Title: Establishing the impact of COVID-19 on the health of domiciliary care workers in Wales: developing a model for UK service planning and carer support
Funder: Economic and Social Research Council

Abstract: Aim: to understand rates of COVID-19 infection and key health outcomes as a consequence of COVID-19 for Domiciliary Care Workers (DCWs) in Wales and to inform service planning and public health policy. Specific objectives 1. Within DCWs: - Quantify rates of suspected and confirmed COVID-19 infection; - Quantify rates of key health outcomes such as mental health contacts, diagnoses, psychotropic medication and admissions, fit notes, non-COVID-19 respiratory related hospital admissions, deaths involving COVID-19 / all-causes of death; - Explore outcome variation by demographics, work-related factors, lifestyle and comorbidities; - Explore changes over time (pre/during COVID-19) to identify the potential excess in respiratory infections not necessarily recorded as COVID-19 (overall influenza-like illness (ILI) / pneumonia / exacerbations of severe asthma / all cause hospital admissions). 2. Undertake qualitative interviews with DCWs to inform the analytic models assessing determinants of COVID-19 infection and key health outcomes. 3. Examine how generalizable the findings of Objective 1 are to other nations.

Lay abstract: 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.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: INFECTION;MENTAL HEALTH;RESPIRATORY