LTCcovid Country Profiles

Responses to 2.08. Impacts of the pandemic on people working in the Long-Term Care sector

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.

 

Overview

As discussed in Part 1, the pandemic arrived at a time when there were already shortages in long-term care staff in most countries, which can be attributed to poor pay and conditions, as well as lack of professional prestige of the sector (see for example Van Houtven et al. 2021).

Staff working in long-term care have been at increased risk of infections and deaths (even compared to the health sector) and have experienced particularly stressful and distressing situations, and huge increases in workload, resulting in negatives impacts on mental health, as summarised below. This section is aims to provide an overview of the evidence of these impacts so far, building on a systematic review by Gray et al (2021) that covers evidence up to March 2021.

Increased risk of infection and deaths:

People who work in the Long-Term Care sector, both in care homes and in community settings have been particularly exposed to infections (see for example data from England and Wales, below, showing that social care is the employment sector with the highest COVID-19 death rates, nearly double those experienced by health care sector staff).

Evidence from the United States (Xu et al., 2020)  suggests that some of the additional risks experienced by staff working in nursing homes can be linked to availability of Personal Protection Equipment (the analysis found that nursing homes with at least 1-week supply of PPE were less likely to have staff shortages during the pandemic).

Poor working conditions:

The challenge of having to implement measures to reduce risks of infections that were upsetting (and sometimes harmful) for care home residents, particularly those living with dementia, has been highlighted by some studies, for example Leontjevas et al, 2021 and Giebel et al., 2022), with staff experiencing increased challenging behaviour from residents and sometimes from family and relatives who were upset with the visiting restrictions.

Wellbeing and health impacts:

There is growing qualitative and quantitative evidence showing the negative impacts of the pandemic among staff working in care homes, although there is often a difficulty in ascertaining the extent to which this differs from before the pandemic due to lack of baseline data.

Mental health impacts:

Quantitative studies identified by a systematic review showed a high prevalence of mental health systems including anxiety, depression, PTSD and secondary traumatic stress, similar impacts were described in the qualitative studies, as well as exhaustion and burnout (Gray et al., 2021).

A study in Ireland shows that nursing home staff had higher prevalence of suicidal ideation and planning than that observed in studies of hospital staff. The study also found high prevalence of post-traumatic stress and mood disturbance moral. Many staff also reported that they were not able to cope with work demands (Brady et al., 2021).

A longitudinal qualitative study in the UK found that staff working in care homes reported increased workloads and burnout, worsening mental health, and experiences of conflict and relationship breakdown with family carers. They also reported difficulties linked to having to try to communicate with residents while wearing face coverings (Giebel et al, 2022).

Factors affecting or moderating mental health impacts:

The review by Gray et al (2021) identified these factors as affecting between mental health outcomes and working/pandemic conditions:

  • – Availability of Personal Protection Equipment (PPE)
  • – Lack and delays in testing
  • – Working conditions: shift working, staffing levels, workload and redeployment
  • – Conflicting and unclear guidance, poor communication
  • – Contact with ‘at risk’ or positive residents, fear of contagion
  • – Death and bereavement
  • – Feeling undervalued and abandoned
  • – Degree of support from colleagues, management and psychologists
Moral injury

Many of the measures that staff were asked to implement to prevent or control COVID infections resulted in staff feeling conflicted due to the impacts of the measures on the wellbeing and health of care home residents and their families. Brady et al, (2021) and Iaboni et al (2022) report high levels of moral injury or distress among care home staff.

Positive impacts:

The systematic review by Gray et al (2021) found that two studies reported positives from the pandemic: peer-support networks to communicate with other homes (Spilsbury et al, 2021) and increased teamwork and cooperation (White et al., 2021).

Evidence on what works to improve outcomes for care home staff during the pandemic:

The systematic review by Gray et al. (2021) identified a mixed-methods evaluation of a training intervention to provide rapid guidance and learning Extension for Community Health Outcomes (ECHO). The study found a high level of satisfaction with the training, an increase in participant’s comfort levels in work ing with people who had COVID or were at high risk and reports of increased confidence (Lingum et al., 2021).

References:

Brady C., Fenton C. , Loughran O. , et al. (2021) Nursing home staff mental health during the Covid?19 pandemic in the Republic of Ireland. Int J Geriatr Psychiatry.1,10. https://doi.org/10.1002/gps.5648

Giebel, C., Hanna, K., Marlow, P., Cannon, J., Tetlow, H., Shenton, J., Faulkner, T., Rajagopal, M., Mason, S. & Gabbay, M. (2022). Guilt, tears and burnout—Impact of UK care home restrictions on the mental well-being of staff, families and residents. Journal of Advanced Nursing, 00, 1– 12. https://doi.org/10.1111/jan.15181

Gray K.L., Birtles H., Reichelt K. and James I.A. (2021) The experiences of care home staff during the COVID-19 pandemic: A systematic review, Aging & Mental Health, DOI: 10.1080/13607863.2021.2013433

Iaboni, A., Quirt, H., Engell, K. et al. Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 22, 74 (2022). https://doi.org/10.1186/s12877-022-02759-4

Leontjevas, R., Knippenberg, I. A. H., Smalbrugge, M., Plouvier, A. O. A., Teunisse, S., Bakker, C., Koopmans, R. T. C. M., & Gerritsen, D. L. (2021). Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands. Aging & Mental Health, 25(7), 1314–1319. 

Lingum, N. R., Sokoloff, L. G., Meyer, R. M., Gingrich, S., Sodums, D. J., Santiago, A. T., Feldman, S., Guy, S., Moser, A., Shaikh, S., Grief, C. J., & Conn, D. K. (2021). Building long-term care staff capacity during COVID-19 through just-in-time learning: Evaluation of a modified ECHO model. Journal of the American Medical Directors Association, 22(2), 238–244. https://doi.org/10.1016/j.jamda.2020.10.039 

Spilsbury, K., Devi, R., Griffiths, A., Akrill, C., Astle, A., Goodman, C., Gordon, A., Hanratty, B., Hodkinson, P., Marshall, F., Meyer, J., & Thompson, C. (2021). SEeking AnsweRs for Care Homes during the COVID-19 pandemic (COVID SEARCH). Age and Ageing, 50(2), 335–340. https://doi.org/10.1093/ageing/afaa201 

Van Houtven, C., Miller, K., Gorges, R., et al. (2021) State Policy Responses to COVID-19 in Nursing Homes. Journal of Long-Term Care, (2021), pp.264–282. DOI: http://doi.org/10.31389/jltc.81

White, E. M., Wetle, T. F., Reddy, A., & Baier, R. R. (2021). Front-line nursing home staff experiences during the COVID-19 pandemic. Journal of the American Medical Directors Association, 22(1), 199–203. https://doi.org/10.1016/j.jamda.2020.11.022 

Xu H., Intrator O., Bowblis J.R. (2020) Shortages of staff in Nursing Homes during the COVID-19 Pandemic: What are the Driving Factors? JAMDA, https://doi.org/10.1016/j.jamda.2020.08.002

International reports and sources

Systematic review of the experiences of care home staff during the pandemic (covering evidence from March 2020 to March 2021):

Gray K.L., Birtles H., Reichelt K. and James I.A. (2021) The experiences of care home staff during the COVID-19 pandemic: A systematic review, Aging & Mental Health, DOI: 10.1080/13607863.2021.2013433

Workload

An Health Services Union (HSU) survey of 1,000 aged care workers released on 13th January 2022 found 90% of respondents reported they were experiencing understaffing, 84% reported excessive workloads, 82% thought that their aged care facility was unprepared for the Omicron wave and 36% were working in facilities that had implemented 12-hour shifts.

(p. 71 – The Senate (October 2021), Select Committee on Job security, Second Interim Report)

https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024764/toc_pdf/Secondinterimreportinsecurityinpublicly-fundedjobs.pdf;fileType=application%2Fpdf

The Royal Commission’s September 2020 special report into COVID-19 noted evidence from unions that pointed to a lack of acknowledgement of the increased staffing numbers required to support the measures in the Visitation Code and the workload this created.

Financial impacts

The Australian Services Union submission to the Royal Commission reported on a survey on the impact of COVID on its members in home care. It noted that almost half of the respondents lost hours of work due to COVID restrictions and that the situation was worse in non-local government employment.

At various points in the pandemic, workers have been prevented from working across more than one private residential aged care site. While the Commonwealth government provided providers with additional funds to allow workers to be employed for at least their normal total hours (see  https://www.health.vic.gov.au/covid-19/supporting-the-aged-care-workforce-during-covid-19), however there has been considerable variation on how this has worked in practice and there have been some industrial disputes where employers did not honour pre-single site working arrangements.

Evidence of impacts on mental health of aged care workers

A national online survey carried out in September and October of 2020 asked 288 senior staff working in residential aged care homes about the impact of COVID-19 on the mental health of residents and staff. The study aimed to identify the perceived impact of the pandemic on mental health, the restrictions and stressors that staff identified as affecting mental health and the views of staff about programmes and resources to support mental health. The study used mixed methods, using qualitative narratives to complement the quantitative findings.

It found a high prevalence of staff who demonstrated poor mental health, in particular loneliness, anxiety and stress. The most commonly identified stressors where related to media exposure to COVID-19 outbreaks, concerns about their own safety as well as the safety of residents and their own families, and fear of inadvertently infecting residents. Staff identified potential helpful having training in supporting the mental health of residents, on-site and tele-health counselling and having technical support for video conferencing (Brydon et al., 2021).

References:

Brydon A, Bhar S, Doyle C, Batchelor F, Lovelock H, Almond H, Mitchell L, Nedeljkovic M, Savvas S, Wuthrich V. National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clin Gerontol. 2021 Oct 11:1-13. doi: 10.1080/07317115.2021.1985671.

Last updated: January 17th, 2022   Contributors: Sara Charlesworth  |  Wendy Taylor  |  Adelina Comas-Herrera  |  

A survey of care home staff in Ontario by Iaboni and colleagues (2022) found that staff experienced high level of moral distress about the impact of measures such as isolation on residents’ quality of life, and fear about the reaction of residents to the measures.

References:

Iaboni, A., Quirt, H., Engell, K. et al. (2022) Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 22, 74. https://doi.org/10.1186/s12877-022-02759-4

Last updated: February 6th, 2022   Contributors: Andrea Iaboni  |  

A report conducted by the Danish union representing staff in the LTC sector (FOA) evaluated how LTC staff were affected by the pandemic: overall, the union members experienced that management in the LTC sector has generally communicated well how and why the various restrictions were introduced. Communication around PPE, however, has been less clear and often changed. Also, Work Environment in Denmark, the public authority in charge of regularly checking how employees are thriving, sent home their employees in the Spring of 2020 until Aug 2020, which meant that there was no focus on the work environment in these early and confusing months of the pandemic.

The FOA report is based amongst other on a member survey in the Spring 2020 (10.510 respondents), conducted with Copenhagen University. The survey shows that the fear of getting infected was most prominent among staff in the LTC sector, compared to the hospital, psychiatry, ambulant services and child-care sectors (Nabe-Nielsen et al, 2021).

As part of the national evaluation of the spread of COVID-19 and related mortality, the national research center VIVE has conducted a register analysis of all the conducted COVID-19 tests and has identified how many tests were administered to staff in the nursing home and home care sector and with what result: Staff have been regularly tested, even more often than residents in the nursing homes and relatives. As was the case of service users, an increase in infection rates was seen among staff in the LTC sector at the end of the year 2020 (Hirani et al, 2022).

The higher risk of getting infected continued also after the first wave: A report from Statens Serum Institut in Jan 2022 concluded that one in seven LTC staff had been infected (14 pct.) just within the 4 first weeks of 2022 (source:  https://www.fagbladetfoa.dk/Artikler/2022/01/25/Knap-hver-7-ansatte-i-aeldreplejen-er-blevet-smittet-i-aarAlle-er-slidte).

 

Reference:

Bredal, C.; Manniche, K. and Dam-Hansen, A. (2021) I Corona Frontlinjen. Erfaringer fra medarbejderne i ældreplejen – Danmark. Friedrich Ebert Stiftung https://library.fes.de/pdf-files/bueros/stockholm/18119.pdf

Hirani, J.C.; Mikkelsen, M, and Kjellberg, J. (2022) Test, smitte og covid-19-relateret dødelighed under covid-19-epidemien 2020 – 2021. Delrapport 2. https://www.vive.dk/da/udgivelser/test-smitte-og-covid-19-relateret-doedelighed-under-covid-19-epidemien-2020-2021-delrapport-2-17873/

Nabe-Nielsen, Kirsten; Juul Nilsson, Charlotte; Juul-Madsen, Maria; Bredal, Charlotte; Preisler Hansen, Lars Ole; Hansen, Åse Marie (2021): COVID-19 risk management at the workplace, fear of infection and fear of transmission of infection among frontline employees, in: Occupational & Environmental Medicine, 78, pp. 248–254, https://oem.bmj.com/content/oemed/78/4/248.full.pdf

Last updated: May 25th, 2023

Over the first two waves of the pandemic, a total of 47,428 cases were recorded among social care staff (source). As of 2 August 2023, 19 professionals are known to have died from Covid-19 across the entire health and care sector. Some 158,336 cases have been recorded among health and care professionals between 2020 and August 2023, with 27,296 care staff cases recorded by survey (source). . 

High levels of staff absences were recorded, and the lack of support to care staff across the sector have contributed to a widespread feeling of anger among staff, who have felt undervalued especially in comparison to counterparts working in health services (source). 

The degradation of working conditions for staff, often faced with difficult choices with little support, and additional tasks, has increased staff exits from the sector and further exacerbated difficulties in recruiting and retaining new staff. (source) 

Last updated: October 23rd, 2024   Contributors: Camille Oung  |  

Quantitative evidence of negative impacts on the mental health of nursing home staff:

An online survey of 390 nursing home staff across the Republic of Ireland during the third wave of the pandemic ( 20th November 2020 to 4th January 2021) gathered data on COVID-19 exposure and mental health. They study found that nursing home care staff reported high levels of post-traumatic stress, mood disturbance and moral injury (distress experienced when an individual witnesses or engages in acts that contradict their moral beliefs) during the pandemic. There was also high prevalence of suicidal ideation (13.8%) and planning (9.2%), a higher prevalence than that observed in hospital workers during the pandemic. 24.6% of staff also reported that they were not able to cope with work demands (work ability).

The study found significant differences between different staff groups, with health care assistants reporting a significantly higher degree of moral injury than non-clinical staff (Brady et al., 2021).

Evidence on the impact of COVID on working conditions in public and private sectors

A study by Mercille et al., (2022) illustrated that nearly 39% of care workers worked more hours during the pandemic compared to pre-pandemic times, while 16.5 % worked fewer hours. Those employed by private providers were more likely to experience increased working hours relative to those employed by public providers.  Moreover, care workers reported that they had to work when they were affected by the pandemic because of the derogations. Nearly 70% of care workers in reported receiving little or no COVID-19 training. Moreover, those employed by public sector providers received somewhat better conditions relative to those employed by private providers, e.g. the former were more likely to receive sick pay when they were either sick themselves or had close contacts of positive cases. Public providers were also more likely to inform their staff of contact with positive cases. However, the study showed no significant difference between private and public providers in terms of availability of PPE, testing or the use of derogations.

References:

Brady C., Fenton C. , Loughran O. , et al. (2021) Nursing home staff mental health during the Covid?19 pandemic in the Republic of Ireland. Int J Geriatr Psychiatry.1?10. https://doi.org/10.1002/gps.5648

Mercille, J., Edwards, J. and O’Neill, N. (2022) Home care professionals’ views on working conditions during the COVID-19 pandemic: the case of Ireland, 6(1-2): 85–102, International Journal of Care and Caring, DOI: 10.1332/239788221X16345464319417

 

Last updated: March 4th, 2022

A study of the self-rated mental wellbeing (depression, trauma, quality of life at work, etc) of over 300 employees (91 clinicians, nurses and physiotherapists; 99 care workers and 110 administrative personnel) in multiple nursing homes in Northern Italy found that 1 in four employees reported symptoms consistent with severe post-traumatic stress disorder, 16% reported moderate to severe depression symptoms and 11% severe anxiety. 40% of the sample declared that their mental health status had a negative impact on their social and professional life.

Last updated: January 2nd, 2022   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

A qualitative study involving semi-structured interviews with family and professional carers of people with dementia found that professional carers experienced increased workload due to:

  • Additional responsibilities and care tasks, particularly due to implementing Infection Prevention and Control measures and due to additional care demands during outbreaks (in terms of providing care to people who were quarantining and increased care needs due to COVID-19 infections)
  • Having to work extra hours due to staff shortages
  • In the community, workers also found it burdensome to have to make decisions about reducing care and having to communicate if care needed to be stopped or reduced.

The study also found that staff in care homes experienced stress as a result of relatives of people with dementia not adhering to rules and felt conflicted about having to implement measures that they perceived to be harmful and too strict. Some also expressed guilt that they had contact with residents while their relatives were not able to visit (Smaling et al., 2022).

A study analysing the minutes and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands) shows concern about the staff mental wellbeing. In particular, the Outbreak Teams were concerned about emotional exhaustion due to high workloads, fear of infection and verbal abuse by residents’ family members (van Tol et al, 2021).

Another qualitative study with care workers in care facilities highlighted a number of moral challenges faced by care professionals. These challenges were related to  to the visitor ban policy, residents’ loneliness and despair, as well as deaths. Moral challenges triggered different responses from care workers from acceptance  to deviating from protocols and ‘acts of rebellion’ as well as leading to clashes between care workers and with superiors. Overall, the paper noted that care workers experienced a degree of moral distress (van der Geugten et al., 2022).

References:

Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519

van der Geugten, W., Jacobs, G. and Goossensen, A. (2022) The struggle for good care: moral challenges during the COVID-19 lockdown of Dutch elderly care
facilities, 6(1-2): 157–177, International Journal of Care and Caring, DOI: 10.1332/239788221X16311375958540

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study BMJ Open 2021;11:e053235. doi: 10.1136/bmjopen-2021-053235

Last updated: March 7th, 2022

Perceptions and experiences of care home staff 

A study by Bilal and colleagues (published in August 2020) explores the experiences and perceptions of staff providing care to elderly residents across three care homes in Karachi. The results of the study highlighted the constant levels of fear and anxiety that care home staff experienced throughout the first few months of the pandemic, although this was alleviated somewhat by the availability of protective gear and training. The study also highlighted discrimination felt by caregivers, which was due to an ignorant fear among the public that they might be spreading the infection because of their close contact with elderly people. One carer described a driver cancelling his delivery of food to their care home (Bilal et al., 2020).

References:

Bilal, A., Saeed, M. A., & Yousafzai, T. (2020). Elderly care in the time of coronavirus: Perceptions and experiences of care home staff in Pakistan. International Journal of Geriatric Psychiatry, 35(12), 1442–1448. https://doi.org/10.1002/GPS.5386

Last updated: January 29th, 2022   Contributors: Daisy Pharoah  |  

Impact on wellbeing and quality of life

Emerging evidence suggests that, since the pandemic began, health and care workers have been at high risk for significant psychological distress. Greene et al. (2020) surveyed a convenience sample (n = 1194) of health and social care workers from across the UK in the summer of 2020, to identify predictors of clinically significant distress (PTSD, anxiety, and depression) during the early phase of COVID-19.  The study found that clinically significant distress was common: just under 60% of participants met the threshold for PTSD, anxiety, or depression. This was less likely in participants with higher incomes. Predictors for a clinically significant mental disorder were concerns about passing COVID-19 onto others, being unable to discuss concerns with managers, being stigmatised, and not having reliable access to PPE.

Respondents to a survey (n = 163) conducted in early 2020 across the UK by The Queen’s Nursing Institute reported feeling worse (42%) or much worse (15%) in terms in terms of their mental and physical health as a result of working in conditions induced by the pandemic. Contributing factors to this included poor management, undervalued work (especially as compared to hospital staff), a lack of support from government, poor working conditions (including feeling inadequately protected by PPE), an increased workload, and concerns about the care workforce.

A recent study compared cross-sectional data from at three timepoints during the pandemic to examine how the workforce (health and social care) in the UK has been affected by the pressures of COVID-19, and how employers can help rebuild their services. Wellbeing and work-related quality of life was significantly compromised between May/July 2020 and May/July 2021, with respondents increasingly using negative avoidant coping strategies (such as substance abuse and self-blame) during this period. Between December 2020/November 2021 and May/July 2021, burnout was found to significantly increase. Consistent with other literature, the study that highlights that despite its resilience, much of the health and social care workforce has been overwhelmed by the COVID-19 pandemic (Gillen et al., 2022).

Impact on staff working in care homes

A longitudinal qualitative study found that staff were feeling overburdened and burned out, this was attributed to increased workloads, lack of support, and the emotional impacts of having to implement measures that were causing distress to residents and their family members (Giebel et al, 2022).

References:

Giebel, C., Hanna, K., Marlow, P., Cannon, J., Tetlow, H., Shenton, J., Faulkner, T., Rajagopal, M., Mason, S. & Gabbay, M. (2022). Guilt, tears and burnout—Impact of UK care home restrictions on the mental well-being of staff, families and residents. Journal of Advanced Nursing, 00, 1– 12. https://doi.org/10.1111/jan.15181

Gillen, P., Neill, R. D., Manthorpe, J., Mallett, J., Schroder, H., Nicholl, P., Currie, D., Moriarty, J., Ravalier, J., McGrory, S., & McFadden, P. (2022). Decreasing Wellbeing and Increasing Use of Negative Coping Strategies: The Effect of the COVID-19 Pandemic on the UK Health and Social Care Workforce. Epidemiologia 2022, Vol. 3, Pages 26-39, 3(1), 26–39. https://doi.org/10.3390/EPIDEMIOLOGIA3010003

Greene, T., Harju-Seppänen, J., Adeniji, M., Steel, C., Grey, N., Brewin, C. R., Bloomfield, M. A., & Billings, J. (2020). Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19. MedRxiv, 2020.10.21.20216804. https://doi.org/10.1101/2020.10.21.20216804

Queen’s Nursing Institute. (2020). The Experience of Care Home Staff During Covid-19. A Survey Report by The QNI International Community Nursing Observatory. July. https://www.qni.org.uk/wp-content/uploads/2020/08/The-Experience-of-Care-Home-Staff-During-Covid-19-2.pdf [accessed 11/10/2020]

Last updated: March 8th, 2022   Contributors: Daisy Pharoah  |  

Sickness levels during the Omicron wave

A survey of members of the National Care Forum (the largest body representing not-for-profit care providers) released on the 13th January 2022 found that providers reported an 18% vacancy rate and 14% absences as a result of Omicron.

Impact in terms of COVID-related mortality

Data from the Office for National Statistics show that, between 9 March 2020 and 31 December 2021, there were 1,131 deaths of social care workers aged 20 to 64 attributed to COVID-19 in England. People working social care had higher rates of death involving COVID-19 compared to people of similar age and sex. For men working in social care, there were 203 deaths per 100,000 (compared to 77 for the general population and 78 for health care workers in the same age groups) and 93 deaths for 100,000 for females, compared to 43 for the general population and 36 for women working in healthcare.

Mental and physical health impacts

Emerging evidence suggests that, since the pandemic began, health and care workers have been at high risk for significant psychological distress (Greene et al., 2020). A study by Nyashanu et al. (2020) explored some of the triggers of mental health problems among healthcare workers during the first phase of the COVID-19 pandemic in early 2020. Semi-structured interviews with forty healthcare professionals from nursing homes and domiciliary care agencies in the English Midlands revealed various factors causing distress and anxiety. These included: a fear of infection and infecting others, lack of guidance from central government, death and loss of professionals and residents, unreliable testing and delayed or false results, staff shortages, and unsafe hospital discharges. Another important source of stress was the lack of recognition of care staff, which sat is stark contrast to the recognition showed to professionals in the NHS. Participants felt that they were not being adequately recognised as frontline healthcare workers, which negatively impacted their morale. This lack of recognition also caused delays in receiving PPE and testing; a further cause of stress.

Hussein (2020) reported findings from a survey of 296 frontline care workers that took place during July and August 2020. It found that nearly half of the respondents (47%) indicated that their general-health had worsened since the onset of COVID-19 and 60% indicated that the amount of time their jobs made them feel depressed, gloomy, or miserable had increased since the start of the pandemic. Additionally, 81% reported an increase in the amount of time that their jobs made them feel tense, uneasy, or worried. A significant minority of 23% indicated their job satisfaction had increased, whereas 42% said that they had become a little or a lot less satisfied with their job since COVID-19 (Hussein 2020). In another survey of 43 care home managers in England, 75% of managers reported that they were concerned for the morale, mental health, and wellbeing of their staff (Rajan et al, 2020). In addition, data reported by Skills for Care indicates that the percentage of days lost to staff sickness have increased by 180% (from 2.7% before the pandemic, to 7.5% between March and August 2020).

Impact on wellbeing and quality of life

A recent study compared cross-sectional data from at three timepoints during the pandemic to examine how the workforce (health and social care) has been affected by the pressures of COVID-19, and how employers can help rebuild their services. Wellbeing and work-related quality of life was significantly compromised between May/July 2020 and May/July 2021, with respondents increasingly using negative avoidant coping strategies (such as substance abuse and self-blame) during this period. Between December 2020/November 2021 and May/July 2021, burnout was found to significantly increase. Consistent with other literature, the study that highlights that despite its resilience, much of the health and social care workforce has been overwhelmed by the COVID-19 pandemic (Gillen et al., 2022).

References:

Greene, T., Harju-Seppänen, J., Adeniji, M., Steel, C., Grey, N., Brewin, C. R., Bloomfield, M. A., & Billings, J. (2020). Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19. MedRxiv, 2020.10.21.20216804. https://doi.org/10.1101/2020.10.21.20216804

Gillen, P., Neill, R. D., Manthorpe, J., Mallett, J., Schroder, H., Nicholl, P., Currie, D., Moriarty, J., Ravalier, J., McGrory, S., & McFadden, P. (2022). Decreasing Wellbeing and Increasing Use of Negative Coping Strategies: The Effect of the COVID-19 Pandemic on the UK Health and Social Care Workforce. Epidemiologia 2022, Vol. 3, Pages 26-39, 3(1), 26–39. https://doi.org/10.3390/EPIDEMIOLOGIA3010003

Hussein, S. (2020). The Impact of COVID-19 on social care workers’ workload, wellbeing and ability to provide care safely: Findings from the UK. PSSRU blog

Nyashanu, M., Pfende, F., & Ekpenyong, M. S. (2020). Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: Lived experiences of care workers in the Midlands region, UK. Health & Social Care in the Community. https://doi.org/10.1111/HSC.13204

Rajan, S., Comas-Herrera, A. and Mckee, M., 2020. Did the UK Government Really Throw a Protective Ring Around Care Homes in the COVID-19 Pandemic?. Journal of Long-Term Care, (2020), pp.185–195. DOI: http://doi.org/10.31389/jltc.53

Last updated: March 8th, 2022   Contributors: Daisy Pharoah  |  

Mental Health Impacts

Emerging evidence suggests that, since the pandemic began, health and care workers have been at high risk for significant psychological distress. Greene et al. (2020) surveyed a convenience sample (n = 1194) of health and social care workers from across the UK in the summer of 2020, to identify predictors of clinically significant distress (PTSD, anxiety, and depression) during the early phase of COVID-19.  The study found that clinically significant distress was common: just under 60% of participants met the threshold for PTSD, anxiety, or depression. This was less likely in participants with higher incomes. Predictors for a clinically significant mental disorder were concerns about passing COVID-19 onto others, being unable to discuss concerns with managers, being stigmatised, and not having reliable access to PPE.

It is noted that the sample only included 14 participants from Northern Ireland, so it is possible that the results are not fully representative of the experience in this part of the UK.

References:

Greene, T., Harju-Seppänen, J., Adeniji, M., Steel, C., Grey, N., Brewin, C. R., Bloomfield, M. A., & Billings, J. (2020). Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19. MedRxiv, 2020.10.21.20216804. https://doi.org/10.1101/2020.10.21.20216804

Last updated: March 8th, 2022   Contributors: Daisy Pharoah  |  

Data from the Office for National Statistics show that, between 9 March 2020 and 31 December 2021, there were 56 deaths of social care workers aged 20 to 64 attributed to COVID-19 in Wales. People working social care had higher rates of death involving COVID-19 compared to people of similar age and sex. For women working in social care, there were 83 deaths per 100,000 (compared to 43 for the general population and 53 for health care workers in the same age groups), the rates for men cannot be compared meaningfully due very small numbers.

 

Last updated: February 3rd, 2022   Contributors: Adelina Comas-Herrera  |  

Impacts on community-based workers:

A qualitative study of the experiences of 33 home health workers in New York City carried out from March to April 2020 found that workers felt invisible even though they were on the frontline of the COVID-19 pandemic, had high risk of virus transmission and were forced to make difficult decisions between their work and personal lives, exacerbating existing inequities. The majority of respondents were women of color. The respondents were aware that, due to lack of Personal Protection Equipment and relying on public transport, they were at high risk of infection and they also posed a risk to the people they provided care to and own their families. As well as anxiety about COVID risks, the respondents were also concerned about the implications of the pandemic for their already precarious financial situation (Sterling et al., 2020).

Impacts on nursing home staff:

Qualitative analysis from an electronic survey of 152 nursing home staff from 32 states carried out from 11th May to 4th June 2020 found that staff were working under complex and stressful circumstances. Respondents reported burnout and described enormous emotional, physical and mental burdens of having to taken heavier workloads and learning new roles and processes. They expressed concern about the situation experienced by residents, which added to the emotional toll and fears about becoming infected and infecting their families as a result. Respondents also expressed feeling demoralised as a result of negative media coverage of nursing homes and feeling that hospital staff were given much more praise, resources and recognition (White et al., 2021).

References:

Sterling M.R., Tseng E., Poon A. et al. (2020) Experiences of Home Health Care workers in New York City during the Coronavirus-2019 pandemic. JAMA Intern Med. 180(11):1453-1459. doi:10.1001/jamainternmed.2020.3930

White E.M., Fox Wetle T., Reddy A. and Baier R.R. (2021) Front-line nursing home staff experiences during the COVID-19 pandemic. JAMDA 22(1):199-203. https://doi.org/10.1016/j.jamda.2020.11.022

Last updated: January 10th, 2022

There is no information to-date on the formal LTC workforce specifically, but some information on the impact on unpaid carers (who make up the bulk of the LTC workforce) can be found in section 2.07.

Last updated: January 3rd, 2022   Contributors: Daisy Pharoah  |  

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica Breuer, Jorge Browne Salas, Jenni Burton, William Byrd, Sara Charlesworth, Adelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin Hämel, Nina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’Donovan, Camille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. Schmidt, Agnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.