Post-basic education training,age and gender of healthcare workers for elderly patients in Germany and Canada: A comparison

1 Introduction

A healthcare worker is a broad term referring to an individual who provides paid care to other individuals. The dictionary defines carer as an unpaid or paid person who helps a patient with daily living activities [1]. The term carer is used in Europe and Australia, and caregiver is used in North America and China. Burau, Theobald and Blank [2] explained that care workers have an occupational status they are also known as personal and home care aides, companion, and caregivers. The carers work for family, children, young people, adults, and elderly in various care situations. The unpaid carers or caregivers are relatives, friends, or neighbors and seek no professional training or educational qualifications. In other contexts, paid care workers are called care assistant, personal care attendant and carer; they are also informally referred to as contracted carers. The paid carer would have four to five clients at a time, which requires that they carefully block their time between clients.

The paid carers or personal care attendants help clients with disabilities, chronically ill or cognitively challenged people. Some healthcare workers simply assist recently discharged patients with short-term needs. In many cases, these care workers care for their clients in their homes, or in home-like settings [3]. Healthcare workers are generally employed in different sectors of the healthcare system, such as hospitals, home-based care, or residential care.

Healthcare workers are the backbone of the healthcare system. They play a key role in providing health and social care services in hospitals, home healthcare, or nursing home environments. As worldwide population ages, healthcare workers increasingly deal with elderly patients’ psychological and social needs [4]. More likely the healthcare systems in countries like Canada and Germany, will face significant challenges in meeting the demands of their aging population.

Canada and Germany are two interesting countries in the way they provide healthcare. Both have a socialized healthcare system, both have an aging population, and both face a crisis in human resources needs to support their aging population. Also, both countries lack the trained healthcare workers needed to meet the growing demand for health clients, minifying the quality of care especially among the elderly [5].

2 Methods and data

Data was drawn from the German Socioeconomic Panel [24] and the Canadian Survey of Labor and Income Dynamics [25]. The German Socioeconomic Panel is a wide-ranging longitudinal survey of private households. Since 1984 the Panel’s data have been collected annually through interviews of the same respondents [26]. The German Socioeconomic Panel uses a systematic sampling technique and has accrued 24,481 data responses from year 1998 using a computer-assisted interview questionnaire. Responses were obtained from the three healthcare workers: nurses, elder carers and care assistants. The total number of healthcare workers from the German Socioeconomic Panel dataset came to 571 healthcare workers, including 219 nurses, 231 elder carers and 121 care assistants.

For comparative purposes, we used similar data from the Canadian Survey of Labor and Income Dynamics. However, unlike the German Socioeconomic Panel, the Canadian national survey sample was cross-sectional, and accrued data based on a stratified sample and a multistage design that uses probability sampling [27]. The sample from the Canadian Survey of Labor and Income Dynamics data was collected based on a questionnaire designed for computer-assisted telephone interviews [27]. The Canadian Survey of Labor and Income Dynamics accrued a total of 49,787 responses from “Care Workers” those being: “1” = Nurses, “2” = Elder Carers and “3” = Care Assistants. The Canadian dataset comprised 2,580 healthcare workers from the original 49,787, including 947 nurses, 493 elder carers and 1,140 care assistants.

3 Results

The sociodemographic data of healthcare workers include age, gender, employment status, salary, employment status, salary earnings, education, and training. The independent variables of age, gender, and basic educational training as the independent variables. A logistic regression was performed using employment status and earnings as the dependent variables.

This study explored the relation between sociodemographic variables of age, gender and training (educational and professional) on employment status. Considering the main findings, the results showed that German healthcare workers age and further training was directly related to employment, that with increased years of training i.e., experience, the more likely Germans healthcare workers (nurses, elder carers and care assistants) will be employed. However, when it comes to wages, the German sample of healthcare workers, maybe ambivalent in taking up further training on the job or outside, because many may find out that when their advanced training has been completed, their wages do not significantly improve, which might indicate that annual wage increase may be due to overtime work, thus leaving little time to pursue further professional training. It is well documented that increased post-basic training is concomitant with pay increase leading to positive incentive for healthcare workers [32]. But, when such training comes at the cost of an increased workload, it might have adverse impact on the continuation of work in the healthcare system. In many studies, it is shown that the high turnover rates among healthcare workers have substantive implications for the services provided for the elderly clients, but also for the working conditions of the remaining staff in the same institution. Those remaining staff are shorthanded and overworked, leading to a number of human errors in drug administration, social and physical support for the elderly; thus, diminishing morale in the workplace and subsequently leading many healthcare workers to leaving the profession [33].

Elder carers and care assistants further training results showed the strong relation of annual income, these results may include income due to overtime for both Canadian and German samples. The Canadian sample data analysis showed that with increased years of experience, nurses earnings did not increase over a 10-year period, but did for elderly healthcare workers and nurse assistants. Even with an increase in age, there was no increase in salary, which could be demoralizing for many of the healthcare workers and leave the possibility of quitting the job. However, the German sample results indicate that although training among nurses and elder carers had no impact on monthly wages, a statistically significant relationship with annual wages was shown. This relationship might not exclude such factors as further training and suggests that increased earnings with years of training and further professional development, maybe a moral motivator to impute quality health services with existing prerogatives to retain healthcare workers in the health system.

For both Canadian and German healthcare workers’ annual income increase may be due to overtime work as a top-up of their monthly salary. While desired by many healthcare workers, studies however have shown that working overtime lowers the probability of remaining employed [34] and thus the healthcare worker leaving work altogether. While the effect of ‘overtime’ confirms previous peer reviewed research on nurses and doctors, that in addition to arduous working hours and commuting time, overtime adds another burden for healthcare workers’ having to extend their work hours leading many healthcare workers (namely, healthcare workers for elderly patients) to discontinue training.

Healthcare organizations might also find it financially difficult to support training for staff. While desiring to maintain the regiment of work for their staff, caring for elderly patients in a custodial setting, healthcare workers are restricted in their movement, they have strict work hours and may have few opportunities for further training (see Table 5 for comparative findings between Canada and Germany of further training on employment status, monthly wages and annually earning). However, those who do enjoy such an opportunity, do so to advance their careers and to gain an occupational advantage and possibly leaving the practice of healthcare into more technical and administrative work [35].

Registered nurses in Canada and Germany have the privilege to further their educational training toward higher degrees; in particular, those with a bachelor’s degree or the basic educational qualification, could pursue a master’s or doctorate degree in nursing [35]. This opens opportunities for professional growth that leave many practitioner jobs open for novice and new entrants in the profession. When the demand of practitioners is not fulfilled, both countries Canada and Germany open their doors for foreign labor. This issue has made training in healthcare a requirement for the new entrants, especially for those foreign health care workers that may also need language training [36]. While the call to maintain standard practices in professional development to allow healthcare workers remain up to date with current knowledge in the field [37], it appears that Canada and Germany both lack the prerogatives and incentives for further training; stressing on the need for new policies, strategies, and planning in healthcare development to further improve the work conditions and professionalization of healthcare workers meeting the requirements of a new generation of elderly clients.

Overall, the findings in this study confirm the relationship between further training, employment, and increased annual wages. Given the relation between educational training with employment and wage-related variables. There may be other variables at play such as job satisfaction and attrition, all may have an indirect impact on quality care of the elderly. A well-trained and financially rewarded healthcare worker will no doubt offer professional and robust care for the elderly. In this context, health service managers and policy makers are advised to pay more attention to the importance of employees’ professional development and employment benefits as in wages.

Certain limitations of the study must be underlined in the data collected. As in much of the existing literature on the topic. The data obtained for the Canadian sample was cross-sectional and collected on an annual basis rather than being longitudinal. Cross-sectional studies may be biased because they only capture the current measure at the time of healthcare workers’ current service. Longitudinal data and its analysis follow through the healthcare workers overtime and give a fuller picture of healthcare workers characteristics. It is also worth mentioning that such data linked to patient care and sociodemographic information could provide rich and new knowledge on quality healthcare, especially for the care of elderly clients.

Last, an important and significant component of this study was the examination of the differences between the Canadian and German data on further training. Both nations’ healthcare systems face the same extenuating conditions, particularly in terms of further training and in linking that training to promotions and salary increases. Both countries are in front of a crossroads and a critical strategic decision in regard to healthcare policies and strategies. Both countries are in need for trained healthcare workers and demand supersedes that of supply. What strategies both countries may take can affect the quality of life of future elderly generations. Clearly any decisions made relies on the integration of the current research and findings, that elderly care must be professionalized and linked to a qualification system, instituting the highest standards of care through training and retraining and rewarded through salary and other job security incentives. Further, health related colleges and training organizations must strategize to increase or even double the size of students in areas of geriatrics and geriatric care.

Both Canada and Germany have somewhat fluid immigration rules for professionals, especially those in great demand. So, when there is a demand for healthcare workers the immigration doors are open to health professionals from developing nations. But what these policies are doing is depleting health professional and “good” health professionals from source countries other than Canada and Germany and mostly from nations of developing economies, both countries need to find grounded and long-term solutions that enact and effective healthcare services for elderly generations.

As a caveat, the data obtained were at the national level, perceived satisfaction data and quality care information have not been collected. Although such data and its analyses would be significant for policy makers in making better decisions on post-basic education and further training in the healthcare profession. Beyond the scope of this study, further analysis could explore the relationship between working time and wages and between professional development and wage satisfaction.

Conflict of interest

None to report.