Occupational health risks and provision gaps among live-in caregivers: findings from a qualitative interview study of Polish live-ins in Germany.

Abstract

Background: Migrant live-in caregivers play an important role in home-based long-term care, yet their working and living conditions remain largely underregulated. Despite increasing evidence of precarious employment and health risks among live-in caregivers internationally, little is known about their occupational health risks and access to occupational health care.

Methods: This qualitative interview study is part of the project Live-In Health and reports findings from 16 semi-structured interviews with Polish live-in caregivers (15 females and one male) working in German private households. Interviews were conducted in Polish, transcribed, translated into German, and analyzed using qualitative content analysis following an inductive-deductive approach. Identified work-related strains and risks were structured in four main domains according to established occupational risk assessment frameworks from the German care sector.

Results: Participants reported extensive occupational health risks across the four main domains: physical strain (e.g., musculoskeletal strain from patient transfers), psychological strain (e.g., social isolation, conflicts with agencies, emotional burden), occupational safety and health including working hours (e.g., long working hours, insufficient recovery time, lack of preparation and insurance coverage), and exposure to biological and hazardous substances (e.g., wound care, unhygienic living conditions). Access to occupational and general health care in Germany was largely absent. Preventive services, occupational medical examinations, and accident insurance coverage were inconsistently available or missing altogether. Live-ins described substantial barriers related to legal ambiguity, agency practices, lack of information, and unclear responsibilities. At the same time, informal support from families, ambulatory care services, and peer networks emerged as partial coping resources.

Conclusions: Polish live-in caregivers in Germany are exposed to considerable occupational health risks while remaining largely excluded from occupational health care structures. The findings highlight substantial gaps in the implementation of existing occupational safety and health regulations for caregivers in private households. Strengthening occupational health protection for live-in caregivers requires enforceable working time regulations, reliable insurance coverage, accessible occupational health services, and clearer oversight of intermediary agencies. Tailored, low-threshold occupational health approaches are urgently needed to address the structural vulnerabilities of this workforce and to ensure healthy and sustainable care provision for the growing demand in home-based care for older people in Germany.