There is no lack of demand for unskilled homecare, yet it still struggles to shake off the stigma of its Cinderella status. Will it ever make it to the ball?

The sector is beset by problems. For one, it is affected by the acute staffing crisis hitting the entire healthcare sector. But it is even worse in unskilled domiciliary care – because to workers in that market jobs outside of healthcare services are equally appealing, they are equally qualified to do them, and they pay as well. So providers need to set themselves apart as attractive employers, or carers scoot off to work administrative roles or provide other unskilled labour, fuelling the sector’s notoriously high turnover.

Staff stay when they feel there is a degree of career progression available, when salaries are attractive and when they are given higher degrees of autonomy in managing workloads and coordinating care. None of these things are the norm.

Change must come from the very top – and not all governments have been quick off the mark when it comes to creating favourable policies. Providing a big enough workforce to cater to the rising needs of ageing populations across the world requires, in many cases, labour reform to open markets further to less affluent migrant workers from abroad. And as a medium-term solution, it is crucial for countries to attract carers from elsewhere while domestic numbers improve. Governments must also commit more money to the sector – those that have failed to do so, like in the UK or the Nordics, have made it difficult for businesses to provide high quality care and adequate staffing numbers.

Thirdly, sizeable black markets exist in many countries – certainly in Italy, Spain and Germany. Until policy lifts more of this labour out of the dark and into the light of regulation, huge market potential remains untapped and swathes of workers remain underpaid, unprotected and in insecure work. Though elsewhere, tight regulation puts pressure on organisations to provide staff numbers and quality above and beyond their funding levels, creating an impossible situation.

We see successful businesses using models that are different – some supply carers exclusively from Eastern Europe, others organise staff in a non-hierarchical way, increasing retention. Certainly many of these pay staff above market rates. But the success of the for-profit sector as a whole will remain at the mercy of (often) unfavourable government funding, inadequate policy and difficult regulators. Few appear willing to step in to wave a magic wand.