Exploring post-pandemic policies on staff testing, sickness pay and absence related to COVID and respiratory infections in English care homes

Abstract Background Residents of care homes for older people are at risk of illness and hospitalisation from respiratory infections. Care home industry pay and conditions may contribute to the risk that staff will transmit infection to residents at times when respiratory viruses are circulating. We sought to understand post-pandemic care home providers’ policies and practices on care home testing for COVID-19, sickness absence due to respiratory infections and consequent shift backfill in English care homes, and to explore the costs to providers of outbreaks of respiratory infections. Methods In mid-2024, we interviewed 11 senior managers from 10 privately owned care homes or care home groups across England providing services to older people. The sample was diverse in terms of region, size of provider and Care Quality Commission rating. Interview transcripts were analysed using the framework approach and findings tabulated. Results At the time of the interviews, none of the care homes conducted asymptomatic COVID-19 testing. A minority required staff with respiratory infection symptoms to test for COVID-19. Policy for most providers was to only pay Statutory Sick Pay (SSP) to symptomatic staff. Few offered enhanced sickness pay. Care homes backfilled vacant shifts by offering other employed staff the extra shifts, calling in internal bank staff, zero-hours contractors, or care agency staff. Outbreaks of respiratory illness could increase costs for providers in replacement staffing, personal protective equipment, cleaning hours and equipment, additional administrative duties, and loss of income from new residents due to home closure. Conclusions Care homes’ COVID-19 testing and sickness pay policies were in line with current public health guidance on COVID-19 testing and SSP regulations. Pay and conditions have been linked to presenteeism in the social care sector and may contribute to the risks of staff transmission to residents at times when respiratory infections are highly prevalent. Although regular staff testing combined with self-isolation for those who test positive may be effective in reducing transmission of infection, such policies require careful design given the important financial implications for care workers, care home providers and for the wider public health and care sector.