"People, not tasks": A critical perspective on the transformation of work in long-term care

Aging populations and persistent staff shortages driven by high turnover are putting long-term care (LTC) systems under growing pressure. Existing research has mostly examined the symptoms of this staffing challenge - such as job dissatisfaction - rather than its underlying organizational and governance structures. This article addresses that gap by examining how LTC reforms have reshaped the labor process and negatively affected care provision. We conducted a conceptual review of academic and policy literature in English, German, French, and Italian, combining interdisciplinary database searches with selected policy documents. Our analysis draws on a framework that combines critical perspectives on New Public Management, as well as labor process theory, and the "logic of care." We identify three mechanisms that generate tensions for LTC workers: the standardization of care into measurable tasks, intensified work with reduced autonomy, and the curtailment of relational care. We illustrate these dynamics through the case of Switzerland, where high levels of resources and care quality coexist with similar sectoral dysfunctions. Addressing staffing shortages in LTC will require structural and organizational reforms that better recognize and support the central role of relational care, which is crucial to both workers and residents.