Expanded and unclear responsibilities: the evolving role of home care workers as a lifeline during the COVID-19 pandemic -a focus group interview study

Home care services, with the aim to support older adults in their homes, faced intense external pressure to create sustainable working conditions for staff during the COVID-19 pandemic. Studies have indicated elevated burnout and stress among residential care staff, and it is likely that similar challenges exist in home care services. Overall, the consequences for staff's work environment and health under the extremely strained conditions of the COVID-19 pandemic merit closer examination. Therefore, the aim is to illuminate home care workers’ experiences of their work environment and health risks while supporting older adults during the COVID-19 pandemic. To gain an in-depth understanding of personal experiences during the pandemic, five focus group interviews (FG) were held in northern Sweden during spring 2022. Open-ended questions were delivered via a semi-structured interview guide. Thematic analysis was used to guide data analysis. Expanded and unclear responsibilities characterized the work environment during the pandemic. This was summarized into four sub-themes: my own health was jeopardized; a wind of change towards more responsibility; struggling between being a lifeline and being contagious; and organization and management as facilitators or hindrances. The findings underscore the importance of management strategies and organizational preparedness to support staff’s mental health and mitigate challenges during crises. The health risks associated with increased workload, stress, and mental burdens were evident in the narratives. The study emphasizes the need to strive for a good work environment, set priorities to reduce workloads and mental stress, and incorporate time for recovery among staff during crises. It is also of great importance that different authorities in healthcare and social care create effective cooperation so that information, knowledge, and policies are effectively disseminated to frontline staff who have the concrete responsibility for our elderly.