Impact of COVID-19 on Domiciliary Care Workers in Wales: The OSCAR Qualitative Study, 2021

To obtain a free account please register with the UKDA.

This qualitative sub-study was embedded in the broader data linkage OSCAR study which aimed to assess the health impact of working during the COVID-19 pandemic upon domiciliary care workers (DCWs) in Wales, UK. The qualitative study aimed to explore care worker experiences during the pandemic. We explored factors that may have varied the risk of exposure to COVID-19 as well as adverse health and wellbeing outcomes. Registered DCWs working in Wales were invited to take part in a semi-structured telephone interview. In total, 24 DCWs were interviewed between February and July 2021. Emergent themes were identified through a process of inductive analysis using thematic coding. Several emergent themes related to risk of exposure to COVID-19. General changes to the role of the DCW during the course of the pandemic were identified. Practical challenges for DCWs in the workplace were also reported. These included reports of staff shortages, clients and families not following safety procedures, initial shortages of personal protective equipment (PPE), problems with standard use PPE, client difficulty with PPE and the management of rapid antigen testing. A general lack of government/employer preparation for a pandemic was described. This included the reorganisation of staff clients and services, sub-optimal information for many DCWs, COVID-19 training and the need for improved practical instruction and limited official standard risk assessments specifically for DCWs. Pressures to attend work and DCW’s perception of COVID-19 risk and vaccination were reported.

Domiciliary Care Workers (DCWs) are employed in both public and private sectors to support adults at home. The support they provide varies but often includes personal care, which demands close contact between care worker and the person being supported. Since the start of the COVID-19 pandemic, people working across the care sectors in England and Wales have experienced higher rates of death involving COVID-19 infection. Social care workers, in both residential and domiciliary care settings, have been particularly badly affected, with rates of death involving COVID-19 approximately double that for health care workers. We do not fully understand the full impact on domiciliary care worker mortality, how COVID-19 has affected worker health more broadly, and the risk factors which contribute to these. Existing evidence on deaths from the ONS relies on occupational classification. However, for many individuals reported as dying with some COVID-19 involvement, information on occupation is missing (18% and 40% missing for males and females respectively). The impact of COVID-19 on the health of domiciliary care workers (DCWs) is therefore likely to be considerable, including on COVID-19 infection itself, mental health, and respiratory illnesses. We aim to generate rapid high-quality evidence based on the views of care workers and by linking care workers' registration data to routine health data. We can use this information to inform public health interventions for safer working practice and additional support for care workers. Our study will use a combination of research methods. We will use existing administrative data involving carer professional registration records as well as health care records. Our analysis of these data will be guided in part by qualitative interviews that we will conduct with domiciliary care workers in Wales. The interviews will address the experiences of care workers during the course of the pandemic. Registration data for care workers in Wales will be securely transferred from the regulatory body, Social Care Wales (SCW) to the Secured Anonymised Information Linkage (SAIL) Databank at Swansea University. These data will be combined with anonymised health records made available from the SAIL databank. Information which could be used to identify individual care workers will be removed in this process. We expect that this will create a research database of all domiciliary care workers in Wales, approximately 17,000 individuals. From this group we will also identify about 30 care workers to be approached via SCW to take part in a qualitative interview. The interview sample will be chosen so that it includes workers from a variety of backgrounds. In our analysis, we will describe the socio-demographic characteristics of the group of care workers in the research database, for example, their average age. We will establish the number of care workers with both suspected and confirmed COVID-19 infection. Will explore how infection with COVID-19 has impacted on key health outcomes, including whether workers were admitted to hospital or died. We will also explore the health of care workers before and during COVID-19 pandemic. We will use the information gained from interviews with care workers to guide the way we analyse the health records of the care workers. Finally, we will examine how well the results from our analysis of care workers in Wales can be used inform what may be happening for workers in other countries in the UK. To ensure that our findings will be of most use to those working in social care, we will work with an Implementation Reference Group. The group will include key stakeholders such as representatives from regulators from across the UK. Working with this group, we will provide rapid recommendations to drive public health initiatives for care worker safety. This may include changes in working practices and longer-term service planning to support care worker health needs.