New Publication: Risk Recognition Policies for the Long-Term Care Workforce during the First Year of the COVID-19 Pandemic: A Multi-Country Study


The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community ageing care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. The COVID-19 pandemic has disproportionately impacted residents and staff living and working in long-term care homes. Long-term care homes, commonly known as nursing homes or care homes, are facilities that primarily support ageing adults with functional, social and complex medical needs. By January 2021, long-term care residents accounted for a large proportion of COVID-19 deaths globally, making up an estimated 39% of deaths in the United States (US), 59% in Canada, 34% in the United Kingdom (UK) and 75% in Australia.

This analysis sought to review policy measures targeting the long-term care workforce across seven high-income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work.

Environmental scan of publicly available policy documents and government news releases published between March 1, 2020, and March 31, 2021, across seven high-income jurisdictions.

While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK.

In the first year of the COVID-19 pandemic, policy measures were widely introduced in Canada and Australia in recognition of the increased risks faced by long-term care workers. In the UK, these were only introduced in Wales and Scotland, and in the US these measures were limited to only 11 states during the first year of the pandemic. In addition, there were widespread efforts taken to restrict multi-site work in Canada, the U.K, and Australia to limit virus transmission, though with the uneven implementation of corresponding economic protection measures to compensate long-term care workers for potential income loss. While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes. All seven jurisdictions in this study rely on long-term care workforces that are underpaid, often times precariously employed, and in some circumstances rely on multi-site work arrangements, yet the implementation of compensation and support has been uneven. In particular, there were considerable gaps in the US and parts of the UK in spite of considerably higher levels of risk overall as measured by population-level case counts and mortality than in Canada and Australia. Future studies should consider evaluating the impact of these measures and their effectiveness in reducing income loss among long-term care staff as a result of the pandemic. 

Read the full publication:

Reed, A. C., Murmann, M., Hsu, A., Turnpenny, A., Van Houtven, C., Laberge, M.,Low, L.F., Hussein, S., Allin, S. (2022). Risk Recognition Policies for the Long-Term Care Workforce during the First Year of the COVID-19 Pandemic: A Multi-Country Study. Journal of Long-term Care, (2022), 22–39. DOI:

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Professor of Health and Social Care Policy, the London School of Hygiene and Tropical Medicine, UK

Shereen Hussein is a Professor of Health and Social Care Policy at the Department of Health Services Research and Policy (HSRP) at the LSHTM. She is a Co-Director of the PRUComm policy research unit. She is also an Honorary Professor at the University of Kent and King’s College London in the UK and the University of Southern Queensland in Australia.

Shereen is a demographer with expertise in labour-migration, sociology and economics. Her primary research revolves around ageing, family dynamics, migration and long-term care. Shereen has previously worked with the United Nations, the Population Council, the World Bank, and the League of Arab States. Her current research focuses on ageing demographics, long term care demand and migration within the UK and Europe and the implications on policy and practice.

Shereen has conducted extensive research on population ageing and its impact on long term care and health policy and practices in the UK, internationally and in the Middle East and North Africa (MENA) region. She has contributed to recent United Nations’ policy response to ageing in the region through collaboration with UN-ESCWA and directly providing expert consultations to several countries in the region including Turkey, Oman and Egypt. Shereen leads many large research projects on ageing and long-term care in the UK and contributes to a large project addressing responses to dementia in developing countries STRiDE. Shereen is the founder and lead of the MENARAH network.