Can Iceland Make Care Work More Attractive? Pay, Skills, Status and Workforce Innovation

Care services do not compete only with one another for workers. A person considering employment in an Icelandic nursing home, home-support team or disability service can also choose hospitality, retail, administration, tourism, transport or another public service. A licensed practical nurse may compare long-term care with hospital employment. A support worker may enjoy the human value of care but still leave if hours, progression or workload are better elsewhere. Recruitment therefore begins much earlier than the vacancy advertisement: it begins with whether care work itself is attractive enough to choose and sustainable enough to stay in.

This question sits at the heart of the workforce analysis within the Iceland Ageing, Long-Term Care & Community Support Knowledge Hub. Iceland is ageing, home-based care is expected to support more people with complex needs, nursing homes require increasingly skilled teams, and a small labour market means health, welfare and other industries compete for many of the same workers.

Recent Icelandic collective bargaining also shows that the value attached to care work is not an abstract policy issue. Agreements covering parts of the public and welfare workforce run into 2028, while changes agreed for nursing-home employees in 2025 included additional wage increases, greater recognition of responsibility in selected roles, increased availability of professional courses and work towards reassessing the value attached to jobs.

The strategic challenge is therefore broader than raising pay or expanding training separately. Iceland needs an employment model in which compensation, skills, status, management, working conditions and progression reinforce one another strongly enough to make care a credible long-term career.

Attractiveness is a system property, not a recruitment campaign

Care organisations often experience workforce difficulty first as vacancies. That makes recruitment the visible response: advertise more widely, recruit internationally, offer additional shifts or accelerate hiring.

But repeated vacancies can be the final symptom of a much larger employment problem.

If people join and leave within a year, attraction has succeeded while retention has not. If experienced workers remain but discourage friends from joining, organisational reputation is weakening the future pipeline. If support workers gain considerable competence without any corresponding development in role or pay, the sector can train people for careers elsewhere.

The attractiveness of care work therefore reflects a combination of factors:

• pay and predictability of earnings;
• working time, shift patterns and workload;
• the level of skill and responsibility recognised within the role;
• access to education and career progression;
• quality of leadership, supervision and team culture;
• social and professional status; and
• whether technology and job redesign make work better or simply faster.

No single intervention can compensate indefinitely for weaknesses across the rest of the employment proposition.

Pay matters because workers compare care with real alternatives

Care work is sometimes discussed as though vocational motivation reduces the importance of pay. In reality, meaningful work and fair compensation are not alternatives.

Workers need income sufficient to sustain housing, transport, family life and participation in Iceland's wider economy. Shift work, evenings, weekends and emotionally demanding responsibilities also influence how employees judge whether compensation reflects what the role requires.

Collective bargaining is therefore central to Iceland's workforce architecture. Many public and welfare employees work under negotiated collective agreements between unions and public or welfare-sector employers, with agreements commonly specifying salary scales, working conditions, allowances and other employment terms.

For example, the current collective agreement covering licensed practical nurses employed by municipalities runs from January 2025 to March 2028. Other municipal public-service agreements also extend into 2028. These multi-year arrangements provide a degree of predictability while allowing agreed mechanisms to reflect wider labour-market developments.

That wider comparison matters. Public-sector agreements have included mechanisms intended to prevent wages falling materially behind broader labour-market development. In a country with a highly active labour market, care cannot be considered attractive in isolation from what workers can earn elsewhere.

The fair work and responsible employment question is therefore directly connected to long-term care capacity. Sustainable pay is not only a labour-relations issue; it affects whether services can recruit and retain enough people to deliver public policy.

The 2025 nursing-home dispute exposed the importance of perceived job value

One particularly relevant development concerned employees working in nursing homes under the agreement between Efling and Samtök fyrirtækja í velferðarþjónustu, the Association of Companies in Welfare Services.

A dispute over implementation developed during 2025. A resolution later that year maintained the agreement through March 2028 while introducing additional changes. Wage increases for nursing-home employees varied according to factors including occupation, seniority, education and responsibility. The agreement also expanded the role of certain supervisory job titles within institutional arrangements, increased the availability of professional courses and initiated further work on job-value assessment.

The detail matters because it illustrates several dimensions of attractiveness operating together.

Employees were not only negotiating the amount appearing on a payslip. The settlement also touched education, responsibility and the value formally attached to different kinds of work.

This is an important strategic lesson. Care work becomes more attractive when increased skill and increased responsibility can be recognised visibly rather than accumulated informally without progression.

Operational scenario: higher pay improves recruitment but not the job

A nursing home experiencing repeated vacancies introduces improved compensation for difficult-to-fill shifts. Applications increase and several new employees join the service.

Six months later, turnover remains high.

Exit conversations show that pay helped people choose the job, but it did not determine whether they stayed. Employees report unpredictable rota changes, limited feedback from managers and little clarity about how a competent support worker can progress into a more advanced role.

Experienced staff are also frustrated that they routinely coach new employees and carry additional responsibility without formal recognition.

The home changes its workforce strategy. Pay remains important, but management introduces clearer role expectations, structured supervision and development routes. Experienced workers can move into recognised mentoring or senior responsibilities where the operating model supports them. Training is linked to demonstrable competence and future opportunity rather than simply mandatory completion.

Turnover does not disappear, but the employment proposition becomes more coherent.

The scenario demonstrates why salary alone cannot make care work attractive. Pay may open the door; the experience of the job determines whether people continue walking through it.

Job evaluation can make invisible responsibility visible

Many care roles contain responsibilities that are easy to undervalue because they are embedded in everyday interaction.

A support worker may recognise subtle deterioration in someone with dementia, de-escalate distress, provide intimate personal assistance, communicate with relatives, follow complex safety procedures and make repeated judgements about when professional help is required.

These tasks can appear routine because skilled workers perform them calmly.

Formal job evaluation can therefore matter. Where pay structures assess responsibility, knowledge, complexity and working conditions accurately, they help make visible what care work actually requires.

The challenge is to avoid job descriptions becoming static while the service model changes around them.

As people remain at home with more complex health needs and nursing-home residents require more intensive support, roles that were previously defined around relatively basic assistance may absorb greater responsibility.

Periodic reassessment of job content becomes part of workforce sustainability because workers are unlikely to view ever-expanding expectations as fair if role status and reward remain unchanged.

Status is partly produced by how care work is described

Public discussion often sends contradictory messages about care workers.

During periods of workforce pressure, they are described as essential. In everyday workforce structures, many roles may still be treated as relatively low-skilled because they do not require a long professional degree.

Those descriptions are difficult to reconcile.

Not every care role is a regulated profession, and qualifications need to remain proportionate. But work can be skilled without being professionally licensed.

Communication, observation, risk recognition, emotional regulation, dementia support and relationship-based practice all develop through training and experience.

The wider workforce assurance challenge is to distinguish appropriately between regulated professional judgement and substantial frontline competence. Recognising the latter does not blur professional boundaries; it creates a more accurate account of how long-term care actually works.

Education can make care a career rather than a temporary job

Iceland already has several educational pathways that can contribute to a more developed care workforce.

Licensed practical nurses have formal professional education and national licensing, and further university-level development is available in specialist fields. The University of Akureyri, for example, offers additional vocational university education for licensed practical nurses, including specialisations designed to strengthen clinical competence, professionalism, communication and management skills.

Other professional groups working across welfare services also have opportunities for postgraduate development. Social educators, whose work can be important within disability services, can pursue further study focused on areas such as self-determination, support for people with significant needs and the education of non-specialist staff.

For workers entering care without formal healthcare qualifications, structured workplace education can also strengthen capability. Landspítali's caregiver training resources illustrate one approach: theoretical learning is combined with discussion, practical demonstration, supervised practice, progress tracking and final confirmation of completion.

The important element is the connection between learning and work.

The broader principle of continuous professional development becomes much more powerful when employees can see what greater competence enables them to do next.

Training without progression can unintentionally accelerate turnover

Education does not automatically improve retention.

If workers develop skills but the organisation offers no route to greater responsibility, recognition or earnings, training can simply make them more employable elsewhere.

This does not mean employers should restrict learning to protect retention. It means career architecture needs to develop alongside education.

A support worker might progress through increasingly complex roles, become a recognised mentor, specialise in dementia or rehabilitation support, undertake further formal education or move towards a regulated profession where admission requirements permit.

Not every employee will want progression. Some value expertise within a stable frontline role. That expertise should also be recognised rather than assuming career development always means leaving direct support for management.

The stronger workforce model creates both vertical and lateral development.

Vertical progression increases responsibility. Lateral progression creates deeper specialist competence while allowing the worker to remain close to people receiving care.

Operational scenario: a capable care worker can see no future in care

A 24-year-old employee joins a municipal home-support service after initially expecting to work there for a year. She proves particularly skilled at supporting older people with cognitive impairment and is frequently asked to help newer colleagues.

Three years later, she remains on broadly the same role structure.

She has completed internal training and carries informal responsibility, but cannot see what the additional competence leads to. Friends working elsewhere have clearer promotion routes, and she begins considering leaving the care sector altogether.

The municipality reviews the problem as part of wider leadership and workforce development. Rather than creating managerial titles simply to retain people, it maps the capabilities actually required in future home support.

A pathway is developed through which experienced workers can gain recognised responsibility for mentoring, dementia-informed practice and aspects of service coordination while remaining within appropriate role boundaries. Further education is signposted where employees want to move towards licensed practical nursing or another profession.

The worker chooses to remain and takes on a recognised development role.

The lesson is not that every employee needs promotion. It is that capable workers need to be able to imagine a future inside care. Where the only obvious route to progression is leaving, the sector effectively exports the people it has invested in developing.

Management quality is part of the employment proposition

People rarely experience an organisation through its workforce strategy document. They experience it through shifts, supervisors, colleagues and the way managers respond when work becomes difficult.

This makes frontline leadership central to attractiveness.

A worker who feels listened to after a challenging incident, receives constructive supervision and trusts managers to address unsafe workload has a different employment experience from someone on the same salary whose concerns disappear into the organisation.

Management quality also influences fairness. Rotas, annual leave, overtime allocation, access to training and responses to sickness can all strengthen or undermine trust.

In small services, one poor manager can affect a significant proportion of the workforce. Conversely, a strong team leader can stabilise a difficult-to-recruit service because workers value the environment they create.

Attractiveness therefore cannot be separated from leadership development.

The Governance Maturity Assessment can help organisations examine how leadership, accountability, escalation and organisational assurance connect. It is not an Icelandic employment standard, but its relevance lies in testing whether workforce concerns reach decision-makers early enough for the operating environment to change.

Predictable work can matter as much as headline pay

Care services often require evenings, weekends and sometimes overnight work. Those requirements cannot simply be designed away.

But predictability can be improved.

Workers trying to organise childcare, education, family responsibilities or a second income may find late rota changes particularly difficult. A theoretically flexible workplace can become less attractive if flexibility works mainly in favour of the employer.

Home-care scheduling creates additional challenges because demand changes and travel affects capacity. Nursing homes face sickness cover and twenty-four-hour staffing requirements.

The question is therefore not whether every shift can be fixed months in advance. It is whether uncertainty is distributed fairly and whether staffing models are robust enough to prevent chronic last-minute disruption.

This connects with safe staffing and deployment. A rota is not sustainable simply because every shift is eventually filled. The method used to fill it may be producing exhaustion, turnover or excessive dependence on a small group of employees.

Workforce wellbeing cannot be reduced to resilience training

Care work involves emotional exposure that many other jobs do not.

Employees witness deterioration, distress, bereavement and changing family relationships. They may experience aggression or emotionally difficult situations. Home-care workers operate alone for significant parts of the day. Nursing-home staff form relationships with people whose health may decline over years.

Supporting wellbeing therefore requires more than teaching employees to cope better with difficult conditions.

Workload, staffing, supervision, recovery time and organisational response all matter.

The staff wellbeing and engagement principle becomes strongest when organisations use employee experience as operational evidence.

If repeated staff feedback identifies insufficient time between visits, unsafe lone-working conditions or excessive overtime, the response should examine the work rather than simply offer additional wellbeing resources.

Psychological support can be valuable. It should complement, not substitute for, a sustainable operating model.

Operational scenario: overtime is concealing a retention problem

A home-care team appears to have manageable vacancy levels. Service delivery remains stable and most scheduled visits are completed.

Closer analysis shows that a group of experienced employees are routinely working additional hours to cover gaps. Because the same staff volunteer repeatedly, managers have regarded the arrangement as flexible and successful.

Sickness begins to rise. Two of the most experienced workers then indicate that they are considering leaving because they feel permanently responsible for protecting the rota.

The organisation stops treating overtime as neutral capacity.

Workforce information is redesigned to show repeated additional hours, concentration of overtime among individuals, annual-leave disruption and changes in sickness alongside vacancy and turnover.

The Predictive Workforce Risk Module can support organisations examining comparable patterns by connecting staffing pressure with retention and continuity risk. It is not an Iceland-specific workforce instrument, but the principle is useful: apparent capacity may sometimes be borrowed from the future wellbeing of the existing workforce.

The service recruits and redesigns some scheduling arrangements before losing its core employees. The intervention is more effective because workforce pressure becomes visible before turnover records it retrospectively.

Professional status should not require leaving frontline care

Many care systems create an unintended hierarchy in which greater status comes primarily from moving away from direct support.

A highly experienced frontline worker becomes a supervisor, then manager, because those are the routes associated with advancement. The service can lose excellent practice in order to create career progression.

Iceland has an opportunity to value advanced frontline capability more deliberately.

Experienced practical nurses, care workers, social educators and other staff can contribute to mentoring, quality improvement, rehabilitation, dementia care and complex support without every development pathway ending in administration.

Role design should therefore recognise expertise as well as hierarchy.

This can strengthen both status and service quality. New employees gain visible role models within frontline practice, while experienced workers can build careers without abandoning the work that originally attracted them.

Workforce innovation should improve jobs, not merely increase throughput

Innovation is often presented through technology, but workforce innovation is wider.

It can include different role combinations, self-organising teams, multidisciplinary working, redesigned shifts, protected development time, improved supervision and administrative simplification.

The test should be whether innovation improves both service outcomes and the experience of delivering care.

A productivity intervention that increases the number of visits per employee while making every shift more rushed may damage attractiveness. A digital process that removes duplicate documentation can improve it.

The distinction is fundamental.

Care is relational work. Productivity should therefore remove friction around the relationship rather than continually compress the relationship itself.

Technology can make care work more attractive when it removes low-value burden

Iceland's strong digital infrastructure creates considerable scope to redesign work.

Mobile access to electronic records can reduce the need for community staff to return to an office simply to document activity. Digital scheduling can improve route planning. Automated medication support can remove selected routine interventions. Remote specialist consultation can reduce professional isolation in rural teams.

These developments can improve employment quality when they give workers better information and more time for meaningful activity.

They can have the opposite effect if technology becomes another layer of monitoring, alerts and documentation.

A poorly designed digital system may require staff to record the same information repeatedly. Algorithmic scheduling may optimise travel while disregarding continuity. Remote-monitoring technologies may generate large numbers of alerts that staff must process without removing other responsibilities.

The wider principles of automation and workflow design therefore matter directly to workforce attractiveness.

Organisations considering significant technology-enabled job redesign can use the Digital Transformation Readiness Assessment to examine whether digital systems, workforce capability, governance and workflow are aligned. The tool is not an Icelandic technology standard; its relevance lies in testing whether technology actually improves the operating model rather than merely digitising existing burden.

Operational scenario: digital scheduling increases productivity and makes the job worse

A municipal home-support service introduces new scheduling software. The system identifies opportunities to reduce travel gaps and fit more visits into each shift.

Initial performance figures are positive. Travel time decreases and the number of completed contacts per worker rises.

Within several months, staff feedback reveals a different picture.

The algorithm frequently allocates unfamiliar workers because geographic efficiency is weighted more heavily than continuity. Short gaps that previously gave employees time to catch up after complex visits disappear. Workers feel that every delay now puts the remainder of the route behind schedule.

People receiving support also report seeing more unfamiliar staff.

The municipality recalibrates the model. Continuity becomes an explicit scheduling factor, buffers are retained for selected high-complexity visits and employee feedback is reviewed alongside productivity data.

The system still reduces avoidable travel, but it no longer treats every minute outside direct contact as waste.

The scenario demonstrates why workforce innovation needs balanced evidence. An intervention can improve an efficiency metric while weakening the job sufficiently to create future retention problems.

Care workers should help design workforce innovation

Employees usually understand sources of unnecessary work with exceptional clarity.

They know which information is entered twice, which handovers add value, where travel planning creates inefficiency and which tasks routinely consume professional time without improving care.

Innovation designed without frontline involvement can therefore miss obvious opportunities or create unintended burden.

The principles of co-production and lived experience can be extended carefully into workforce redesign by recognising staff experience as implementation evidence alongside the voices of people receiving services.

The two perspectives should not be treated as competing interests.

People using care benefit from workers who have enough time, information and continuity to support them well. Employees benefit from systems that remove avoidable work and give them greater confidence that they can deliver the standard of care expected.

Migration strengthens supply but should not become the low-cost route into care

International workers are increasingly important to Iceland's care economy. Their contribution can support recruitment and bring valuable experience into services.

But a sector seeking to become more attractive cannot rely on migrant labour to accept employment conditions that domestic workers reject.

Workers arriving from abroad need the same opportunities for fair pay, predictable work, language development, training and progression as colleagues born in Iceland.

If internationally recruited employees become concentrated permanently in the least desirable shifts or lowest-status roles, care organisations may fill vacancies while entrenching a divided workforce.

Conversely, if migration is linked with genuine career pathways, it can strengthen the future professional pipeline. Internationally recruited workers can develop into experienced care staff, licensed practical nurses, registered professionals, supervisors and leaders.

The employment model should make that future visible.

Rural areas need a broader definition of an attractive job

Pay and career structure matter everywhere, but employment attractiveness in rural Iceland can depend on factors beyond the workplace.

Housing availability, transport, professional isolation, employment opportunities for partners and access to education can all influence whether people accept and remain in a role.

A small municipality may therefore struggle even when salary is comparable with a larger urban employer.

This changes what workforce innovation looks like.

Remote education can make progression possible without relocation. Regional specialist networks can reduce professional isolation. Shared posts may provide broader career experience. Predictable scheduling can make long travel more manageable.

Where housing is a significant local constraint, workforce planning may also need to connect with wider municipal development rather than treating accommodation as wholly separate from essential-service capacity.

Rural recruitment is strongest when the proposition answers not merely “Why take this job?” but “Can I build a viable life here?”

Quality improvement can increase professional pride

Attractiveness is also shaped by whether workers believe they are able to do good work.

Chronic understaffing, repeated service failures or unresolved safety concerns can erode professional pride even where pay is competitive.

Conversely, employees who see their ideas influence practice and see measurable improvements in outcomes can experience greater ownership of the service.

This gives embedding learning into everyday practice a workforce dimension.

Incident reviews, complaints and quality data should not be experienced solely as mechanisms for identifying error. They can show teams where change has worked and provide evidence that skilled practice matters.

The Quality Dashboard Builder can help organisations bring workforce and outcome information together so that staffing decisions can be understood through their effect on quality as well as cost.

When employees can see the connection between their work and meaningful outcomes, status becomes something experienced internally as well as awarded externally.

Employers need to know what different workers value

There is no single care workforce.

A student working part time may value flexible shifts. A parent may prioritise predictability. An experienced practical nurse may want professional development. An internationally recruited employee may value language support and recognition of prior qualifications. An older worker may need adjustments that make a physically demanding role sustainable.

A uniform employment proposition will not respond equally well to all of them.

Workforce data should therefore be combined with employee engagement rather than assuming that the cause of turnover is obvious.

Useful questions include:

• why applicants choose one employer over another;
• why new starters leave during their first year;
• what experienced staff say makes them stay;
• which workers use development opportunities and which do not;
• whether particular shifts or teams experience repeated turnover; and
• whether job redesign improves both service outcomes and employee experience.

The objective is not to personalise every contract individually. It is to understand whether the employment model is flexible enough to compete for a changing workforce.

Governance should measure the strength of the employment proposition

Senior leaders can easily receive vacancy, sickness and turnover figures. Those are important but largely describe the consequences of the employment environment.

Stronger workforce governance also monitors leading indicators.

Are employees able to access training? Are supervisors holding meaningful developmental conversations? Are overtime levels becoming concentrated? How many staff move into more skilled roles? Are newly recruited employees still present after twelve or twenty-four months? Does one manager or location have persistently different retention?

Pay also needs context. Wage increases can improve attractiveness while workload or housing costs continue to erode their practical effect.

Governance should therefore assess workforce strategy as a connected system rather than reviewing compensation, recruitment, training and wellbeing through separate organisational channels.

The strongest question is whether care is becoming more attractive relative to workers' alternatives, not merely whether individual initiatives have been completed.

Making work more attractive can increase capacity without increasing headcount immediately

The relationship between attractiveness and service capacity is often underestimated.

A service that reduces turnover retains experience. Better progression increases competence. Improved management can reduce avoidable sickness and conflict. Better scheduling can reduce wasted time. Technology can remove administration. Predictable work can increase willingness to accept contracted hours.

These improvements do not create unlimited capacity, and demographic change will still require additional workers.

But they reduce the amount of recruitment needed merely to replace people already lost.

This is particularly important in Iceland because the total labour pool is limited. The sector cannot rely on continually finding large numbers of new workers while avoidable attrition continues.

Retention and job quality are therefore forms of capacity creation.

The future care career may need a clearer skills ladder

Iceland's future workforce could benefit from a more visible continuum between entry-level care work, experienced support roles, licensed practical nursing and other professional pathways.

The exact architecture will depend on Icelandic education, union and professional arrangements, and should not blur regulated scopes of practice.

But the underlying direction is important.

A worker entering care should be able to see what skills they can develop, which qualifications are available, what responsibility those capabilities enable and how progression is recognised.

Microcredentials, part-time study, workplace learning and blended education may increasingly help people develop while remaining employed.

Employers also need to value experienced workers who do not pursue formal academic routes but demonstrate substantial practical competence.

A mature skills ladder therefore contains both qualification and capability, with clear boundaries around regulated professional practice.

International learning: care sectors compete through job quality as well as pay

Iceland's collective bargaining arrangements, small labour market and welfare institutions are specific to the country. Another system could not simply reproduce its agreements or workforce structures.

The transferable lesson lies in seeing attractiveness as a combined employment proposition.

Countries frequently respond to care shortages by increasing recruitment funding while leaving job design largely unchanged. That approach can fill vacancies temporarily while turnover continues to recreate them.

Pay matters significantly, but its effect is strengthened or weakened by management, working time, status, development and the ability to deliver good care.

Other systems can adapt the principle without copying Iceland's mechanisms: workforce sustainability improves when policy asks not only how to recruit more people into care, but why a capable person would choose to remain there for ten or twenty years.

Conclusion

Iceland cannot recruit its way out of every future care workforce pressure. A small labour market, population ageing and growing complexity mean long-term care will continue competing intensely for workers with healthcare and the wider economy. International recruitment can widen supply and education can build new professional capacity, but neither will be enough if experienced employees continue to leave because the employment proposition is weak.

Making care work more attractive therefore requires several elements to move together. Pay must remain credible against alternative employment. Job evaluation needs to recognise changing skill and responsibility. Training should connect with visible progression. Frontline expertise needs status without forcing good practitioners into management. Rotas, supervision and wellbeing need to make long careers realistic rather than merely possible. Technology and workforce innovation should remove low-value burden rather than compress human care into ever tighter schedules.

Recent Icelandic collective bargaining already points towards this broader agenda by linking compensation with education, responsibility and job value. The stronger opportunity is to turn those principles into a sustained workforce model across long-term care and community support.

The strategic test is simple but demanding: can a person enter care, develop, earn fairly, be respected for their expertise and still want to remain years later? If Iceland can make the answer increasingly yes, workforce attractiveness becomes more than an employment objective. It becomes one of the country's most important forms of long-term care infrastructure.