LTCcovid Country Profiles
Responses to 3.06. Support for care sector staff and measures to ensure workforce availability
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 is compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project are moderating the entries and editing as needed.
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. 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.
People working in the long-term care sector, particularly in care homes, have had a very high exposure to COVID-19 infections, experiencing higher mortality than people working in other sectors, as well as severe impacts in terms of their mental health and wellbeing (see section 2.08). In response, countries have adopted measures to mitigate these impacts. The emphasis has been primarily in reducing their risk of infection and that they transmit the infection to the people they support, and to ensure that they can continue to work. There seems to have been much less emphasis (with some exceptions) in providing support to mitigate the negative impacts of the pandemic on the workers themselves.
An important context to this is that there were long-standing workforce shortages in the long-term care sector before the pandemic in many countries (see section 1.11). This has been identified as a factor that has severely hampered the ability of the sector to respond to the additional challenges posed by the pandemic and to maintain care standards (see for example Andersen et al.). In some occasions, when high numbers of staff became ill or needed to self-isolate, this has led to care failures, with examples of care homes that became completely overwhelmed and unable to function due to lack of staff.
This section provides examples of the strategies adopted in different countries to support care staff and ensure workforce availability throughout the pandemic. We distinguish between five main types of measures: measures that aim to reduce the risk of infection among care staff and support them in continuing to work, measures that aim to address stresses arising from the pandemic, measures to monitor the situation, measures to increase the pool of workers and measures to support providers experiencing acute workforce shortages.
Measures to reduce the risk of infection among care staff and support them in continuing to work
Reducing risk of infection in the workplace
Access to adequate Personal Protection Equipment, good Infection Prevention and Control practices, testing, single site working and ventilation are key to reduce risk of infection both for staff working in Long-Term Care and for people who use care services.
Reducing risk that staff acquire infections in the community and bring them into care settings
A number of countries requested that staff remain onsite in LTCFs for shifts lasting a few weeks and then quarantine for a week before returning to work (S.Korea, Turkey).
Measures to make it easier for staff to continue to work
Several countries rolled out support services for their care staff. Provisions for childcare prioritized for LTC staff were provided in Denmark, Finland, and Germany. Food services were provided to staff in Germany and Finland.
Measures that aim to address negative impacts from the pandemic on LTC staff
Supporting staff who have to quarantine
The precarious working conditions of care staff mean that in many countries they had no access to sick pay if they tested positive, or had to go without wages if they had to self-isolate due to being a close contact of someone who had tested positive. In Denmark COVID-19 has been recognised as a work-related injury, giving the person an entitlement to claim for compensation.
Additionally, accommodation for quarantine for care workers who did not want to quarantine with family was provided in Germany and S.Korea.
One-off “bonus” payments
There are several examples of countries offering one-off or intermittent “bonus” payments to encourage workers to stay in the sector (see for example Austria, Germany, Finland, Hong Kong and Canada, below) and compensate for the additional work and stress during the pandemic.
Measures to increase the pool of workers
Measures to make employment in the sector more attractive
Some countries have adopted longer-term measures to address pay and conditions (see section 4.05. for reforms to address LTC workforce recruitment, training, pay and conditions). In the United States pay for workers in nursing homes increased by 14.7% between February 2020 and October 2021.
In British Columbia, where care home workers were restricted to working in a single site, all employees received a common hourly wage regardless or their facility and employer.
Recruitment of staff who are new to the sector:
Several countries sought to recruit students (Australia – although tricky – given lack of training, Netherlands), retirees (Netherlands), people who were not able to work during lockdowns – flight attendants, restaurant workers (Sweden), voluntary sector (S.Korea, Israel). Some countries, like Australia, used online platforms to support the recruitment drive.
There have been concerns that staff recruited in this way did not have appropriate training and experience.
Increased involvement of family carers in formal care:
South Korea, for example, increased support to family carers who were already very involved in care provision.
Re-deployment of staff from low infection areas to high infection areas
There are examples of this in S.Korea and among large care providers in Australia.
Relaxation of requirements in terms of qualifications, visa, etc.
For example in Germany and Turkey.
Information systems to monitor the staffing situation
Denmark and Sweden added the reporting of COVID-19 infections to the list of workplace injuries to better monitor the situation (Denmark, Sweden).
Several countries where Ministries of Health did not previously have oversight over the care sector increased their oversight to better document and understand who is working in LTC and where they are working (Canada).
Measures to support care providers facing acute staff shortages:
As well as financial support, in many countries there are rapid response teams or “strike teams” available to be deployed to care homes that are experiencing large outbreaks or severe workforce shortages (see section 3.06.01).
Andersen L.E., Tripp L., Perz J.F., Stone N.D., Viall A.H., Ling S.M., Fleisher L.A. (2021) Protecting Nursing Home Residents from Covid-19: Federal Strike Team Findings and Lessons Learned. NEJM Catalyst. DOI: 10.1056/CAT.21.0144
International reports and sources
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: Charlesworth and Low, 2020; DoH).
Due to surge of Omicron, is also stipulated that to the extent reasonably possible, personal care workers must not provide personal care to residents at more than one aged care facility in South Australia.
Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020. https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf
Last updated: January 19th, 2022
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: January 6th, 2022
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: March 3rd, 2022
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/). Denmark also provided financial help to LTC facilities to recruit unemployed or former LTC workers, as well as providing financial help to LTC facilities to recruit LTC students (Source: OECD paper).
Last updated: January 26th, 2022 Contributors: Joanna Marczak |
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: January 12th, 2022 Contributors: Joanna Marczak |
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/).
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).
Care strengthening bill
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.
Increase of minimum wage for care workers & ‘pandemic-bonus’
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 (Lorenz-Dant, 2020). 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).
Emergency childcare for essential workers
While children of staff working in system relevant jobs (including health and LTC) could access emergency childcare, there have been demands to expand available childcare services to reflect the demands on care workers (Presseportal, 2021; Ministerium für Kultus, Jugend und Sport Baden-Württemberg, 2020).
Financial support towards catering costs
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 (Lorenz-Dant, 2020).
Access to regular testing
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 (BIVA Pflegeschutzbund, 2022)
Initiatives to recruit care workers
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) (Lorenz-Dant, 2020). In addition, some staffing rules and operational frameworks were relaxed (Langins et al., 2020).
BIVA Pflegeschutzbund (2022) Besuchseinschränkungen in Alten- und Pflegeheimen wegen Corona. Available at: https://www.biva.de/corona-im-pflegeheim/besuchseinschraenkungen-in-alten-und-pflegeheimen-wegen-corona/#bw
Langins, M., Curry, N., Lorenz-Dant, K., Comas-Herrera, A. & Rajan, S. (2020) ‘The COVID-19 Pandemic and Long-Term Care: What can we learn from the first wave about how to protect care homes?’ Eurohealth, 26(2). Available at: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf
Lorenz-Dant, K. (2020) Germany and the COVID-19 long-term care situation. LTCcovid, International Long Term Care Policy Network, CPEC-LSE, 26 May 2020. Available at: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf (Accessed 3 February 2022)
Ministerium für Kultus, Jugend und Sport Baden-Württemberg (2020) Notbetreuung wird vom 27. April 2020 an erweitert. Available at: https://km-bw.de/,Lde/Startseite/Service/2020+04+20+Notbetreuung+wird+vom+27_+April+2020+an+erweitert (Accessed 3 February 2020).
Presseportal (2021) Pflegekräfte stärken bedeutet auch Kinderbetreuung sichern bpa fordert bessere Notbetreuungsangebote für Kinder von Pflegenden in Nordrhein-Westfalen. Available at: https://www.presseportal.de/pm/17920/4816116 (Accessed 3 February 2022)
Last updated: February 12th, 2022
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
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: January 6th, 2022
Reports of increased volunteerism to assist NGOs and care sector staff are available, although there is limited information on formal processes (source: Haaretz).
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 center was established to support LTC facility managers with medical and management advice (source: EuroHealth, 2020)
The Government also enacted emergency measures to ensure the availability of migrant home care workers in Israel. As of July 20th, 2021, the work permit of 3,000 migrant home care workers was extended to ensure continued care for older people during the pandemic (source: The Marker).
This regulatory ease did not solve the shortage of foreign workers in the field of LTC because this guideline does not apply to a foreign worker in case the care receiver named on the working permit dies. In this case, the work visa of the foreign worker is revoked, denying the legal frame to go work for another patient. At the same time, the state did not approve the entry of new foreign workers into the country, so the shortage of foreign workers (which existed before the epidemic) only worsened. The lack of thousands of foreign workers impacted the demanded wages of the caregivers, and families report wage demands that may reach as much as NIS 15,000 a month, which has made the care impossible for many families (source: The Marker).
During the first and second waves of the pandemic Long Term Care Facilities experienced a severe shortage of nurses due to both the effect of Covid-19 on the overall population and specific dynamics of LTC sector (high level of burnout, low commitment, preference to work in other care settings when possible). No support was provided in this respect to care providers from public authorities, and single institutions implemented corporate actions to try to guarantee care standards (i.e. transfer of care workers from one unit to another, transfer from different regions, collaboration with other care providers, relocation from care settings closed during lockdown).
With respect to measures addressed to staff in the LTC sector, it is noted that Regions have mainly focused on giving very operational and peremptory indications on the use of PPE, without giving space to training and emergency management preparation practices. There is variability between more general indications provided to the staff of the organisation (e.g. Piedmont) and cases in which the indications have been provided in detail for the individual professional figures (e.g. Tuscany). Once again, the issue of training of care workers and not of care homes has been delegated to the local level and managed by each structure or in conjunction with the healthcare companies. Also in this case, most attention was on the issues of isolation and containment of cases both by limiting movement and through the use of devices, without due attention to what the staff of the facilities could and should have done during the emergency or to any greater or different need for staff.
Generally speaking, this situation negatively impacted the wellbeing and job satisfaction of care workers. Moreover, in 2021, the Italian NHS and LTC sector in facing a massive shortage of care workers due to lack of vocational training and the absence of professionals (source: Amnesty International Italy, 2021).
A recent study by the OECD, published in October 2021, reported that during the first wave of the Covid-19 pandemic, Japan not only prolonged LTC foreign workers’ contracts and visas, but it also offered them special rewards. Moreover, Japan assisted LTC workers’ mental well-being while providing them free services for psychological support.
Rocard, E., P. Sillitti and A. Llena-Nozal (2021), “COVID-19 in long-term care: Impact, policy responses and challenges”, OECD Health Working Papers, No. 131, OECD Publishing, Paris, https://doi.org/10.1787/b966f837-en.
Last updated: November 24th, 2021
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: January 26th, 2022 Contributors: Joanna Marczak |
Since the start of Covid-19, Norway financially contributed to the recruitment not only of numerous LTC workers, but also of students, and former LTC workers. Moreover, Norway adopted additional emergency strategies as it prolonged LTC foreign workers’ visas and modified the allowance of working hours for LTC staff members within their facilities.
Rocard, E., P. Sillitti and A. Llena-Nozal (2021), “COVID-19 in long-term care: Impact, policy responses and challenges”, OECD Health Working Papers, No. 131, OECD Publishing, Paris, https://doi.org/10.1787/b966f837.
Last updated: January 6th, 2022 Contributors: Elisa Aguzzoli |
During the pandemic, the central government increased the remuneration of medical and nursing staff in LTC sector, there was also an increase in sickness benefit of medical and care employees during quarantine and isolation in response to high infection risk they face in every-day work ( (source: Ageing policies – access to services in different EU Member States). To address workforce challenges which were brought to attention during the pandemic, experts recommended investment in the training and employment of nursing and care staff. For example, it was recommended that additional educational activities should be offered to trainees (e.g. trainee nurses in LTC), taking into account the apprenticeship of foreign workers. For current employees, it was recommended that training is provided regarding the application of new technologies in LTC sector, as well training to assure the necessary minimum knowledge in the field of psychology, public health (disease prevention), medicine and digitization. Recommendations were also issued to revise the standards, working conditions and increasing wages in LTC sector, to incentivise and address workforce shortages in LTC sector (source: Alert Zdrowotny 3).
In response to the pandemic, local authorities introduced regulations restricting employment of LTC staff to a single facility, and made efforts to enable isolation of staff and residents within the facility (source: ESPN Flash Report 2020/43).
There have been multiple measures to support care sector staff and ensure workforce availability in South Korea.
In order to minimize the risk of care workers to be infected with COVID-19, 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.
There were steps to address worker shortages by seeking volunteers and paying family carers, and, in areas of 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.
A study by the OECD highlights that health workers in Korea were rewarded with a special bonus, and received a permanent increase in their salaries. LTC workers who showed mild Covid-19 symptoms also received paid leave which was often approved by the facility’s manager. Korea has defined and categorized Covid-19 as an occupational disease.
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: ).
Rocard, E., P. Sillitti and A. Llena-Nozal (2021), “COVID-19 in long-term care: Impact, policy responses and challenges”, OECD Health Working Papers, No. 131, OECD Publishing, Paris, https://doi.org/10.1787/b966f837-en.
Last updated: November 25th, 2021 Contributors: Elisa Aguzzoli |
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: January 6th, 2022
In Slovenia, medical teams were deployed to residential care settings 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: January 12th, 2022
In response to concerns about availability staffing linked to the spread of the Omicron variant, on the 30th December 2021 the Territorial Council for Social Services approved a provisional relaxation of the criteria required to recruit social care staff.
Last updated: January 13th, 2022 Contributors: Sara Ulla Díez |
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: January 12th, 2022 Contributors: Joanna Marczak |
Case Study of a Care Home in Istanbul (Özten et al, 2021)
A report describes successful pandemic response measures in a nursing home in Istanbul (one of the biggest in the country). Among other strict preventative measures to protect staff and residents, were the implementation of a 15-day shift plan, regular PCT testing and temperature checks, restricted access for staff to different areas of the building, and an assigned quarantine ward for any residents with suspicious symptoms.
Psychosocial support was also offered to staff, in order to mitigate stress and anxiety that may arise from being on-site and away from family for 15 day periods: for example, group communication therapies were offered, and staff were encouraged to use video calling technology to retain contact with their families (Özten et al, 2021)
Özten O, Aytekin Akta? T, Süer H, Do?an H, Üner A, Özp?nar S, Ayy?ld?z Y, Bekta? H, Saka B. 2021. A 15-day Working Shift Prevent the Cross-contamination of Coronavirus Disease-2019 in a Nursing Home in Turkey. Eur J Geriatr Gerontol 2021;3(3):131-133
Last updated: January 26th, 2022 Contributors: Daisy Pharoah |
Overview: A Timeline
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.
On March 19, 2020, social care staff were designated as ‘key workers’ to enable them to continue to access childcare once schools were closed. On May 6, 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.
On May 11, 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.
On 15 May, 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.
On October 1, 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.
On January 17, 2021, DHSC announced a £120 million Workforce Capacity Fund to help local authorities to boost staffing levels. 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.
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.
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 individual 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.
In October 2021 the DHSC launched a national recruitment campaign highlighting the positive aspects of working in the social care sector. There are other measures in place to facilitate rapid recruitment to the sector, such as recruitment guidance and resources by Skill for Care (RecruitmentReady), and free rapid online induction and refresher training.
The Capacity Tracker, a web-based digital insight tool and the Adult Social Care Workforce Dataset are being used to monitor the situation. As of November 2021 the vacancy rate in social care was 9.2%
Published on November 3, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This will provide £162.5 million through the workforce recruitment and retention fund to support local authorities and providers to recruit and retain sufficient staff over winter, and support growth in workforce capacity of the existing workforce, until 31 March 2022.
The DHSC has made available guidance and resources to support the wellbeing of people working in health and social care, including a collaboration with charities that provide mental health support, and a risk reduction framework for providers to reduce the risk of infection for staff working in social care.
To release the recruitment pressures (old and new pressures stemming from the new wave of Omicron), in December 2021, the government announced that care workers, care assistants and home care workers will be added to the Shortage Occupation List as part of the health and care visa to make it quicker, cheaper and easier for social care employers to recruit eligible workers to fill employment gaps. The changes are planned to come into effect early 2022, initially for a period of 12 months. The inclusion on the Shortage Occupation List will stipulate an annual salary minimum of £20,480 for carers to qualify for the Health and Care visa and it will allow applicants and their dependents to benefit from fast-track processing, dedicated resources in processing applications and reduced visa fees.
The adult social care – winter preparedness plan: 2021-22 sets out the measures that will be applied across the adult social care sector to meet the challenges over the winter 2021 – 2022. This states that the government are supporting a national recruitment campaign with a focus on social media and a younger audience, and working to establish minimum terms and conditions for existing staff. A budget of £12 billion, an increase of £7 million on last year, is being provided to support the wellbeing of health and social care staff. This includes targeted support to the primary and community care and social care workforce of £2 million.
A workstream will be developed on the wellbeing of those working in social care/social work as part of the new National Wellbeing Programme to be implemented from autumn 2021. The Workforce Specialist Service, launched in February 2021, also provides tailored, confidential mental health support to regulated staff across the NHS and social care workforces.
Up to £48 million of funding will be made available to enable employers to update the hourly rate of Adult Social Care Staff offering direct care. The funding will enable an increase from at least £9.50 per hour to at least £10.02 per hour, which will take effect from December 1, 2021.
The Social Care Staff Support Fund has been extended to the end of March 2022 to continue to ensure that social care workers who are ill with COVID-19, or self-isolating in line with public health guidance, receive their normal income for that period.
Results from a survey collected in early 2020 from 163 care staff across the UK illustrated concerns about workforce shortages and availability have been reported as a major factor for poor mental well-being and a general negative experience of working in care in the early stages of the pandemic. Another cause for stress and anxiety was the increased workload, which is likely to be due to extra measures taken to reduce the spread of the virus and increased staff absences (The Queen’s Nursing Institute, 2020).
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 24th, 2022 Contributors: Daisy Pharoah |
A survey of 11,920 nursing homes (NH) in May 2020 found that 15.9% reported shortages of licensed nurse staff, 18.4% of nurse aides, 2.5% of clinical staff and 9.8% of other staff. The study found that staff shortages were associated with COVID-19 related factors: NHs with any case of COVID-19 among residents or staff were more likely to experience staff shortages. NHs with more supplies of Personal Protection Equipment (PPE) were less likely to report staff shortages. Also, NHs with higher staffing levels (particularly higher ratios of registered nurses) were less likely to report shortages (Xu et al., 2020).
The KFF Health Systems Tracker reports that average earnings rose by over 14.7% between February 2020 and October 2021, from $669.90 to $768.56 per week. Wages of home healthcare workers rose by 13.8% from $586.46 to $667.28. This is in the context ongoing declines in the numbers of people working in this sector, which accelerated during the pandemic.
Xu, H., Intrator, O., & Bowblis, J. R. (2020). Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?. Journal of the American Medical Directors Association, 21(10), 1371–1377. https://doi.org/10.1016/j.jamda.2020.08.002)
Last updated: January 6th, 2022
Contributors to the LTCcovid Living International Report, so far:
this list is regularly updated to reflect contributions to the report, if you’d like to contribute please email firstname.lastname@example.org
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.