Norwegians are aging rapidly. As a result, there is an unprecedented demand for elder care workers, both in institutional settings and at home. The aging of the population coupled with a long-standing policy aimed at keeping remote areas of the country populated has resulted in a shortage of healthcare professionals in big cities and in rural areas. The one million people living in rural, often remote, areas of Norway are desperate for high quality care.
Striving for high quality elder care
Norwegian policy makers have been talking about quality in elder care for many years. In policy documents, such as the Care Plan 2020, the need for high standards of care is subject to intense scrutiny. Special attention is paid to the healthcare workforce in the plan.
In other words, quality care professionals and policy makers understand the importance of quality employment to the provision of quality care. The literature on quality of employment has long posited that policies of employment and relationships between employees are central to achievement levels among workers. Most of the crucial factors for employee well-being—e.g., professional development and good working conditions– are linked to increased productivity.
Realities at work, a far cry from policy ideals
The healthcare workforce in Norway is quite diverse. It includes highly skilled staff as well as ‘unskilled’ workers, ethnic Norwegian professionals, and immigrants. The latter are often educated in their home countries, but some have gotten their healthcare degrees in Norway. Regardless where they hail from, all healthcare workers want to advance and experience upward mobility.
However, as I found out in my study on the experiences of immigrant healthcare assistants working with elderly patients in Norway, immigrant healthcare assistants wanted to progress in their jobs, but in reality they faced many more constraints than opportunities. They expressed concerns about poor working conditions, lack of opportunities for professional development, and having demanding yet undervalued jobs.
Many worked on zero hour contracts. Working on such contracts while trying to meet basic livelihood needs—paying bills, buying groceries–is very difficult. It is nearly impossible to have resources to pay for little extras: an outing with a colleague, coffee with a friend, or a trip outside the city. Because of their constant need to “hunt shifts” and resulting unpredictable schedules, immigrant healthcare assistants experienced social exclusion. In turn, this hinders their social and cultural integration and their opportunities to learn and practice Norwegian.
The challenge policy makers face in distinguishing reality from ideals means that the lived experiences of occupational groups such as immigrant healthcare assistants are not given appropriate attention in policy determinations. Policies focus on ideals such as quality care outputs without a corresponding investment in resources for elderly care. The current experiences of the immigrant healthcare assistants create an alarming image of a workforce that is increasingly comprised of immigrants who experience a cycle of career ‘traps’ in low-status occupations.
The healthcare assistant positions are filled by immigrants whose education and training often goes unrecognized and who cannot afford to take time off or to pay for tuition for skill development in healthcare careers. With fewer career opportunities due to the lack of credential and skill recognition, immigrant healthcare assistants often find it challenging to find jobs.
Policy-level failure to pay attention to the needs of the workforce
In a welfare regime rooted in the obligation to take care of elderly citizens, quality care for the elderly is the responsibility of the state, not the individual. Against this background, a major objective of the current elder care policy is the promotion of quality elder care, including medical and social support.
There is a huge gap between the skills of the workforce in close, continuous contact with the elderly and the ideal requirements on providing quality care in terms of a high level of professional expertise. As the level of professional competency rises through investment in development programs, effectiveness and quality care outcomes are expected to be achieved. The managers of Norway’s long-term care institutions concur that a key challenge with the primary workforce lies with training. Both managers and immigrant healthcare assistants at the long-term care institutions worried about the tendency to segregate the unskilled category of healthcare assistants due to the lack of financial resources for continued learning or training. Ironically, structural and institutional arrangements indirectly prevent the ‘unskilled’ immigrant healthcare assistant workforce from participating in the very training programs aiming to secure skilled or professional expertise.
I therefore argue that the current Norwegian policy of promoting quality elderly care is inherently flawed as it aims to supply care workers with professional expertise yet its implementation tends to decrease the opportunities for the unskilled to become skilled.