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Are long-term care jobs harmful? Evidence from Germany

Abstract

Like many OECD countries, Germany is currently facing a shortage of long-term care (LTC) workers. This situation is concerning in the context of the ageing of the German population. A potential reason why Germany fails to recruit and retain LTC workers is that LTC jobs are particularly demanding (physical and psychological strain) which may be harmful to health. However, there is a lack of empirical evidence demonstrating this effect. This article fills the gap in the literature by exploring to what extent LTC jobs reduce workers’ health over time. We estimate a dynamic panel data model on the German Socio-Economic Panel (v.35; 1984–2018), which allows adressing selection issues into occupations. Our paper provides innovative findings on the impact of LTC occupations on workers’ health. We confirm that LTC jobs have a negative impact on self-reported health. Our results have strong policy implications: we emphasize the need to provide sufficient assistance to LTC workers, who are at risk of facing more health issues than other workers. This issue is key to increase the attractiveness of LTC jobs and reduce turnover in the LTC workforce.

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Fig. 1

Notes

  1. The OECD’s definition excludes the hospital sector of LTC jobs. Nevertheless, distinguishing between the hospital and residential/home sectors is only possible after 2012 using the revised NACE classification (see Table 6). To include as little noise as possible in our estimation, we include the hospital sector among LTC jobs before 2013 but differentiate the two sectors after this year. Panel C corrects this approach.

  2. Duration (or job tenure) is defined here as the number of waves/years observed in the job.

  3. Few immigrants (2% of our sub-sample) acquired German citizenship over the period considered. We only consider here responses in the first wave.

  4. For parsimony, we comment on the results only for panel B, but the conclusions hold for panel A.

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Correspondence to Thomas Rapp.

Appendices

Appendix A

Detail description of similar jobs

See Tables 5 and 6.

Table 5 ISCO-88 and ISCO-08 concordance
Table 6 NACE and NACE (rev.2) concordance

Appendix B

Self-perceived health for panels A, B and C

See Fig. 2.

Fig. 2
figure 2

Self-perceived health distributions of panels A, B and C. The two top graphs (panel A) show the self-perceived health distributions for our group of interest (left chart), composed of long-term care and similar workers, and our first comparison group (right chart), composed of all remaining workers. The middle graphs (panel B) reproduce the distributions for long-term care jobs (left chart) and for similar jobs (right chart). The bottom graphs (panel C) describe the distributions for the LTC workers (left chart) and for personal care workers and nurses practising in hospital settings (right chart). Source: GSOEP, v35 (1995–2018). Skewness (S) and Kurtosis (K) descriptives, with Kolmogorov-Smirnov (KS) tests: Panel A: (a): S = − .80; K= 3.42 ; KS test = 0.0940*** (b): S = − .77; K=3.31 ; KS test = 0.0881***; Panel B: (c): S = − .83; K= 3.46 ; KS test = 0.0832*** (d): S = − .75; K = 3.25 ; KS test = 0.0901***; Panel C: (e): S= − .80; K = 3.35 ; KS test = 0.0833*** - (f): S = − .57; K = 2.94 ; KS test = 0.0787***

Appendix C

Sensitivity analyses

See Tables 7, 8, 9 and 10.

Table 7 Main results with a non-dynamic FE model
Table 8 Main results with a CRE specification
Table 9 Main results with a non-dynamic CRE specification
Table 10 Probability of reporting poor health for the three panels

Appendix D

Stratified analyses—Panel A

See Tables 11, 12, 13 and 14.

Table 11 Impact of long-term care jobs by education level
Table 12 Impact of long-term care jobs by employment status
Table 13 Impact of long-term care jobs on health for women and for German citizens
Table 14 Impact of long-term care jobs on health—before and after nomenclature change

Appendix E

Stratified analyses—Panel B

See Tables 15, 16, 17, and 18.

Table 15 Impact of long-term care jobs by education level
Table 16 Impact of long-term care jobs by employment status
Table 17 Impact of long-term care jobs for women and for German citizens
Table 18 Impact of long-term care jobs on health—before and after nomenclature change

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Rapp, T., Ronchetti, J. & Sicsic, J. Are long-term care jobs harmful? Evidence from Germany. Eur J Health Econ 22, 749–771 (2021). https://doi.org/10.1007/s10198-021-01288-y

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  • DOI: https://doi.org/10.1007/s10198-021-01288-y

Keywords

  • Long-term care
  • Workforce
  • Health

JEL codes

  • I19
  • J14
  • J28
  • J81