Occupational health care for temporary migrant workers using the example of live-in caregivers

In Germany, an estimated 300,000 to 600,000 care workers are employed in so-called live-in arrangements to care for older people. The employment of these people is predominantly in temporary, transnational employment relationships and is characterized by high psychological stress and low social protection. While the precarious working conditions are already the subject of socio-ethical and labor law discussions, there is still a need for research into the lack of occupational health and safety and the integration of these employees into occupational health care.

Project title: Occupational health care for temporary migrant workers using the example of live-in caregivers
Areas of activity: Prevention in the workplace - further developing further develop occupational health care	Funding body: FoGA funding program ("Research on health in the world of work") of the Federal Ministry of Labor and Social Affairs (BMAS) Federal Institute for Occupational Safety and Medicine (BAuA)
Funding format: Research project
Project management: Prof. Dr. med. Andreas Seidler Study coordination: Dr. rer. nat. Melanie Schubert Charlotte Pietzsch Project partners: Prof. Dr. med. Steffi G. Riedel-Heller Prof. Dr. phil. Liane Schenk liane.sc henk@charite.de Prof. Dr. med. Antje Bergmann	Institution: Institute and Polyclinic for Occupational and Social Medicine, Faculty of Medicine, TUD Dresden University of Technology Institute for Social Medicine, Occupational Medicine and Public Health, Faculty of Medicine, Leipzig University Institute of Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin School of Medicine, Faculty of Medicine, TUD Dresden University of Technology
Project teams (in alphabetical order) Berlin: Dresden: Leipzig:	Employees (in alphabetical order) Liane Schenk, Amelie Schirmer Antje Bergmann, Peggy Borchers, Stephanie Drössler, Maria Girbig, Daniel Kämpf, Astrid Klein, Charlotte Pietzsch, Henna Riemenschneider, Lea Scheuvens, Melanie Schubert, Andreas Seidler, Agnieszka Sykut, Verena Weihofen Charlyn Görres, Margrit Löbner, Steffi G. Riedel-Heller, Katja Schladitz, Franziska Welzel
Scientific Advisory Board (in alphabetical order): Prof. Dr. Albert Nienhaus Prof. Dr. Kinga Daria Polańska Dr. Ulrike Rösler Prof. Dr. med. Hajo Zeeb	Institution: German Social Accident Insurance Institution for Occupational Health Services (BGW), Hamburg Nofer Institute of Occupational Medicine, Łódź Federal Institute for Occupational Safety and Health (BAuA), Berlin Leibniz Institute for Prevention Research and Epidemiology, Bremen

Project description:
The cooperation project aims to record the situation of migrant live-in caregivers in Germany - using the example of Polish workers - both from the perspective of the caregivers themselves and from the perspective of occupational health stakeholders. Based on this, tailor-made solutions are to be developed and implemented on a pilot basis in order to realize holistic occupational health care in accordance with Occupational Health Rule 3.3.

Methodology:
In order to achieve the project objectives, qualitative research methods will be used to analyze the problem situation and develop approaches for action (WP1 & WP2). Building on this, a pilot intervention is carried out (WP3).

Situation analysis and needs assessment (WP1):
Guideline-based, partially standardized individual interviews (n=40) will be conducted with Polish live-in caregivers and relevant experts in occupational health care. The work-related hazards of the live-ins, their knowledge of and access to German occupational health and safety, including existing obstacles and challenges, are systematically recorded from different perspectives. Based on the results, specific problems are described and the resulting needs formulated.

Research to Action Lab - generating options for action (WP2):
The interdisciplinary group of participants in the research lab includes the main specialist groups involved in occupational health care as well as key stakeholders and employer and employee representatives. Two group discussions will be held with a maximum of eight participants. The aim is to identify the most suitable solutions for holistic occupational health care in the setting of live-in care for the areas of activity identified in WP1 and thus scientifically prepare the transfer into practice (WP3).

Pilot intervention study (WP3):
The action approaches prioritized in WP2 will be bundled in a model intervention and tested on a pilot basis. The implementation of the intervention will be evaluated (process evaluation). The evaluation will focus on acceptance, feasibility and implementation accuracy in order to identify support factors and obstacles. Finally, transferable elements of the project results will be extracted to enable their application to other transnational employment settings.

Current status

WP1 (completed): The project conducted guided, semi-standardized interviews with 16 live-in nurses and 24 experts on working conditions and occupational health care. After a pre-test, the interviews were translated where necessary, transcribed and qualitatively analyzed using MAXQDA. The results show that many live-in nurses work under precarious working conditions. Employment contracts are often inadequate, legal requirements such as minimum wage and social insurance are sometimes circumvented, and bogus self-employment is widespread. Many care workers are unaware of their rights or are unable to enforce them effectively. In addition, families are often de facto employers without being able to fully meet the legal and financial requirements. Overall, there is only limited access to occupational health and preventive care services.

WP2 (completed): In the Research to Action Lab (hybrid, 12 experts), results from WP1 were presented and the central problems of occupational health care for live-in caregivers were discussed: unclear employment relationships, legal gray areas and a lack of control mechanisms in occupational health and safety. Proposals for action were developed in the workshop and subsequently evaluated by the scientific advisory board using the Delphi method. This resulted in three central intervention recommendations for the pilot study: Information and awareness-raising for caregivers:inside, households and general practitioners:inside on workloads, medical care and occupational health and safety. Comparative literature research on occupational health care in Germany, Switzerland and Austria with derivation of practical recommendations for Germany. Addressing the care of live-in caregivers in occupational health and general medical training and continuing education events

WP3: in progress

For further information:
Project management: Prof. Dr. med. Andreas Seidler, MPH; e-mail:
Project coordination: Dr. rer. nat. Melanie Schubert and Charlotte Pietzsch