Strategies to support social care workers during COVID-19: a global scan of responses to severe staffing challenges

All over the world, COVID-19 has placed huge demands and stresses on social care workers – but what kinds of policy initiatives have been attempted to support them? This global scan by IPPO partners INGSA and the Blavatnik School of Government focuses on a wide range of approaches, from economic incentives and physical and mental health support to ad hoc immigration measures

Burnout, anxiety, stress and fatigue

Social care workers have been at the forefront of workforce challenges posed by COVID-19 from the outset of the crisis, experiencing exhausting workloads and often harrowing experiences amid heightened personal risk of contracting the virus. Given the widespread shortages of care staff that already existed before the pandemic struck, this has led to them – along with healthcare workers – reporting and exhibiting dramatically increased levels of burnout, anxiety, stress and fatigue (World Health Organization, 2021).

So how have different countries around the world responded to the social care staffing challenges posed by the pandemic? This research scan highlighting notable social care workforce strategies around the world focuses on a range of different types of policy initiative, which we have divided into the following categories:

  • Economic incentives;
  • Physical and mental health support for care workers;
  • Provision of vaccines and personal protective equipment (PPE) to care workers;
  • Increased staffing levels and measures to tackle staff shortages;
  • Ad-hoc immigration measures; and
  • Childcare support.

Information on these policy initiatives was collected through the Oxford COVID-19 Government Response Tracker (OxCGRT) and the International Network for Government Scientific Advice (INGSA) databases and contributor networks.

Overview of findings

Several states in the United States and Canada have implemented wage supplements or wage increase programmes for workers in long-term care facilities, personal care homes and other social care workers. In other US states such as Illinois, social care staff were offered financial incentives to encourage them to get COVID-19 vaccinations. In California, the Skilled Nursing Facility Hero Awards Program was launched, which provides a one-time $500 stipend for licensed vocational nurses (LVNs) and certified nurse assistants (CNAs). Other countries, such as Austria, have offered financial bonuses for social care workers that came from abroad.

A few countries have sought to mitigate the impact of the COVID-19 pandemic on care staff’s physical and mental health. For example, Denmark declared a COVID-19 infection a work-related injury that carries entitlement for compensation. Sweden, Slovakia and the Channel Islands have all provided mental health support for social care workers affected by the COVID-19 pandemic.

Several countries have implemented vaccine mandates or provided additional PPE equipment. In Canada, Croatia and Denmark, for example, healthcare staff are required to undergo regular COVID-19 testing. In several states in the US and also in New Zealand, workers in residential care facilities and other various healthcare facilities are encouraged or required to get the COVID-19 vaccination.

Multiple countries have also sought to limit the impact of staff shortages in their social care workforce strategies. For example, some provinces and states in Canada and the US have established training programmes for positions as certified nursing assistants or personal support workers in health care facilities. Other countries and states, such as India and the US state of New York,have hired nursing students to mitigate staff shortages during the COVID-19 pandemic. Austria and Italy implemented additional ad-hoc immigration measures for social care workers from abroad.

1. Economic incentives

In Australia, the government set up an incentive payment package for residential and home care workers continuing to provide direct care services during the pandemic. This includes nurses, allied health workers, and personal care workers, as well as workers providing domestic care, meal and shopping services, respite services, and social, community access and transport support.

In Austria, on 31 March 2020 the regional government of Upper Austria announced a 1,000 bonus for live-in migrant care workers who choose to stay in Austria. This policy was then standardised at a federal level, and all care workers who remained in the country were offered a bonus of 500. In response to reduced staffing levels and increased demand due to the COVID-19 pandemic, this policy aimed to retain as many live-in migrant care workers as possible.

In Canada, the state of Saskatchewan implemented a Temporary Wage Supplement Program targeting workers in long-term care facilities, personal care homes and other social care workers. The programme aimed to provide CA$400 a month for two months.

Finally, looking at policies across the United States:

  • In April 2020, California’s Office of Statewide Health Planning and Development launched the Skilled Nursing Facility Hero Awards Program. This provides a one-time $500 stipend for licensed vocational nurses (LVNs) and certified nurse assistants (CNAs) that are currently working in a skilled nursing facility (1, 2).
  • On 21 September, Colorado’s Joint Budget Committee approved a wage increase for the state’s direct care workers. Beginning January 1, 2022, minimum wage for direct care workers will be raised to $15 an hour. This policy will apply to direct care workers funded with any state dollars working in-home and community-based settings. It is said to benefit workers including personal care workers, homemakers, direct support professionals, and others who provide direct, hands-on care. This wage increase is aimed at attracting and retaining caregivers. Colorado has the second fastest-growing aging populations in the country. By 2040, the state expects 1 in 4 people to be over the age of 60. Wage increases are a small step in addressing staff satisfaction and retention (1, 2, 3).
  • McLean County, Illinois is providing financial incentives to encourage COVID-19 vaccination among healthcare staff, with bonuses ranging from $500 to $1000. Moreover, as of April 1, eligible in-home care providers will receive retroactive pay and wage increases. One-time bonus payments will be issued to certain providers for services provided from January 1 through March 31, 2021. In addition, a rate increase effective January 1, 2022 will increase minimum wage to $15 an hour.
  • In 2020, Michigan governor Gretchen Whitmer enacted a temporary wage increase for direct care workers. The $2 per hour increase includes social care-workers who provide direct patient care at nursing facilities, licensed home for the aged, or adult foster care facility and front line workers employed by child caring institutions. In March 2021, the Michigan legislature supported an extension of this initiative, supporting a $2.25/hour wage increase through the end of September.
  • In April 2020, New Hampshire established a stipend programme to incentivise nursing home staff and frontine workers working during the pandemic. This was designed to address staff shortages in nursing homes.

2. Physical and mental health support for care workers

In Barbados, guidelines were established aimed at protecting paid domestic workers to reduce transmission risks in the workplace, including physical distancing and hygiene guidance, and a requirement that employees absent from work due to suspected COVID-19 cannot be required to return to work unless cleared by a Medical Officer of Health. Householders who are experiencing symptoms of COVID-19 cannot force or require domestic workers to report for duty.

In the Channel Islands, in May 2020 increased mental health support was provided to social care workers. This measure was intended to help mitigate additional pressures brought by the COVID-19 pandemic.

In Denmark, a COVID-19 infection among long term care staff is listed as a work-related injury. This policy entitles care workers to claim workers’ compensation in the case of COVID-19 infection that likely occurred in the workplace.

In Malta, care home staff had to voluntarily opt for a live-in, and facilities had to ensure adequate sleeping arrangements, provision of food, family skype calls and psychological sessions. Facilities who had opted for live-in arrangements either followed a 2 or 3 weekly rota. Staff were advised on mandatory swabbing prior to entering the facility for the live-in period that was coordinated by the Public Health Authority. Other care homes opted to stay in lockdown (a total of 12 weeks) until the ease of measures from the Public Health Authority. There was an increase in expenses with staff working for longer hours and living away from their loved ones that was compensated by the care homes.

In New Zealand, staff are provided with access to psychosocial, cultural and welfare support in order to support their wellbeing. The government also provided temporary accommodation options for health and disability workers living with a vulnerable person. A new phone counselling service for frontline workers was established, as well as a special COVID-19 clinical advice line for community health providers.

In Slovakia, the government launched a policy aimed at protecting the health and improving the mental wellbeing of care workers due to potential additional pressure due to the COVID-19 pandemic.

Sweden’s regions received a total of SEK 500 million for crisis support, talk support or trauma support for staff in welfare services.

In the United States, in April 2020 the state of California offered no-cost or low-cost hotel rooms to workers that were at high-risk of exposure to COVID-19 or tested positive for the virus.

3. Provision of vaccines and PPE to care workers

In Australia, all residential-aged care workers were required to be vaccinated by September 2021 as a condition of working in a residential aged care facility. Incentive payments were established for primary care vaccination providers administering an in-reach clinic in a residential aged care or disability care setting. Funding included a AU$1,000 payment once a minimum threshold of 50 unvaccinated residential aged care or disability support workers (cumulative) were vaccinated (1 dose) at an in-reach clinic, and an additional AU$20 for every dose provided to an unvaccinated residential aged care or disability support worker thereafter.

In Canada, the government of Manitoba announced mandatory rapid testing for designated frontline workers that are not fully vaccinated commencing 18th October 2021.

In Costa Rica, social and health workers were the first group of professionals to receive the COVID-19 vaccination.

In Croatia, all health and social care workers require vaccination or a negative COVID-19 test, or risk being unable to work. This policy comes in light of rising infection rates.

In the Czech Republic, in November 2020, staff of residential care homes received 3 million additional FFP2 masks. The policy intended to provide additional protection to care workers in high risk environments.

In Denmark, all care home staff are required to take weekly PCR tests; unvaccinated staff are required to take two tests a week. This policy aims to curb the spread of infection among workers, and between care workers and residents.

In New Zealand, workers in residential care are required to get their first dose of the COVID-19 vaccine by 30 October 2021, and be fully vaccinated by 1 December 2021. Staff are provided with refresher training and updated PPE recommendations based on the latest international experience, research and guidance.

In the United States, several states issued vaccine mandates for staff. Specifically:

  • On 5 August 2021, California issued a vaccine mandate requiring workers in various healthcare settings to receive their vaccinations by September 30 (1, 2).
  • Colorado vaccination mandates are in place for health and social care workers at facilities including assisted living homes, nursing homes and hospitals. All workers must be vaccinated by 31 October. After that, hospitals and other facilities are not allowed to hire unvaccinated staff (1, 2).
  • Effective 18 August 2021, Maryland mandated vaccination (2) to all workers in hospitals and nursing homes. All employees must show proof of vaccination or be subject to regular screening and testing. Nursing homes that fail to comply will face doubled fines, increased civic penalties and tougher law enforcement actions.
  • On 16 August 2021, outgoing New York Governor Andrew Cuomo announced that all healthcare workers in New York State would be required to be vaccinated against COVID-19 by 27 September.

4. Increased staffing levels and measures to tackle staff shortages

In Canada, Ontario launched a CA$115 million worth new college programme aimed at training more than 8,200 new Personal Support Workers for roles in the health and long-term care sector.

In India, the state of Himachal Pradesh hired nursing students with the monthly incentive of Rs 6000 and healthcare students for Rs 10,000 due to shortages of healthcare workers in the state.

In the Netherlands, a large IT-platform was launched to match healthcare personnel with healthcare providers in need of help. This platform is for the entire healthcare system, including long-term care and seeks to bridge staffing shortages and capacity concerns and a collaboration of trade associations, unions, regional employer organisations, professional associations, private initiatives and the Ministry of Public Health, Welfare and Sports.

In New Zealand, a special Accommodation Assistance Fund was established for health and disability workers to access if they needed to be deployed to other parts of the country to backfill workers or to provide additional support.

Within the United States:

  • In April 2020, California committed to supporting long-term care staff members during the pandemic. Efforts included retraining 600 nurses to support facility compliance with COVID-19 guidance, working to decompress facilities to slow the spread of COVID-19, and reaching out daily to skilled nursing facilities to assess needs and challenges.
  • In Illinois, Malcolm X College is offering a free, eight-week CNA (certified nursing assistant) course for Chicago residents.
  • Maryland’s General Assembly passed a bill (2, 3) that created a direct workforce grant initiative dubbed the Direct Care Workforce Innovation Program. It will provide matching grants up to $50,000 to expand successful recruitment strategies in the healthcare sector.
  • New Hampshire launched an initiative in mid-2020 entitled ‘New Hampshire Needs Caregivers!‘ (1) to help individuals start a healthcare career as a Licensed Nursing Assistant (LNA) at a nursing home. The initiative aims to address problems exacerbated by the COVID-19 pandemic, including training outside of nursing homes and care facilities. Moreover, the state is planning to hire a recruiting firm to tackle the problem of staff shortages.
  • Anticipating staff shortages due to the vaccine mandate coming into effect at the end of September 2021, New York Governor Kathy Hochul released a comprehensive plan that includes declaring a state of emergency to allow healthcare professionals licensed outside of New York, as well as recent graduates and retirees, to practice. Other options include deploying medically trained National Guard personnel, working with the federal government to send Disaster Medical Assistance Teams to local health systems.

5. Ad-hoc immigration measures

In Austria, on 30 March 2020 the regional government of Lower Austria chartered a flight for 281 temporary care workers from Bulgaria and Romania to Vienna. These care workers were brought in to mitigate staff shortages due to the COVID-19 pandemic.

In Italy, a special temporary regularisation of domestic and care workers was enacted in May 2020 to avoid labour shortages. This regularisation scheme provided pathways for undocumented migrant workers to formalise their positions and seek either government support or formal work contracts.

6. Childcare support

In Cuba, free and accessible care is guaranteed for the primary school-age children of healthcare workers.

In Tennessee, the COVID-19 Essential Employee Child Care Payment Assistance programme provides financial support to essential worker families, including workers at  long-term care facilities, social workers, support workers, and care workers.

Global scan authors

Martina Di Folco, Annalena Pott, Naomi Simon-Kumar, Toby Phillips, Tatjana Buklijas, Lucas André Almendra, Sakina Bano Mendha, Alexandra Boothroyd, Sam Aboubacar Coulibaly, Yago Evangelista Tavares de Souza, Arlette Kayembe, Im Chiew Ng, Caitlin Sarro, Farah Sayad, Saba Ul-Hasan, Mirava Yuson, Hui Zhou.

Highlighted care workforce measures by country

COUNTRY SUMMARY
Australia
  • All residential care workers require vaccination. Incentive payments for primary vaccination providers for vaccinating residential aged care and disability support workers.
  • Incentive payment package for care workers.
Austria
  • Bonuses for live-in migrant care workers, first on a regional, then on a federal level.
  • The country also chartered an airplane to transport healthcare workers from abroad.
Barbados
  • Specific health guidance for the protection of domestic workers.
Canada
  • Temporary wage supplement programme for workers in healthcare facilities and mandatory rapid testing.
  • In Ontario, a new college programme for training healthcare workers launched.
Channel Islands
  • Additional mental health support.
Costa Rica 
  • Social and healthcare workers were among the first to be vaccinated.
Croatia
  • All care workers require vaccination or a negative COVID-19 test.
Cuba
  • Free care services for the children of healthcare workers.
Czech Republic
  • Provision of 3 million additional FFP2 masks for staff of residential care homes.
Denmark
  • COVID-19 infections among long-term care staff are listed as workplace-related injuries. All care home staff are required to take weekly or bi-weekly PCR tests.
India
  • Nursing students were hired in the state of Himachal Pradesh.
Italy
  • Regularisation scheme for undocumented migrant workers was put in place.
Malta
  • Live-in arrangements for healthcare staff.
New Zealand 
  • Workers in residential care homes are required to be vaccinated.
  • Ongoing psychosocial, cultural and welfare support for workers in care roles.
  • Refresher training and PPE guidance provided to staff at residential facilities.
  • Temporary accommodation for health workers.
Slovakia
  • ‘StressHelp’ programme provides additional mental health support to care workers.
Sweden
  • SEK 500 million for crisis support to health and social care staff.
United States
  • California: Launch of Skilled Nursing Facility Hero Awards Program. No-cost or low-cost hotels for healthcare staff. Vaccinate mandates for healthcare workers.
  • Colorado: Wage increase for state-direct healthcare workers. Vaccination mandates are in place for healthcare workers.
  • Illinois: Financial incentives for COVID-19 vaccination of healthcare workers. Malcolm X College provides free CNA courses.
  • Michigan: Temporary wage increase for healthcare workers.
  • New Hampshire: Creation of stipend programme and launch of an initiative that seeks to help individuals start a career in healthcare.
  • Maryland: Creation of direct workforce programme. Maryland also mandates vaccination for healthcare workers.
  • New York: Requirement for healthcare workers to be vaccinated. Implementation of a comprehensive plan to mitigate staff shortages.