INTERNATIONAL REPORTS

Responses to 3.06. Support for care sector staff and measures to ensure workforce availability 


Australia

In April 2020, the Australian government announced the use of an online platform, Mable, which recruits workers in nursing, allied health, personal care, domestic assistance, and social support service. While Mable generates additional staff in the event of staffing shortages, concerns were raised about the inexperience of surge staff and their ability to provide adequate care. International students were allowed to work for up to 40 hours. The maximum number of hours worked was increased in order to better supply the health care workforce (Sources: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf; https://www.health.gov.au/ministers/senator-the-hon-richard-colbeck/media/contingency-measures-to-ensure-continuity-of-aged-care-during-covid-19).

Last updated: September 10th, 2021


Austria

Austria implemented measures that required its hospitals to offer support to care homes in the form of personnel, expertise, and equipment (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

In Austria almost 33,000 people with LTC needs receive support from 66,000 ‘personal’ migrant live-in carers. Closed borders at the beginning of the pandemic posed challenges. Two provinces charted flights to bring live-in carers from Eastern European countries back to Austria. Carers were quarantined for two weeks (without income and having to contribute to accommodation). Carers who decided to stay were offered a €500 bonus. A hotline helped to coordinate 24-hour care. Considerable efforts were made to maintain the live-in model. Care workers experienced challenges with complex paperwork (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).

A panel survey of over 20,000 Austrian employees conducted in May 2020 found that 46% of care professionals reported their job to be ‘mentally stressful’, while this was only the case for 11% in other jobs. In addition, only 38% of carer workers think they will reach pension age in their sector (versus 61% of other professions). During the pandemic, one third of care workers reported ‘stress due to time pressure and changing labour processes’ (Source: https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/).

Last updated: September 10th, 2021


Austria

Austria implemented measures that required its hospitals to offer support to care homes in the form of personnel, expertise, and equipment (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Canada (British Columbia)

A single site order was introduced on March 25, 2020, meaning that workers in British Columbia’s LTC and assisted-living facilities were limited to working in a single facility. On March 26, 2020, LTC operators were asked to provide personal and employment information, including name, contact information, and Social Insurance Numbers for all staff to the ministry to support decisions about the allocation of staff among facilities. On April 10, 2020, all employees within the scope of the Single Site Order would receive a common hourly wage regardless of their facility and employer. On April 15, 2020, Regional Health Boards were ordered to establish a working group to make recommendations to their Medical Health Officer about the assignment of staff because staffing shortages became a bigger issue following the Single Site Order (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Last updated: September 10th, 2021


Denmark

There is ongoing work to try to collect statistics on the number of nursing home staff infected with COVID-19. In the meantime, the number of care staff reporting the disease as a work-related injury gives an indication of the situation. On April 24, 2020, a new guideline was published that underlined that COVID-19 would be regarded as a work-related injury if the person had been exposed to the disease and was tested positive. This gives the person an entitlement to claim for workers’ compensation. As of May 21, 242 people had reported COVID-19 as a work-related injury, and of these 42 people were employed in a nursing home. The majority of all cases relate specifically to the disease, while 9% relate to skin diseases caused by wearing Personal Protection Equipment (PPE) (Source: https://www.aes.dk/da/Temaer/COVID-19.aspx).

Regarding measures to increase or maintain the availability of health workers, emergency child care facilities are provided (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Last updated: September 10th, 2021


England (UK)

The social care action plan recognised the urgent need to increase the social care workforce during the pandemic ‘to cover for those who are not in work, and to relieve the pressure on those that are’. The action plan included an ‘ambition’ to attract 20,000 people into social care over 3 months (Source: https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan) .

On March 19, 2020, Social care staff were designated as ‘key workers’ to enable them to continue to access childcare once schools were closed (Source: https://www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision).

The Infection Control Fund aims to ensure that all care workers isolating in line with guidance continue to receive their full wages and face no loss of income (Source: https://www.gov.uk/government/publications/adult-social-care-infection-control-fund-round-2/adult-social-care-infection-control-fund-round-2-guidance). Beyond this however, no specific financial support has been offered to social care workers.

On 6 May 2020, the Government launched a dedicated CARE app to support the social care workforce during COVID-19, offering access to guidance, learning resources, discounts, and other support all in one place (Source: https://www.gov.uk/government/news/dedicated-app-for-social-care-workers-launched).

On May 11, 2020, the Department of Health and Social Care (DHSC) published guidance on maintaining the health and wellbeing of the adult social care workforce. This placed the responsibility on employers to check in on team members regularly, especially those who are working remotely. It stated that employers should encourage teams to create a wellness action plan so that employees can identify how to address what keeps individuals mentally well at work. This additionally suggested that employers should encourage those who are identified as being extremely clinically vulnerable to stay at home. Where this is not possible, they should be supported to work in roles or settings that have been assessed as lower risk. Emergency funding from the adult social care winter plan can be used to cover the cost of maintaining income for social care staff that are currently unable to work because of self-isolation measures.

On 15 May 2020, the Government announced a new wellbeing package for social care staff delivered through the CARE app including two new helplines, led by the Samaritans and Hospice UK. This is intended to help support care staff with their mental health and wellbeing and support those who have experienced a traumatic death as part of their work or help with anxiety and stress (Source: https://www.gov.uk/government/news/care-home-support-package-backed-by-600-million-to-help-reduce-coronavirus-infections#history).

On October 1, 2020, DHSC announced a second round of funding worth £546 million for the Adult Social Care Infection Control Fund. This is to be extended until March 2021, following on from May 2020, when the fund was initially worth £600 million. The purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movements between sites. This includes ensuring that staff who are isolating in line with government guidance receive their normal wages, limiting all staff movement between settings unless necessary, limiting the number of different people from a home care agency visiting a particular individual, limiting or cohorting staff, supporting active recruitment of additional staff, and providing accommodation for staff who proactively choose to stay separate from their families (Source: https://www.gov.uk/government/publications/adult-social-care-infection-control-fund-round-2).

On January 17, 2021, DHSC announced a £120 million Workforce Capacity Fund to help local authorities to boost staffing levels (Source: https://www.gov.uk/government/news/social-care-to-receive-269-million-to-boost-staff-levels-and-testing). The aim of this is to strengthen social care staff capacity so that safe and continuous care is achieved by all providers of adult social care. This additionally stated that providers should not be deploying people in care homes if these people are being deployed to provide care in other settings, unless in exceptional circumstances. This places the responsibility on Local authorities for contacting private providers with excess capacity to redeploy these staff into other settings to best meet workforce demand. This fund can be used to pay overtime rates to encourage staff to work additional shifts, cover childcare costs to allow staff to take on hours they would usually be unable to work, and enable care providers to overstaff at pinch points to lessen the impact of any staff absences should they arise. Additionally, Local Authorities are responsible for considering whether there are trained individuals who have been made redundant from care providers which have exited the market and so would be able to transition quickly into a new care setting. There may be individuals without care experience who have recently been made redundant and may require support applying to the care sector and training (Source: https://www.gov.uk/government/publications/workforce-capacity-fund-for-adult-social-care).

On February 9, DHSC announced that the government was asking people to register their interest in taking up short-term paid work in the adult social care sector to meet urgent demand during winter (Source: https://www.gov.uk/guidance/short-term-paid-work-in-adult-social-care).

On March 3, DHSC published guidance on restricting workforce movement between care settings. This stated that staffing requirements should be planned so that routine movement is not required to maintain safe staffing levels, with mitigations such as exclusivity contracts and block booking used to minimise staff movement where temporary staff are needed. Additionally, should a provider need to deploy an individual between two settings, they should ensure a 10-day interval between the individual attending the two settings. The individual must have a PCR negative test in the 7 days before starting the placement. Additionally, this states that providers should cohort staff to induvial groups of residents and ensure staff movement is limited between these groups. Providers should take steps to limit the use of public transport by staff and discourage lift sharing arrangements (Source: https://www.gov.uk/government/publications/restricting-workforce-movement-between-care-homes-and-other-care-settings).

Last updated: September 10th, 2021


Finland

In Finland, retired staff and students that do not fall into high risk groups have been recruited to maintain staffing levels (Source: https://www.lse.ac.uk/lse-health/assets/documents/eurohealth/issues/eurohealth-v26n2.pdf).

Last updated: September 10th, 2021


France

High levels of staff sickness were experienced, and as a result, various platforms for redeployment of staff were put in place. Regional platforms put in place by the regional authorities (ARS) were largely more successful than the national platform, which only reached 62 care homes (Sources: http://www.senat.fr/rap/r20-199-1/r20-199-11.pdf; https://renfortrh.solidarites-sante.gouv.fr/).

A grant was announced in October to award a bonus to all social care staff, both in care homes and domiciliary care (Source: https://solidarites-sante.gouv.fr/actualites/presse/communiques-de-presse/article/vote-unanime-a-l-assemblee-nationale-sur-l-amendement-bourguignon). Those care home staff in the 40 most affected departments (sub-regions) received a bonus of €1,500, and €1,000 in the other departments, and a €1,000 pro rata bonus for domiciliary care workers. Salary bands are to be re-evaluated by April 2021 and the entry level salary will be increased by €180/month in the public and not-for-profit sector and €160/month in the private sector (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf). In April 2021, the Ministry for Health and Solidarities announced that pay scales for domiciliary care workers and domiciliary care nurses would be revalued and increased by 13 to 15%, effective from October 2021 (Source: https://solidarites-sante.gouv.fr/actualites/presse/communiques-de-presse/article/avenant-43-vers-une-hausse-historique-des-salaires-des-aides-a-domicile#:~:text=Avec%20l’agr%C3%A9ment%20que%20le,services%20de%20soins%20infirmiers%20%C3%A0). This represents an annual investment of €200 million per year allocated to regional authorities. For ‘category A’ workers with 1 year of experience, this would represent a monthly increase of €33.5 from €1539 per month to €1573. For ‘category A’ workers with 10 years of experience, this would represent a monthly increase of €227 per month from €1539 per month to €1749 per month. The increases are even more significant for those holding a qualification.

More recently, the government has used ‘Intermediary Associations’ that are responsible for the reintegration of vulnerable people (out of work), to support social care workers, including in infection control and food preparation etc (Source: https://solidarites-sante.gouv.fr/actualites/presse/communiques-de-presse/article/crise-covid-19-le-gouvernement-soutient-les-associations-intermediaires-en).

Last updated: September 10th, 2021


France

High levels of staff sickness were experienced, and as a result, various platforms for the redeployment of staff were put in place. Regional platforms put in place by the regional authorities (ARS) were largely more successful than the national platform, which only reached 62 care homes (Sources: http://www.senat.fr/rap/r20-199-1/r20-199-11.pdf; https://renfortrh.solidarites-sante.gouv.fr/).

A grant was announced in October to award a bonus to all social care staff, both in care homes and domiciliary care (Source: https://solidarites-sante.gouv.fr/actualites/presse/communiques-de-presse/article/vote-unanime-a-l-assemblee-nationale-sur-l-amendement-bourguignon). Those care home staff in the 40 most affected departments (sub-regions) received a bonus of €1,500, and €1,000 in the other departments, and a €1,000 pro rata bonus for domiciliary care workers. Salary bands are to be re-evaluated by April 2021, and the entry level salary will be increased by €180/month in the public and not-for-profit sector and €160/month in the private sector (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf).

More recently, the government has used ‘Intermediary Associations’ that are responsible for the reintegration of vulnerable people (out of work), to support social care workers, including in infection control and food preparation (Source: https://solidarites-sante.gouv.fr/actualites/presse/communiques-de-presse/article/crise-covid-19-le-gouvernement-soutient-les-associations-intermediaires-en).

Last updated: September 10th, 2021


Germany

In January 2019, the care strengthening bill was enacted which means that there is active encouragement to increase the care workforce (Source: https://www.bundesgesundheitsministerium.de/sofortprogramm-pflege.html). This bill was developed in 2018 (Source: https://www.vdek.com/politik/gesetze/wahlperiode_19.html#ppsg). This does not solve the problem that there are not enough people available and willing to work in LTC.

In April 2020, the German government announced a stepwise increase of the minimum wage for care workers as well as additional paid leave. In addition, care workers in Germany received a one-off ‘pandemic-bonus’ of up to €1,000 as part of their July 2020 pay. In some states the bonus was topped-up to €1,500 (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf). In February 2021 the Federal Minister of Health announced a planned bonus for hospital staff. There are demands to also provide a bonus to LTC workers (Sources: https://www.aerztezeitung.de/Politik/Spahn-plant-weitere-Corona-Praemie-fuer-Klinikmitarbeiter-416931.html; https://www.aerzteblatt.de/nachrichten/121022/Deutscher-Pflegerat-will-Coronapraemie-fuer-alle-Pflegekraefte).

While children of staff working in system relevant jobs (including health and LTC) can access emergency childcare, there have been demands to expand available childcare services to reflect the demands on care workers (Source: https://www.presseportal.de/pm/17920/4816116; https://km-bw.de/,Lde/Startseite/Service/2020+04+20+Notbetreuung+wird+vom+27_+April+2020+an+erweitert).

In Bavaria, the cost of catering for staff in health and LTC settings are financially supported (€6.50 per member of staff per day) as a sign of appreciation (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

Following the national testing strategy, care workers should have access to regular testing. Rules vary between federal states, but LTC staff working in residential or domiciliary care settings should be tested regularly (Source: https://www.biva.de/besuchseinschraenkungen-in-alten-und-pflegeheimen-wegen-corona/#bw).

Earlier in the pandemic, the ‘care reserve’ initiative developed across federal states and separately in some federal states allowed people with a qualification to register. This provided an opportunity to recruit staff if there was a shortage due to infection. There have also been movements in some federal states to prioritise care-related professions when applying for permission to work in Germany and to financially incentivise training to become a care assistant (Pflegeassistenz) (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

Germany relaxed some staffing rules and operational frameworks to relieve pressure on the workforce (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Hong Kong

A survey by the Hong Kong Social Workers and Employment Union in February 2020 showed that about 10% of care workers had to take unpaid leave or experienced pay deductions. The Social Welfare Department responded with a number of measures. These measures included a special allowance for workforce support. This means that subsidised residential and domiciliary care services receive a ‘one-off special allowance for workforce support’ and to ‘maintain daily operations in the event of COVID-19 related staff absences. Costs for this measure were about 130 million Hong Kong Dollars (HKD). In addition, social care providers have received a special allowance to pay the staff in 745 subsidised homes an additional 10% of their monthly salary (capped at 4,000 HKD) for at least 4 months. The additional salary was reserved for staff working during the epidemic. The cost of this measure amounts to approximately 208 million HKD (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).

Last updated: September 10th, 2021


Ireland

The Health Information and Quality Authority provided a ‘Regulatory Assessment Framework of the preparedness of designated centres for older people for a COVID-19 outbreak’ in mid-April 2020. This framework was supposed to help care settings to prepare for a potential COVID-19 outbreak and to develop contingency plans. In Ireland, an agreement was put in place that enabled the Health Services Executive (HSE) to redeploy HSE staff to private nursing homes on a voluntary basis. (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).

Ireland launched recruitment campaigns to attract newcomers and former staff to the sector. Efforts were made to reduce staff working across different care settings. The HSE could support staff with alternative accommodation and transport to facilitate this (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).

Last updated: September 10th, 2021


Ireland

An agreement was put in place that enabled the Health Services Executive (HSE) to redeploy HSE staff to private nursing homes on a voluntary basis (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Recruitment campaigns to attract newcomers and former staff to the sector were launched (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Israel

Reports of increased volunteerism to assist NGOs and care sector staff are available, although there’s limited information on formalised processes (Source: https://www.haaretz.com/israel-news/.premium-unemployment-is-surging-ngos-are-collapsing-so-israelis-volunteer-to-turn-the-tide-1.9168388).

In Israel, the Ministry of Health made special teams available for periods of 7 to 14 days to support residential care settings that were acutely short staffed, and a 24 hour call centre was established to support LTC facility managers with medical and management advice (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Netherlands

On March 16, 2020, the Dutch Youth and Health Care Inspectorate allowed nursing home managers to recruit personnel beyond their traditional pool of employees, enabling them to hire personnel such as medical students (Source: https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf). Several initiatives have been set up to increase the number of staff working in stretched LTC settings, including an IT platform “Extra Hands for Healthcare” to match existing healthcare staff with employers. This included a campaign to recruit healthcare personnel that had left the sector or retired (called “Duty calls”), and a rapid training scheme for those with no previous healthcare training (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Last updated: September 10th, 2021


Republic of Korea

There have been steps taken to address worker shortages by seeking volunteers and paying family carers (Source: https://ageingasia.org/wp-content/uploads/2020/12/COVID_LTC_Report-Final-20-November-2020.pdf).

Care workers who were considered to have been in close contact with cases were quarantined at home, whilst those who continued to work were temporally housed in a hotel, or voluntarily moved into the LTC facility. In some facilities a quarantine was upheld for 14 days during which nurses and nurse assistants voluntarily agreed to be quarantined in the LTC facility to continue resident care.

To overcome shortages in areas with high outbreaks, healthcare workers were directed to sites with large clusters of infections, for example, an additional 2,400 health workers were recruited in Daegu alone (Source: https://ourworldindata.org/covid-exemplar-south-korea).

The Korean government does not appear to have offered a relief plan for workers who do not have employment insurance. They comprise 6.8 million people, and more than half are women, and allegedly many care workers belong to this group (Source: https://www.opensocietyfoundations.org/voices/care-workers-deserve-credit-for-south-koreas-covid-19-response).

 

Last updated: September 10th, 2021


Singapore

Singapore recognised the limitations of their lean workforce in residential LTC and the need to protect it. ‘The implementation of split zones and full contact precautions’ protected facilities from acute staff shortages.

To ensure the functioning of split zones, housing was organised for LTC workers who shared accommodation with staff assigned to different zones, workers in different (health and LTC) care settings, or in dormitories that did not allow for safe distancing. Many care workers working in nursing homes lived in hotels and serviced apartments, others lived on-site (adhering to split zone arrangements) between April 7 and June 1, 2020, during the Circuit Break period. The government paid for meal delivery and dedicated transportation between home and work. Health and LTC workers that were moved into temporary accommodations received $500 to facilitate the transition.

In addition to public recognition, the workforces received care packages and message of support from care facilities and could access ‘professional counselling and emotional support services’. (Source: https://ltccovid.org/wp-content/uploads/2020/08/The-COVID-19-Long-Term-Care-situation-in-Singapore-27July-2020.pdf).

Last updated: September 10th, 2021


Slovenia

In Slovenia, medical teams were deployed to a residential care setting if the regular staff became exhausted or overwhelmed (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Spain

In Spain care workers without the required training certificates could be legally employed (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 10th, 2021


Sweden

Staff shortages due to employees being on sick leave or in self-isolation led to a high use of casual workers, with little or no formal training.  Due to large numbers of temporary care staff with limited or no training in the sector, the government initiated a training program for 10,000 such workers. The state covers the expenses for the municipalities and the workers keep their ordinary pay while in training. To be eligible for the state subsidy, the municipalities have to offer a permanent position to workers who successfully have finished the course. In March 2020, the government abolished the requirement for a medical certificate when on sick leave for the first 14 days. In some municipalities, e.g. in Stockholm, flight attendants, restaurant staff, and other occupational groups who became unemployed due to the pandemic were quickly retrained as care assistants to help in municipal LTC and healthcare services (Sources: https://aldrecentrum.se/wp-content/uploads/2021/02/Johansson-L.-Sch%C3%B6n-P.-2021.-Governmental-response-to-the-COVID-19-pandemic-in-Long-Term-Care-residences.pdf; https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Sweden-22-July-2020-1.pdf).

The Government tasked the National Board of Health and Welfare with conducting an information initiative geared towards social services and municipal healthcare staff with the aim of reducing the spread of infection (Source: https://www.government.se/legal-documents/2020/10/dir.-202074/). The Corona Commission points out that an opportunity has been created for people who contracted COVID-19 when working in or being trained in healthcare facilities or in other handling of an infectious person to receive payments from work-related injury insurance (Source: https://coronakommissionen.com/wp-content/uploads/2020/12/summary.pdf).

Last updated: September 10th, 2021