The pandemic has shown that in the area of long-term care (Rsa, home care) there are numerous problems that have also led to a high number of deaths in these facilities, not to mention those who have remained at home. This is why states are being called upon to intensify investment.

"The Covid 19 pandemic has highlighted all the problems in the long-term care sector (LTC). Older people and health workers have been disproportionately affected by the pandemic. Many OECD countries have taken steps to contain the spread of the infection and mitigate its impact on vulnerable groups. However, the health crisis is highlighting and exacerbating pre-existing structural problems in the long-term care sector (LTC). Healthcare professionals experience difficult working conditions. In addition, there are skills mismatches, poor integration with the rest of health care and inadequate or poorly applied safety standards. Looking ahead, more investment in the LTC workforce and infrastructure is needed to ensure adequate levels of skilled staff, with decent working conditions and priorities in the quality of care and safety." This is the reference the OECD makes to the states in a recent ad hoc document on the subject.

The International Organization points out that "the majority of deaths from COVID – 19 are among the elderly, especially those over 80 years of age who account for 50% of those receiving LTC".

"Some of the countries most affected," the report states, "such as France, Italy, Spain and the United States, have seen a high number of deaths among nursing home residents. While almost seven out of ten elderly people receive care at home. In France, it is estimated that about 50% of total COVID-19 deaths are in nursing homes; In Belgium, half of the deaths from COVID – 19 occurred in LTC facilities. The actual numbers may even be higher because many LTC residents have not been tested. People living at home are not even risk-free, either from the virus itself, or from the social isolation and loneliness that can accompany the efforts of social estrangement."

The many problems on staff. LTC workers "do not always have adequate health training or the ability to implement protocols to reduce infections or other prevention activities. Outbreaks, then, often cause staff absenteeism, as workers take sick leave or are afraid to go to work. In the area of home care, the absenteeism of LTC workers also increases the burden on informal or family carers."

Then there is the issue of "lack of sufficient and qualified medical staff and structural problems with insufficient coordination with the rest of the health system are making the crisis more acute in the LTC".

Poor training. "Less than a quarter of LTC workers have tertiary education across the OECD. Personal care workers – who are not qualified as nurses – make up the majority of the LTC workforce (70%) and have very low access to work requirements."

Low salaries. In 2014, the average hourly wage for LTC workers in 11 OECD countries was EUR 9 per hour, compared with EUR 14 for hospital workers in the same occupation. Low wages are one of the reasons for the high turnover in the sector.

Precarious employment. Precarious or non-continuous employment (e.g. Shifts, part-time work or temporary work) is common in the industry. "Temporary employment is frequent and can offer flexibility to both employers and workers, but it also contributes to job insecurity in the sector, less social protection and a lack of continuity for patients. On average, half of LTC workers work shifts (e.g. morning or afternoon only) in 20 OECD countries. Shiftwork is associated with a wide range of health risks, such as anxiety, exhaustion and depressive syndromes."

Preventable security errors are widespread. Research shows that "over half of the damage that occurs in LTC facilities is preventable and that over 40% of hospital admissions from LTC are avoidable. Residents in LTC facilities often have a compromised immune system or chronic conditions that expose them to an increased risk of infection, especially, but not only, during the COVID-19 crisis. Close proximity and constant contact of residents with healthcare staff and other residents can facilitate the spread of respiratory and other infections. As a result, even before the COVID -19 crisis, health care-associated infections were common in the LTC, with an average prevalence of 3.8% among LTC residents in OECD countries in 2016-17."