Long-Term Care Professionalization and Deprofessionalization in Germany and the Netherlands - the Role of Institutions and Policies

Organizing long-term care (LTC) for the elderly is a growing public concern in all modern welfare states. Growing life expectancy and demographic ageing lead to a rise in the number and the severity of LTC needs. In this situation governments face increasing LTC costs and at the same time pressure for a high quality of care. Thus, the question arises how countries react to these challenges. Because labour is the most expensive part of LTC and also the most important component of care quality developments in the labour force are highly important and are thus at the centre of reform processes. So the main question is: How do countries’ LTC workforces develop in times of increasing cost and quality concerns? Do they opt for cheap, lowly educated labour (including informal LTC) in order to save costs, do they invest in expensive, highly educated labour to increase the quality of care or do they try to combine both strategies? Thus, do they professionalize, deprofessionalize or polarize? Trends in the LTC workforce on education and occupational degrees, as well as on organizational power and reputation are assessed by using national and international comparative data. Therefore, a professionalization continuum is used, which includes both formal and informal LTC work. By comparing two LTC systems with a similar problem structure and similar structure of occupations in LTC – Germany and the Netherlands – since the early 2000s, specific policies and institutions can be traced to influence the trajectory of the LTC workforce.