The centre of gravity of the health and care sector is shifting away from hospitals and nursing homes. Capacity and resource constraints combined with policy pushes for greater access in the community and advances in medtech mean that over the coming decades an increasing amount of care will be delivered in an outpatient setting and at home. But Joseph Musgrave, CEO of Home & Community Care Ireland, Ireland’s trade association for domiciliary care providers, warns us there is a major stumbling block: almost every country lacks a structured career pathway for carers.