental impairments. To obtain the qualification, it is necessary to pass a national exam that tests both technical competence and, for example, ethical understanding of care work. The completion of a certified care training programme, gaining at least three years’ experience, along with completion of an accredited practical training course for care workers, are prerequisites). The exam is in Japanese, meaning candidates need to have fluency in the language to pass. Foreign examinees receive extended exam time and question booklets in which furigana (syllabic characters) is provided for all kanji to aid reading.
As of March Fiscal Year 2026, there are just over 2 million Certified Care Workers (2 075 495). In the most recent session, in Fiscal Year 2025, 21.1% of the approximately 78 500 candidates who sat the exam were foreigners.
Pass rates and recent changes to support candidates
In Fiscal Year 2025, while the overall pass rate was 70.1%, the rate for foreign test-takers was approximately 30%, primarily due to language challenges.
Two measures may facilitate future foreign test takers. The first is a general reform of the system: a partial passing system was introduced in Fiscal Year 2025 so that even if a candidate fails based on the total score, each part will be evaluated separately and passing a part of the exam exempts candidates from retaking it on their next and the subsequent attempts.
The second measure is government has also funded a project to support foreign care workers to study Japanese to improve their employment and retention in long-term care. It involves: Japanese‑language web content for LTC to enable foreign care workers to study independently; the development of learning materials to support foreign care workers to work in Japanese LTC settings; training sessions for staff at facilities that accept foreign care workers; and preparation courses for foreigners who are taking the national examination for certified care workers.
Source: Japanese Ministry of Health, Labour and Welfare.
OECD countries almost universally require ability in the local language
Almost all OECD countries require ability in the destination country’s language (normally an intermediate level) but this varies between being an immigration requirement or an employer expectation. For example, Austria requires a Common European Framework of Reference for languages (CEFR) level B2 in German for most regulated care worker occupations (including the role of healthcare assistant and nurse) but may accept a lower level of German for unregulated care occupations such as live‑in carer or home helper. In Finland, it is the responsibility of the employer to ensure the care worker has sufficient language skills (an A2 level or above is normally required for training programmes). Greece, on the other hand, does not have a formal language requirement but, practically, care workers need some proficiency in Greek to work in the sector.
Korea and Japan include language proficiency as part of their care worker training programmes – both the national care worker exams administered in Japan and Korea are conducted in the respective national languages. The Japanese Government has recently added Japanese language support for national examination applicants of the Certified Care qualification who are foreign-born (refer to Box 4.8). Private recruitment intermediaries for the German care sector incorporate language training in their pre‑arrival programmes for migrant workers up to level B1 to address this.
Communication is an important part of the job and attaining a certain language level can be challenging for migrants. Language proficiency can be a barrier to attracting migrant care workers, particularly for countries with smaller language communities (e.g. non-English, Spanish or French speaking). It may limit migrants’ awareness of their employment rights, slow down the process of qualifications recognition, as well as adaption to new jobs and access to social services. In these circumstances, support from government, employers and/or the sector to improve language skills is important, especially if attaining a certain language level is a pre‑requisite for continued stay or licensing. Combined with skills recognition measures, it can facilitate the labour market integration of migrant care workers.
Some countries facilitate migrants to enter while recognition is underway
Where qualifications are required, there is no standardised approach to the recognition of third country nationals’ qualifications across OECD countries, and recognition processes may be lengthy and bureaucratic. For example, in Germany, the process involves an equivalence assessment (where the authorities compare the foreign training to the German qualification), the provision of certified translations of all documents, and evidence of German language proficiency at B2 level (CEFR). If the qualification is not deemed equivalent, an adaption course or exam may be required. The whole process can take up to three years. Many countries follow similar processes, which may be started abroad but need to be completed in the destination country. In some countries, such as Korea and Japan, there is no recognition process for foreign training/qualifications, and foreign-born care workers must complete the local training and exam (in the local language).
One solution to the long process for recognition is to allow migrants to enter and work while recognition is underway. This benefits employers by providing labour quickly and can benefit migrants too as long as there is a clear path to attaining recognition. Austria and Germany allow skilled workers to enter, and in some cases work, while the recognition process is underway. Changes to the German Skilled Immigration Act in 2024 introduced the “recognition partnership” route, which lets migrants go through the recognition procedure after they arrive in Germany while working in the profession (in regulated occupations such as nursing this is typically only possible at a lower level) (The German Federal Government, 2025[55]).
Provisions to admit migrants for employment while recognition of qualifications is underway can help to reduce barriers and facilitate the international recruitment of care workers. However, there are several factors to consider. First, there is a temporary occupational downgrading, in terms of the tasks performed but also the salary received. For example, during the process, nurses in Flanders are paid on a care assistant scale, and those in Austria and Germany can be paid on an assistant/trainee scale, placing them respectively in a lower occupational category and lower wage group under the collective bargaining coverage or the sectoral care minimum wage (in Germany). The number of hours for additional study – especially language – may be a burden on top of a full-time work week (Missault, 2024[56]). The process usually takes a minimum of six months, but can last much longer, and might not lead to successful recognition of qualifications.
Obstacles related to recognition can lead to attrition (Atanassov et al., 2023[57]), or to a growing stock of nurses working towards authorisation. Of the approximately 1 700 nurses admitted to Denmark between 2019 and 2024 for the purpose of obtaining Danish authorisation – not specifically in the LTC sector – only 200 had achieved this goal by 1 January 2025, while almost all the others were still undergoing the authorisation process, in part due to bottlenecks in the training system. This led Denmark to set a quota for the nurses category – at zero through 2027 (Danish Ministry of the Interior and Health, 2025[58]).
There is a further question of determining who pays for the language and professional training. The reality of occupational downgrading implies a greater need to manage migrants’ expectations around pay and tasks for a lower-level occupation than the one they trained for, or are accustomed to perform, in the origin country – and transparency about the outcomes of the process.
For countries like Germany, which only recruit internationally for registered nurses and nurse assistants, aspects such as the qualification recognition process, and the language support are the most influential in supporting smooth labour market integration. Efforts to digitalise and streamline the recognition process are likely to make it faster and more accessible for migrants and employers.
While improving working conditions is the most effective retention policy (refer to Box 4.1), there are additional measures that can be used to specifically support migrant care worker retention. The following section discusses data on the retention of migrant care workers, followed by measures that can be taken by governments, the sector and employers to improve migrant retention in the LTC sector, with a focus on data and migration system levers.
There is limited evidence on retention outcomes for migrant care workers
Obtaining data on migrant care worker retention is challenging for several reasons. Few countries examine retention in occupation of admission of labour migrants. Tracking retention by occupation is complex and resource intensive as it involves linking administrative data or surveying individual workers, hence it is usually only done in one‑off retrospective studies, rather than routinely. Care work presents the added difficulty in that occupational codes sometimes capture other occupations, such as childcare and domestic work (e.g. cleaning) as discussed earlier in this chapter.
Nonetheless, some data, such as turnover rates, average tenure, or year-to-year continuation in the long-term care workforce, is available for a handful of countries. These are reported in one‑off studies rather than as part of regularly published statistics.
Data collected by the OECD health division (from the EU and Australian Labour Force Surveys) suggests that tenure of foreign-born care workers is slightly shorter than that of the native-born, although this refers only to tenure with the same employer, rather than to continued employment in the care sector (OECD, 2025[1]).
There is mixed evidence on the effect of gaining permanent residence (and hence labour mobility) on retention in the healthcare sector. A study by the Canadian Government on temporary foreign workers employed in the healthcare sector since 2000, found that one year after transitioning to permanent residence (which enables job mobility), nearly two‑thirds of temporary foreign workers remained working in the health sector (Hou, 2025[59]). Although this study is not specific to the LTC sector, it indicates that most migrant healthcare workers do not immediately leave the sector upon getting permanent residence. An earlier OECD report (OECD, 2019[60]) found, however, that many caregivers from Canada’s pilot programmes left the care sector after gaining permanent residence and noted that a longer required period between admission and being eligible for permanent residence could improve retention and limit the need for high intakes in this category.
Data on stay rates of different occupations from a United Kingdom study found that those working as senior care workers, care workers and home carers, and nurses (SOC 2 231) had the highest stay rates (defined as remaining in the United Kingdom not the LTC sector11) among common occupations. Excluding care workers, those working in nursing consistently demonstrate the highest stay rates among occupations with 94% remaining in the United Kingdom five years after their first Skilled Worker visa. This may be explained by several factors: high labour demand in the health and social care sectors, the difficulty of moving roles for licensed professions, such as nursing, and that those arriving on health and social care visas tended to bring higher number of dependents that those on other skilled visas (which makes mobility harder due to factors like schooling). It should be noted that there is a short observation window for care workers and home carers as they were only added to the Skilled Worker route in 2022 (Migration Advisory Committee, 2026[61]).
Evidence is limited on how expanded labour market mobility upon obtaining permanent residence affects longer-term retention in care. In countries where accelerated permanent residence pathways exist, such as Australia and New Zealand, there has not been analysis of whether migrants remain in the care sector after meeting the qualifying employment period. This makes it difficult to assess the extent to which pathways to permanent residence and sector mobility affect retention.
Migration levers can impact retention in the LTC sector in various ways
Governments have a number of useful policy levers to increase retention with the employer for temporary visa holders. They can also create incentives for retention in the country by enabling family reunification, pathways to permanent residence and considering flexible renewal rules.
One commonly used lever is to link temporary work permits to a specific employer, occupation or sector, thereby limiting migrants’ ability to change jobs or move into other sectors. In the care sector, such constraints on occupational or sectoral mobility can result in migrant workers remaining in low skilled care roles for the duration of their initial permit, even where their skills or qualifications could allow movement into other occupations or more highly qualified roles within the sector. From a labour supply perspective, these arrangements can help address sector specific shortages and may be associated with longer observed tenure in care roles. At the same time, reduced employer mobility can reinforce power asymmetries between employers and workers, potentially increasing vulnerability and discouraging workers from reporting poor working conditions or abuse. Restrictions on occupational mobility may also affect overall labour market efficiency by limiting workers’ ability to move to jobs where their skills are most valued, leading to less successful job matching.
Across the OECD many countries limit migrant care workers to the sector and/or employer and sector for the duration of the initial permit. Some countries, such as Israel, admit workers exclusively for work in the care sector, with no possibility of changing sector. Italy has recently introduced a sector‑specific exception to its general labour migration rules, requiring migrants admitted for employment in care to remain in the sector during the first 12 months of their permit. The revised Single Permit (applicable to healthcare workers who fulfil the necessary conditions) streamlines the procedure for non-EU workers to reside and work in the EU. The changes also include the rights to change employer within the scope of the single permit, and protection for single permit holders during unemployment. These measures have a direct impact on third country nationals applying to work in the EU, including in the care sector.
Other countries rely less on direct restrictions and more on conditional incentives. Rather than prohibiting sectoral mobility outright, some systems link access to permanent residence or faster progression to settlement to a minimum period of employment in care. In New Zealand and Australia, for instance, migrants on certain temporary visas can qualify for permanent residence after two years working in the care sector, which is faster than other temporary visa holders.
The design of settlement requirements, such as minimum residence periods, occupational eligibility, and skill thresholds, can influence migrants’ decisions about where and how long to remain employed. In the United Kingdom, care workers are currently subject to the same indefinite leave to remain requirements as other skilled workers. However, proposed changes, if implemented, would extend the baseline qualifying period from five to ten years for all migrants, with potentially longer timeframes for medium‑skilled occupations, including personal care workers. As a result, care workers who entered under the Health and Care Worker visa in 2021‑2022 would no longer meet the revised settlement requirements, as the proposed changes are retrospective. Longer temporary status may be associated with extended retention in the sector but also prolongs periods during which workers have more limited bargaining power and reduced security.
Permit duration and renewal processes are another set of policy levers that can affect retention and turnover in the care sector. Longer initial permits and predictable, streamlined renewal procedures can reduce uncertainty for workers and employers, supporting job continuity and lowering administrative‑driven churn. In contrast, short permits and complex renewal requirements can increase turnover and the risk of status lapses in a sector already facing staffing shortages.
Closely related is the length of time migrants are allowed to remain in the country when they lose or leave a job. Short grace periods may discourage workers from changing employers, even in cases of poor working conditions, reinforcing dependence on a single employer, while longer job‑search periods can support better matching and greater stability of labour supply within the sector. Approaches vary across countries: in the United Kingdom, sponsored skilled workers generally have 60 days to find a new sponsor after job loss; in Germany, job‑search periods of several months may be granted depending on the decision of the local Foreigner’s Authority; and in Canada, recent measures allowing temporary extensions or open work permits for vulnerable workers enable continued job search without immediate loss of legal status.
For migration to play a role, not only as a quick fix but as part of ensuring a sustainable LTC workforce, it is important not only to create a clear pathway to permanent residence but also to create incentives, notably by enabling family reunification – this can be through enabling the principal applicant to sponsor immediate family, non-immediate family, enabling spouse work rights and supporting faster processing for family members. However, this may not be sufficient to ensure retention in the sector if conditions are not generally good for the domestic LTC workforce.
Several actions are in place to support these policy goals at EU level: the European Care Strategy and the Council Recommendation on access to high-quality long-term care provide a comprehensive framework for reforms and investments at EU and national levels to improve provision of care services, and urge Member States to support quality employment, ensure fair working conditions, improve the professionalisation of care, and address skills needs.
In EU/free‑movement contexts, retention may depend less on visa settings and more on working conditions, commuting constraints, recognition of qualifications, language support, housing affordability and attractiveness compared with jobs in neighbouring regions.
Overall, migration settings for the care sector involve multiple policy levers, each associated with trade‑offs between addressing immediate labour shortages, protecting workers, supporting retention, and maintaining labour market efficiency and coherence across migration streams.
Soft measures can improve job quality, onboarding and support
A few OECD countries include migrant care workers in their national retention strategies and many have other soft measures to encourage retention (see Box 4.9). Soft measures that target the retention of migrant workers based on the unique barriers they face, such as communication challenges, cultural differences, discrimination and need for support in daily tasks/orientation can be effective.12 For example, since care workers from abroad may not be familiar with the institutional practices in the destination country, it may be necessary to have pre‑departure training to make it clearer, for example, with videos of typical tasks and the work environment. These services could be provided by the training institution in the origin country, the employer, recruiter or association in the destination country. Providing such information about the job and workplace supports workers to have realistic expectations about their life in the destination country. This could be supported on the ground by high-quality onboarding, buddy-schemes (particularly with a buddy from the same cultural background), and fostering inclusive, respectful workplaces that address discrimination (both from patients and other colleagues) and provide ongoing language and cultural support.
Discussion of foreign caregivers within Japan’s strategy
Japan’s strategy for retaining foreign caregivers, outlined in the Global Health Vision of the Ministry of Health, Labour and Welfare, focusses on improving post-arrival support to improve both working and living conditions to encourage long-term employment. Measures include reducing excessive workloads, promoting safer care practices, alongside practical daily life support, such as host organisations helping workers find appropriate housing, access transportation and open bank accounts. The policy emphasises career development through the creation of career-development plans by the host organisation and worker, better access to training programmes and clear advancement paths, as well as exam preparation for national care qualifications to reduce barriers (e.g. by holding test preparation courses). These efforts aim to reduce turnover and ensure continuity of care for Japan’s ageing population.
Norway’s strategy focusses on strengthening the general health workforce
Norway’s national plan to strengthen recruitment, competence, and professional development in the municipal health and care services (Kompetanseløft 2025) includes actions to improve the recruitment, retention and development of personnel. This includes the “Jobbvinner” Programme – a national recruitment campaign focussed on increasing the number of nurses and healthcare assistants, with emphasis on long-term care, and “Menn I helse” – an accelerated pathway for men to obtain vocational certification as healthcare assistants, which promotes gender diversity and supports workforce capacity in long-term care. There are also training programmes for staff, leadership development for managers, which can support retention. The implementation of the plan is being carried out by the Norwegian Directorate of Health, who works closely with the municipalities. While it does not specifically address migrant care workers, it assumes many of the actions to improve recruitment and retention will impact on them.
Source: Ministry of Health, Labour and Welfare of Japan (2024[62]), Global Health Vision, https://www.mhlw.go.jp/content/10501000/001295190.pdf; Norwegian Directorate of Health, http://www.helsedirektoratet.no/forebygging-diagnose-og-behandling/organisering-og-tjenestetilbud/kompetanseloft-2025.
At the EU level, the project “Nursing Action” funded under the EU4Health programme, focusses on mitigating nursing shortages through improved recruitment and retention strategies. Additionally, the Joint Action “HEROES” aids in strengthening health workforce planning, and seven projects designed to create training opportunities that enable health professionals to upgrade their skills.
In countries which recruit high qualified care workers who must obtain recognition of their qualifications before being able to work at their level, such as Germany and Finland, clear pathways for professional development and skills development, with support for language study and other required training, may support retention. Information on how long this will take and what the outcomes have been can help better inform candidates and manage expectations. The European Commission Recommendation on the recognition of qualifications of third country nationals sets out measures for Member States to simplify and expedite recognition processes to allow faster access to professions. Furthermore, the Commission announced the development of common rules for recognition of qualifications of third country nationals as one of the actions of the Union of Skills.
The Estonian Ministry of Social Affairs has recently commenced a programme to support the attraction and retention of an additional 6 000 care workers by 2030.The programme involves four pillars, one of which is focussed on inclusive onboarding and workplace‑based integration, particularly for migrant care workers. This tailored onboarding aims to support retention and service quality. The programme is still in progress, with no outcomes to report yet.
Slovenia has introduced a range of measures to improve the recruitment, integration and retention of migrant workers in LTC and social protection services. Targeted integration programmes co-finance costs related to temporary accommodation, recognition of qualifications, Slovenian language training, and support for workers’ family members, with particular emphasis on occupation-specific language courses that strengthen safe and high-quality care delivery. The Employment Service of Slovenia complements these efforts through tailored recruitment and integration support, including assistance with employment procedures and documentation, promotion of vacancies in Slovenia and abroad, information on living and working conditions, and Slovenian language courses up to B2 level for both workers and their families. Broader workforce retention measures applicable to all LTC employees include investment in professional development and qualification attainment, scholarships for students in relevant health and social care fields, support for volunteer engagement, initiatives to improve quality and safety through staff training and better human resource management, and the adoption of innovative technologies and equipment to reduce workload, improve working conditions and allow staff to spend more time providing direct care.
In Quebec, a programme called Accompagnement Québec supports new migrants to settle and remain in the province. More information is below in Box 4.10.
Accompagnement Québec is a government-funded support service delivered by Quebec’s Ministry of Immigration, Francisation and Integration that supports newcomers – both permanent and temporary migrants – from before arrival through to long-term settlement in the province. It is aimed at immigrants and their families who need help navigating life in Quebec, particularly in areas such as learning French, accessing employment, understanding public services, and settling in regions outside Montreal. The programme provides personalised support through an assigned integration assistance officer, referrals to local service providers, and access to tools such as francisation courses, labour market integration services, and regional settlement support. By intervening early and offering tailored guidance, Accompagnement Québec aims to improve migrants’ social and economic integration, encourage retention in Quebec – especially in regions facing labour shortages – and support more durable settlement outcomes aligned with Quebec’s linguistic and integration objectives. Participation in the programme is voluntary. Many participants are care workers.
Source: Quebec’s Ministry of Immigration, Francisation and Integration.
As population ageing intensifies, countries will have to rethink their long-term care workforce strategies in a more strategic way, including how migrant care workers, both those already in the country and recruited internationally, can contribute to addressing persistent labour shortages. Governments should promote the role of migrant care workers, and invest in technological innovation, improved labour conditions, and broader health system reforms. Migrant workers already play a critical role in sustaining care systems in many OECD countries yet attracting and retaining them through effective and ethical migration pathways remains challenging, with no one‑size‑fits-all solution. While there is no single solution, structural reforms aimed at improving job quality, wages, working conditions, staffing levels and career opportunities remain fundamental for addressing labour shortages and improving retention.
Successful migration channels for care workers must be embedded within overall LTC workforce planning and designed with careful attention to eligibility criteria. Reviewing and adapting existing labour migration channels to ensure they are fit for care occupations, through realistic, occupation-appropriate language, skills and salary requirements, streamlined processing times, and the selective use of labour market tests, can help ensure that qualified workers are able to enter and remain in the sector. When well designed, such pathways can stabilise essential services, improve the continuity and quality of care, reduce reliance on irregular recruitment, and strengthen worker protections, contributing to the professionalisation of the sector. Where there are no or inaccessible lawful pathways, there are risks of exploitation of migrants and unregulated migration.
At the same time, countries face important trade‑offs in channel design. More accessible pathways with lower entry thresholds may help alleviate immediate workforce pressures but risk increasing worker vulnerability and weakening incentives to improve pay and working conditions if labour-market safeguards and the enforcement regime (labour inspections and legal redress mechanisms) are insufficient. Conversely, more restrictive approaches may limit exploitation but require greater public investment in the LTC sector or shift costs onto families. Granting faster access to permanent residence can support recruitment but may reduce medium-term retention in the care sector if workers transition quickly to better-paid employment elsewhere (more common for personal care workers than registered nurses). These trade‑offs underscore the need to balance flexibility and accessibility with robust labour protections, including clear employment standards, enforceable rights, and mechanisms to prevent misuse of care‑worker pathways.
The approach taken by the United Kingdom, Japan and Canada to develop and test different ways of facilitating care workers is useful, however it can lead to a multiplication of channels and complexity in the migration system. Striking the right balance between open and facilitative channels and admission criteria that restricts candidates due to higher requirements remains a challenge for many countries.
Strengthening retention remains essential for both domestic and migrant workers if the LTC sector is to be sustainable over the medium to long term. This requires sustained investment in training, job quality, and career progression pathways for all care workers, complemented by targeted onboarding and integration support for migrants. Efficient and timely recognition of foreign qualifications and skills, ideally allowing recognition to occur while workers are employed in the destination country and harmonised across jurisdictions, can further enhance retention by reducing administrative barriers.
Finally, better data collection is critical to support evidence‑based policymaking. Data collection on the care work sector in general could be improved, including better capture of the role of informal carers. For migrant workers, robust systems are needed to monitor tenure, mobility between employers, transitions to permanent status, and exits of migrant care workers from the sector. Such data are essential to assess the impact of visa settings on workforce stability, identify retention challenges – particularly after permanent residence is granted – and guide adjustments to migration and workforce policies. Together, these measures can help ensure that migrant labour contributes not only to short-term gap filling but supports the long-term resilience and quality of long-term care systems.
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ISCO 08 (primarily used in Europe)
The International Standard Classification of Occupations (ISCO) is a tool developed by the International Labour Organization to organise all jobs into a clearly defined set of groups according to the tasks and duties withing the job. Other countries’ classification systems are generally aligned to ISCO for reporting purposes. The occupational codes most relevant to long-term care are:
2221 Nursing professionals
3221 Nursing associate professionals
5321 Healthcare assistants
5322 Home‑based personal care workers.
Some care work may be included in the occupational codes below but they are often excluded in Labour Force Surveys:
5329 Personal care workers in health services not elsewhere classified (orderlies, for example)
9111 Domestic helpers and cleaners.
The Americas
The United States uses the 2018 Standard Occupational Classification (SOC) system to track occupations. Aged care or caregiving occupations include the following SOC codes:
SOC 31‑1120 – Home Health and Personal Care Aides
SOC 31‑1131 – Nursing Assistants
SOC 29‑1141 – Registered Nurses
SOC 29‑2061 – Licensed Practical and Licensed Vocational Nurses.
Canada uses the National Occupational Classification (NOC), which is explicitly aligned with ISCO 08. The following occupational codes are relevant:
33 102: Nurse aides, orderlies and patient service associates
44 101: Home support workers, caregivers and related occupations.
Mexico uses the Sistema Nacional de Clasificación de Occupaciones (SINCO). Relevant occupational codes include:
2 821 Nursing Assistants
5 221 Carers of children, disabled persons and old people in establishments
5 222 Carers of children, disabled persons and old people in private homes (note, the latter two do not distinguish between child and elder care)
Asia Pacific
Japan’s Standard Occupational Classification system (JSOC) captures long-term care workers within “service workers”, with the following JSOC codes being relevant:
361: facility-based care workers,
362: home help/home‑visit care workers
Korea uses the Korean Standard Occupational Classification of Occupations (KSCO).
4 211 Care workers (요양보호사, 간병인) provide personal care, assistance with activities of daily living and support services for older people and persons with disabilities in homes and facilities
2 412 Nurse assistants (간호조무사) support nurses and physicians in LTC hospitals and residential care facilities, heavily used in institutional care.
Australia and New Zealand use the Australia New Zealand Standard Classification of Occupations (ANZCO).13 The codes most relevant to long-term care are:
423111 – Aged or Disabled Carer (Provides general household assistance, emotional support, care and companionship for aged or disabled people in their own homes). Skill level 4.
423313 – Personal Care Assistant (Provides routine personal care services to people in a range of healthcare facilities or in a person’s home).
423312‑Nursing Support Worker (Provides limited patient care under the direction of nursing staff).
Note: This table covers the migration pathways available for each country by LTC occupation (this will not be relevant for nationals that do not require a visa, for example, EU nationals working in another EU country). Definitions: Personal support worker/Care aide: Workers providing direct personal care and assistance with daily living activities in residential or home‑based long‑term care settings. Often classified as low‑ to semi‑skilled roles. Assistant nurse / Practical nurse: Mid‑level nursing roles (e.g. enrolled nurses, practical or licensed nurses) requiring formal vocational training but not full professional nursing registration. Registered nurse: Professionally licensed nurses with tertiary‑level qualifications and statutory registration. Key: ✔ Clear, established national labour‑migration pathway for the role; ◐ Partial or conditional pathway (regional schemes, pilots, labour agreements, or tied employment); ✖ No dedicated labour‑migration pathway; access possible only via general work, family, or humanitarian routes.
← 1. This term refers to an (employed) individual residing outside the country in which they were born. Note, this is not necessarily the same as a “migrant” as the individual may have been naturalised and hold the citizenship of the country they reside in.
← 2. A profession or trade for which there is no legal requirement or restriction on practice in relation to licenses, certificates, or registration. This means individuals can work in these fields without needing formal certification or approval from a regulatory body.
← 3. Israel, Spain, Germany, Switzerland, Japan, Norway, Denmark, Czechia, Korea, Hungary, Sweden, Lithuania, Finland, Australia, the Slovak Republic, the Netherlands, New Zealand, Slovenia, Luxembourg, Belgium, France, Estonia, Portugal.
← 4. The method for assessing needs is as follows. People aged 65+ are assigned a score equal to the number of ADL/IADL difficulties they report. Method X:1‑2 difficulties = low needs; 3‑6 = moderate needs; 7‑10 = severe needs. Method Y:1‑2 difficulties = low needs; 3‑7 = moderate needs; 8‑10 = severe needs. The report then estimates prevalence under both methods and averages the results.
← 5. The figures in millions are based on data from the OECD Data Explorer showing that a total of 258 312 241 people were aged 65 and over in the OECD in 2024.
← 6. They assume the following remain the same: proportion of dependent people receiving formal LTC; the balance between formal and informal care; hours of care per recipient; and staffing ratios.
← 7. Note, that these factors are not necessarily deterministic and other factors, such as the type of shortage, type of care occupation targeted and existing migration channels will also have an impact.
← 8. For example, The Eurostat-OECD-WHO Joint Questionnaire on Non-Monetary Healthcare statistics (JQNMHC) includes a question on care workers. It combines healthcare assistants (ISCO‑08 code 5321) and home‑based personal care workers (ISCO‑08 code 5322), and countries respond on a voluntary basis. If countries decide to respond to this question, using administrative data covering the entire population, it might address the sample selection of the LFS, but not resolve the classification issue.
← 9. For example, British Columbia’s Provincial Nominee Programme identifies nurse aides, orderlies, and patient service associates as high demand healthcare occupations, with eligibility requirements including a job offer and minimum standards for language, education, and work experience (www.welcomebc.ca/immigrate-to-b-c/about-the-bc-provincial-nominee-program).
← 10. This could mean 1, overstayed 2, not working in care sector anymore or 3, working in care but not through a registered employer.
← 11. Stay rate was demonstrated by valid visa, indefinite leave to remain or citizenship.
← 12. According to the literature and interviews with experts.
← 13. New Zealand introduced a new system for classifying occupations in 2024, known as the National Occupational List. The ANZCO is still being used during the transition.