Long-Term Care Workforce Challenges in Austria: Recruitment, Retention and Skills

Austria’s long-term care workforce challenge is often expressed through a simple number: how many additional care workers will be needed. The real operational question is more difficult. Which roles are required, in which regions, with what level of qualification, in which service settings, under what working conditions and with what likelihood that people will actually remain in the sector?

This question sits at the centre of the wider Austria Ageing, Long-Term Care & Community Support Knowledge Hub. The country’s ageing population is increasing demand while simultaneously reducing the relative size of the working-age population. Home and community services are expected to support people with higher needs for longer, residential facilities are increasingly caring for people with greater dependency and dementia, hospitals compete for many of the same nursing professionals, and family care cannot be assumed to expand indefinitely.

Austria’s updated national workforce projection illustrates the scale of the issue. Around 51,000 additional or replacement care and support workers are estimated to be required between 2023 and 2030 to maintain existing standards. Looking further ahead to 2050, the average requirement is around 7,000 additional or replacement workers each year, including approximately 5,800 nursing professionals and around 1,200 workers in other care roles.

Those figures are important, but they should not become the workforce strategy. Recruitment without retention can simply accelerate turnover. Expanding lower-level roles without sufficient supervision can move risk rather than create capacity. Increasing graduate numbers without regional planning may leave rural services short. Technology can remove administrative burden but cannot eliminate the human work of care.

The stronger challenge is to build a workforce system in which education, deployment, professional roles, leadership and working conditions evolve together.

Austria needs both expansion and replacement

The projected workforce requirement is sometimes interpreted as evidence that Austria needs tens of thousands of wholly new care jobs. In reality, the figure combines two different pressures: additional demand and replacement of workers leaving existing roles.

That distinction matters operationally.

Demographic ageing creates genuine additional need. More people are likely to require long-term support, while people already using services may live longer with increasingly complex conditions.

At the same time, parts of the existing workforce will retire, change professions, reduce working hours or leave because of workload and working conditions. Replacing those workers does not expand capacity; it prevents capacity from shrinking.

A service may therefore recruit continuously and still experience no net workforce growth.

This makes retention as important as entry. If a residential facility recruits ten workers but loses nine experienced employees during the same period, its recruitment campaign may look successful while organisational knowledge, supervision capacity and continuity continue to deteriorate.

The wider principles of workforce planning are therefore particularly relevant. Workforce strategy needs flows rather than snapshots: who enters, who leaves, who reduces hours, which roles are difficult to replace and how long newly trained staff remain.

Austria’s professional workforce contains several distinct roles

Long-term care is not delivered by one generic category of Pflegepersonal. Austria has a structured nursing and care workforce with different levels of qualification and legally defined scopes of practice.

Within nursing, an important distinction exists between the diplomierte Gesundheits- und Krankenpflegeperson, generally abbreviated DGKP, Pflegefachassistenz and Pflegeassistenz.

DGKP professionals hold the highest level of nursing responsibility within this structure. Their role includes assessment, planning, professional nursing responsibilities, coordination and activities requiring a higher level of clinical judgement.

Pflegefachassistenz, or PFA, represents an intermediate nursing role with a wider competence profile than Pflegeassistenz. Pflegeassistenz, or PA, supports nursing and medical care within a defined legal scope.

Austria also has Sozialbetreuungsberufe and Heimhilfe roles relevant to long-term support, with regulatory arrangements influenced by Land-level legislation as well as national frameworks.

The skill-mix question is therefore not merely how many employees are on duty. It is whether the correct combination of competencies is available.

As long-term care complexity increases, services need to distinguish tasks that genuinely require DGKP expertise from those appropriately performed by PFA, PA or other support roles. Poor skill-mix design can fail in two directions: highly qualified professionals may spend substantial time on tasks that could safely be undertaken elsewhere, while less-qualified workers may be expected to manage situations requiring professional assessment or escalation.

This makes safe staffing and deployment a capability question rather than a headcount exercise.

Training pathways are becoming more diverse

Austria has expanded pathways into nursing and care partly because a single educational route is unlikely to produce sufficient workforce supply.

Pflegeassistenz traditionally involves 1,600 hours of theoretical and practical training, generally completed over one year when undertaken full time. Pflegefachassistenz normally comprises 3,200 hours and takes around two years.

Since 2023, Austria has also introduced apprenticeship pathways in care as a time-limited Ausbildungsversuch. The Pflegeassistenz apprenticeship runs over three years, combining vocational school with practical learning in participating organisations. A Pflegefachassistenz apprenticeship provides a longer route into the higher assistant role.

The strategic significance extends beyond increasing training places.

Apprenticeships potentially bring younger people into care through a pathway that resembles other recognised vocational careers. This can help challenge the perception that care work is something people enter only later in life or after changing careers.

However, training supply only becomes workforce capacity if several conditions are met:

• enough people choose the courses;
• education providers have sufficient teaching and placement capacity;
• services can provide high-quality practical supervision;
• students complete their qualification;
• graduates enter relevant care roles;
• and those workers remain in the sector.

Expanding education therefore has consequences for operational services. Every additional trainee needs people able to teach, supervise and assess them. A workforce shortage can paradoxically make it harder to expand training because experienced workers have less time to support learners.

Operational scenario: recruitment targets expose a supervision bottleneck

A residential provider in Styria expands its intake of Pflegeassistenz trainees because vacancies have become increasingly difficult to fill. The recruitment campaign works well and the organisation attracts more learners than in previous years.

Within several months, a different problem appears.

The experienced staff expected to supervise learners are already managing high resident dependency, sickness absence and new admissions. Supervisory time is repeatedly squeezed between operational demands. Trainees receive inconsistent support and some begin questioning whether they want to remain in the sector.

Management initially interprets this as a student-retention problem. A closer review shows that the training expansion was not matched with protected practice-education capacity.

The organisation redesigns deployment so that supervision responsibility is explicit rather than assumed. Experienced staff undertaking the role receive time and development to support learners properly. The provider also begins tracking not just trainee numbers but completion, employment and twelve-month retention.

The lesson is important at national level. Training places cannot simply be counted as future workers. Education is a production system with its own capacity constraints.

Organisations examining similar workforce pipelines can use the Digital Twin Scenario Modeller to test how training expansion, supervisory capacity, vacancies and turnover interact. It is not an Austrian workforce-planning instrument, but scenario modelling helps expose dependencies that simple recruitment targets can miss.

Recruitment competition exists within care as well as outside it

Long-term care does not recruit from an isolated labour market.

Hospitals, residential facilities, mobile services, disability services and other health and care organisations may compete for people with overlapping qualifications. Workers can also leave the sector entirely for employment offering more predictable hours, less emotional pressure or better working conditions.

The implication is that workforce policy cannot treat each setting independently.

If hospital recruitment improves by drawing large numbers of experienced nurses out of residential care, one part of the health system may gain while another becomes less stable. If mobile services expand without additional workforce supply, residential and hospital staffing may tighten.

This is particularly important because Austria’s policy direction increasingly favours home and community support where appropriate. Expanding mobile care requires a workforce able to travel, work independently and manage complex situations in private homes.

That is not necessarily the same workforce profile as institutional nursing.

Recruitment strategy therefore needs to recognise differences in role attractiveness. Some staff value autonomy and daytime work in mobile services. Others prefer team-based institutional environments. Rural travel may discourage some workers while making local mobile-care employment attractive to others.

The broader recruitment agenda is therefore strongest when roles are designed around what workers value rather than marketed as identical jobs in different locations.

Retention is primarily an operating-model issue

Retention is often approached through benefits, wellbeing initiatives or recruitment branding. These can help, but workers ultimately experience the operating model every day.

Do staffing levels allow care to be delivered safely? Are shifts predictable? Is supervision useful? Can staff take leave without creating guilt or excessive pressure on colleagues? Are difficult incidents followed by support and learning? Is there time for meaningful interaction with residents and clients, or does work feel like permanent task completion?

These questions influence whether a career remains sustainable.

Care workers frequently enter the sector because they value relational work. If workload removes the time required for those relationships, job dissatisfaction can increase even where pay improves.

Retention therefore has a quality dimension. High turnover reduces continuity, consumes supervisory time, weakens team relationships and increases dependence on inexperienced or temporary workers.

The principles of staff retention should consequently be integrated with service design rather than delegated solely to human resources.

Operational scenario: a staffing shortage is really a retention problem

A mobile-care organisation in Lower Austria reports persistent vacancies and begins increasing recruitment activity. Advertising expenditure rises and several new employees are appointed.

Six months later, overall staffing remains almost unchanged.

A workforce review reveals that experienced staff are leaving at almost the same rate as new employees arrive. Exit feedback identifies recurring issues: long travel routes, late rota changes, insufficient recovery between difficult visits and frustration about administrative work completed after the working day.

The organisation therefore changes the question from “How do we recruit more?” to “Why does capacity leak out after recruitment?”

Routes are redesigned geographically, avoidable administrative steps are reduced and staff are involved earlier in scheduling decisions. The provider also differentiates between unavoidable travel associated with rural care and inefficient routing produced by poor planning.

Retention begins to improve.

The scenario demonstrates why vacancy numbers alone can misdirect management attention. A service may not primarily have a recruitment problem. It may have a work-design problem that recruitment continually masks.

Organisations exploring comparable patterns can use the Quality Dashboard Builder to connect vacancies, sickness, turnover, continuity and quality outcomes rather than reviewing each separately.

Pay matters, but workers experience the whole employment proposition

Pay is an obvious component of recruitment and retention, particularly in a labour market where care organisations compete with hospitals and other sectors.

Austria’s care workforce is influenced by collective agreements, Land-level arrangements, provider type and occupation. Reforms in recent years have included measures intended to improve pay and employment conditions in care professions.

Yet remuneration does not operate independently from workload.

A pay rise may improve recruitment but fail to retain staff if shifts remain unmanageable. Conversely, excellent team culture cannot indefinitely compensate for wages workers consider insufficient relative to responsibility and living costs.

The strongest workforce proposition combines several elements:

• fair and understandable remuneration;
• predictable scheduling;
• manageable workload;
• good supervision and leadership;
• development and career progression;
• meaningful professional autonomy;
• and a workplace culture in which difficult care is recognised rather than normalised.

This is why staff engagement and wellbeing should not become a substitute for adequate employment conditions. Wellbeing initiatives are strongest when built on a fundamentally workable job.

Part-time work changes the relationship between headcount and capacity

Care workforce data can be misleading if it focuses primarily on the number of people employed.

A sector may increase headcount while total available working hours grow much more slowly because many employees work part time. This is especially relevant in a female-dominated workforce where caring responsibilities outside paid employment can affect working patterns.

Part-time work is not inherently a problem. Flexible hours can enable people to remain in employment who might otherwise leave the sector entirely.

The workforce-planning challenge is simply to measure capacity accurately.

Ten employees working reduced hours do not provide the same staffing resource as ten full-time equivalents. The effect becomes especially important when services require night, weekend and holiday coverage.

Managers therefore need to understand not only contracted hours but availability by time of day and skill level. A service may appear fully staffed overall while struggling repeatedly to cover specific shifts requiring higher competence.

This is one reason why workforce assurance should include actual deployability rather than establishment numbers alone.

Older workers are both an asset and a planning consideration

Austria’s ageing population affects the workforce itself.

Experienced care workers hold organisational knowledge, professional judgement and supervisory capability that cannot be replaced quickly when they retire. Their departure may therefore create a larger operational impact than headcount data suggests.

At the same time, physically demanding care work can become harder to sustain across a long career.

Workforce strategy needs to consider how experienced staff can remain productive without assuming they must continue undertaking the same physical workload indefinitely.

Potential approaches include specialist practice roles, education, mentoring, coordination, assessment and leadership functions where these genuinely fit service needs.

This does not mean automatically moving every older worker away from direct care. Many value continued relationships with people using services. The stronger approach is flexibility across the career course.

Succession planning also matters. If several senior employees are likely to retire within a short period, services need to transfer knowledge and develop future leaders before vacancies occur.

The succession-planning agenda therefore belongs within long-term care workforce strategy, not solely senior management development.

Rural workforce problems are different from urban workforce problems

Austria’s geography creates significant regional variation in workforce supply.

Vienna and other urban areas have larger labour markets, training institutions and public transport networks. Rural and alpine communities may have smaller recruitment pools, longer travel times and greater difficulty replacing specialist staff.

Mobile services experience geography directly. Travel time reduces the number of visits a worker can complete during a shift. Bad weather can affect routes. A vacancy in a small local team may remove a substantial proportion of total capacity.

Residential facilities in rural areas face different pressures. A nursing home may have physical beds available but be unable to recruit enough qualified workers to operate them safely.

Regional workforce policy therefore needs more than national training totals.

Questions include where students train, where graduates take their first jobs, whether housing and transport influence recruitment, and whether rural roles offer sufficient professional development to retain staff.

Centralised specialist support may also help smaller services. Digital consultation, shared clinical expertise and regional practice networks can extend access to professional knowledge without requiring every location to employ every specialism permanently.

But technology cannot transport a worker into a home where physical care is required.

Operational scenario: nominal residential capacity disappears through vacancies

A district in Carinthia appears to have adequate nursing-home capacity according to its physical bed numbers. Demand nevertheless begins to exceed supply and hospital teams report difficulty finding placements for people with high levels of dependency.

A closer review shows that several beds across two facilities are temporarily unavailable because staffing vacancies make them unsafe to operate.

The region therefore has two different measures of capacity: licensed physical capacity and staffed usable capacity.

The distinction changes the planning response.

Building additional rooms would not solve the immediate problem. Recruitment, retention and skill mix become the priority. The facilities examine whether deployment can be redesigned, whether additional training pathways can be supported locally and which roles are creating the main constraint.

Regional planners also begin monitoring staffed capacity alongside nominal beds.

The issue then becomes visible as a workforce problem rather than an unexplained shortage of placements.

This illustrates the connection between workforce assurance and system capacity. Infrastructure exists only when the workforce required to operate it exists too.

Migration will remain part of Austria’s workforce strategy

Austria already relies on internationally mobile workers within 24-hour care and employs migrant workers across other health and care roles.

International recruitment can increase capacity and bring valuable skills. It can also help fill regional or occupational shortages that domestic training alone cannot address quickly.

But migration should complement rather than replace domestic workforce development.

Qualifications gained abroad may require recognition or Nostrifikation depending on where they were obtained and the profession concerned. For regulated nursing roles, formal recognition protects professional standards while creating an administrative pathway that workers need to navigate.

Language capability also matters because care relies on communication, documentation and clinical escalation.

The strategic risk is overdependence. If Austria assumes that shortages can always be solved through international recruitment, it becomes exposed to ageing populations, wage growth and workforce demand in the countries from which workers are recruited.

Ethical recruitment therefore requires both respect for worker mobility and investment in Austria’s own workforce pipeline.

Skill mix must evolve as care complexity increases

Long-term care is changing not only in scale but in complexity.

People are increasingly supported at home with needs that previously might have led to earlier institutional care. Residential residents may have greater frailty, dementia and multimorbidity. Hospital stays are shorter and transitions back into community settings can involve significant health needs.

This places greater importance on professional assessment, medication-related competence, recognising deterioration, dementia support and coordination with healthcare.

The workforce therefore needs greater capability even while the system seeks efficient deployment.

The answer is not to require every worker to become a nurse. It is to create a clear layered workforce in which people operate at the top of their appropriate competence and know when to escalate.

That requires supervision.

Delegating more work to assistant roles without sufficient DGKP oversight can create apparent productivity while increasing risk. Conversely, retaining unnecessarily restrictive role boundaries can waste scarce professional expertise.

Good skill-mix design is therefore dynamic. It asks what the people using the service now require rather than preserving staffing structures because they are historically familiar.

The wider principles of workforce skill and competence in older people’s services are directly relevant to this transition.

Leadership quality determines whether workforce reforms reach everyday practice

National reforms can expand education, improve funding and adjust professional roles. Workers experience those reforms through local leadership.

A well-led service can use limited workforce capacity intelligently. Managers monitor workload, respond early to absence, protect supervision and involve staff in improvement. Poor leadership can intensify shortages by driving experienced employees away.

Front-line leadership is especially important because care work involves uncertainty. Staff need someone who can make decisions when needs change, resolve conflict and support proportionate risk-taking rather than relying on rigid rules.

Leadership development should therefore not be confined to senior executives.

Team leaders, nursing leads and operational managers shape whether staff feel supported and whether workforce concerns become visible before they become resignations.

Organisations examining comparable leadership arrangements can use the Governance Maturity Assessment to test whether workforce information reaches the level where decisions can be taken. It is not an Austrian regulatory framework, but the underlying question is relevant: can local experience influence organisational strategy?

Absence and sickness reveal workforce resilience

A service can meet its funded establishment and still be fragile.

If safe operation depends on every employee being available for every planned shift, ordinary sickness, leave or training will immediately destabilise the rota.

Resilience therefore requires some ability to absorb predictable variation.

Persistent overtime can create the appearance of resilience while actually increasing future sickness and turnover. Similarly, repeatedly asking part-time workers to add hours may solve individual shifts while undermining retention.

Good workforce planning distinguishes temporary pressure from structural understaffing.

Data should help identify whether particular teams, shifts or service types experience recurring gaps. If night shifts are consistently difficult to fill, the solution may involve pay, job design, skill mix or recruitment rather than general advertising.

This connects with workforce resilience and continuity. Resilience is not the absence of disruption. It is the ability to absorb disruption without systematically transferring excessive pressure to existing staff.

Technology should remove low-value work before it attempts to replace care

Digitalisation is often presented as one answer to workforce shortage. Its strongest role is likely to be more targeted.

Care workers spend time on documentation, scheduling, travel coordination, duplicated data entry and communication between organisations. Better systems can reduce some of this burden.

Mobile documentation can allow records to be completed closer to the point of care. Automated scheduling can improve route efficiency. Interoperable records can reduce repeated collection of the same information. Telehealth can extend specialist input to rural teams. Artificial intelligence may support administrative drafting, translation and pattern recognition.

These are productivity opportunities because they release human time.

But digital systems can also increase workload if they create additional reporting, duplicate paper processes or generate alerts that staff must review without clear value.

Technology therefore needs a workforce-impact test.

The appropriate question is not “Can this task be digitised?” but “Does digitising it reduce burden, improve safety or expand useful professional capacity?”

Organisations examining technology readiness can use the Digital Transformation Readiness Assessment to consider workforce adoption, governance and implementation alongside technology itself.

The wider automation and workflow design agenda is particularly relevant where administrative redesign can release scarce professional time without reducing human contact.

Operational scenario: a digital system saves minutes but initially adds workload

A mobile-care organisation in Salzburg introduces digital documentation to reduce paperwork and improve access to care records.

The expected benefit is significant. Staff should no longer need to return to an office to complete parts of their documentation.

During implementation, however, workers are required to maintain parts of the old paper system while also entering information digitally. Connectivity is inconsistent in some rural areas and several staff are unsure how to correct errors.

For several months, documentation takes longer rather than less time.

Management reviews the implementation instead of concluding that staff are resistant to technology. Duplicate processes are removed, offline functionality is improved and practical training is delivered around real scenarios.

The system begins to generate the intended workforce benefit.

The lesson is simple but important. Digital productivity is not created by purchasing software. It emerges only when workflows change.

If Austria is to use technology as part of its response to labour shortage, implementation quality will matter as much as technical functionality.

Workforce quality needs better evidence than vacancy rates

Vacancies are important but incomplete.

A service with few vacancies may still have excessive turnover, low experience, high sickness or insufficient skill mix. Another organisation may carry several vacancies but maintain strong quality through stable core teams and careful deployment.

Austria’s national Pflegepersonal reporting creates an increasingly important evidence base by bringing together workforce indicators and updating them over time. This supports a shift from episodic workforce studies towards more continuous intelligence.

Useful measures include:

• vacancies and time to fill;
• turnover and destination of leavers;
• age profile and expected retirement;
• full-time equivalents as well as headcount;
• sickness and overtime;
• training intake, completion and retention;
• skill mix by service type and region;
• and relationships between workforce instability and care outcomes.

The final point is crucial.

Workforce metrics become most valuable when connected with the experience of people receiving care. Does turnover reduce continuity? Does understaffing increase delayed admissions? Does low supervision correlate with incidents? Are rural vacancies reducing access to home support?

The principles of data and quality metrics therefore apply directly. Counting staff is only the beginning of workforce assurance.

Workforce reform needs to protect the relational nature of care

Productivity pressure is inevitable where demand increases faster than labour supply.

But care cannot be redesigned as though all work were interchangeable units of activity.

Relationships contribute to outcomes. A worker who knows a person well may recognise subtle deterioration earlier. Familiarity can reduce distress for somebody with dementia. Continuity can make personal care less intrusive.

Removing all apparent inefficiency can therefore create hidden quality losses.

The stronger opportunity lies in distinguishing relational time from avoidable administrative burden.

Technology, better scheduling and clearer role design should protect the time staff spend doing work that genuinely requires human judgement, presence and relationships.

This is particularly important in long-term care because the objective extends beyond completion of clinical tasks. Dignity, reassurance, communication and participation are part of the service outcome.

Workforce efficiency should therefore be judged partly through what workers are enabled to do, not simply how many tasks they complete.

National projections need regional workforce action

Austria has increasingly strong national intelligence about future workforce need. The implementation challenge sits closer to service delivery.

The Länder differ in demographics, geography, training infrastructure, provider markets and workforce supply. A national estimate of 51,000 additional or replacement workers cannot simply be divided evenly across nine regions.

Each Land needs to understand its own workforce flows.

Where are shortages most acute? Which occupations are becoming bottlenecks? How many students train locally? Where do graduates work? Are mobile services losing staff to hospitals? Which districts face retirement clusters? What housing or transport barriers affect recruitment?

Regional planning also needs provider intelligence. Front-line organisations often see workforce change before it appears in aggregated statistics.

The governance challenge is therefore to connect national projection, Land-level planning and provider-level experience.

A central forecast without local implementation will not create workers. Local action without national coordination may simply encourage regions and sectors to compete for the same limited workforce.

International learning: workforce numbers are not workforce capacity

Austria’s workforce challenge reflects pressures seen across many ageing societies, but its response is shaped by its own professional regulation, Länder responsibilities, education system and dependence on migrant labour.

The specific institutional model is not directly transferable.

The broader lesson is more useful: workforce capacity is produced through several connected systems.

Education creates qualified entrants. Employers convert entrants into productive staff through induction and supervision. Working conditions determine whether people remain. Skill-mix design determines how efficiently competence is used. Technology can release or consume staff time. Migration can expand supply but also create dependency. Leadership determines whether problems are addressed early.

A country can therefore increase training places and still experience worsening workforce pressure if retention collapses. It can increase headcount while losing available hours. It can build care facilities without staffing them. It can recruit internationally while underinvesting in domestic careers.

The transferable principle lies in managing the whole workforce lifecycle rather than searching for a single recruitment intervention.

Austria’s strongest opportunity is to turn care into a sustainable career system

The scale of Austria’s future workforce need makes short-term recruitment campaigns insufficient.

Care needs to function as a career system capable of attracting people at different stages of life and giving them reasons to remain.

That means credible entry routes through schools, apprenticeships and adult education. It means visible progression from assistant roles into more advanced practice where workers want it. It means supervision and continuing professional development that improve competence rather than simply satisfy requirements.

It also means acknowledging that not every worker wants the same career. Some will seek clinical progression. Others value stable direct-care roles. Some prefer mobile work; others institutional teams. Workforce strategy should create multiple sustainable routes rather than defining success solely through upward management progression.

The future also requires stronger recognition of care as skilled work. Relationship-building, dementia support, observing deterioration, managing risk and coordinating with families require judgement even where the role is not professionally regulated at the highest level.

If Austria can combine that recognition with manageable working conditions, stronger training capacity and intelligent deployment, the workforce challenge becomes more tractable.

Conclusion

Austria’s long-term care workforce challenge cannot be solved through one recruitment target. The projected requirement for around 51,000 additional or replacement care and support workers between 2023 and 2030 reflects demographic growth, retirement, turnover and the increasing complexity of care. Meeting that requirement requires a system capable not only of attracting people but of converting training into lasting workforce capacity.

The strongest response connects professional roles, education, deployment, retention and regional planning. DGKP, Pflegefachassistenz, Pflegeassistenz and other care roles need to operate within coherent skill-mix models. Apprenticeships and expanded training can broaden entry, but learners require supervision. Migration will remain important, but it should complement rather than replace domestic workforce development. Technology can release capacity where it removes low-value work, but it cannot substitute for human relationships and physical care.

Above all, workforce quality depends on whether people can sustain a career in care. Pay matters, but so do workload, leadership, scheduling, autonomy, development and the ability to provide the kind of relational support that draws many people into the profession in the first place.

Austria now has increasingly sophisticated national workforce projections. The decisive next step is translating them into Land-level and provider-level action. Long-term care capacity will ultimately be determined not by how many jobs exist on paper, but by whether skilled people are available, supported and willing to remain in those jobs where older and disabled people actually need them.