Scottish study of the impact of the pandemic on care home workers

Balhousie Care staff open up about the COVID pandemic in exclusive new research

There is a “moral obligation” to provide more psychological support to care home staff as they continue to live with the impact of the COVID-19 pandemic.

That is the conclusion of a research study in which staff from leading care provider Balhousie Care Group share the emotional and physical effects of the pandemic, and their coping mechanisms.

Care and nursing staff who took part in the study, conducted by the University of the Highlands and Islands and Northumbria University, share how they sacrificed their own family lives for the sake of turning up to work every day and looking after their residents. They also tell of how they kept each other’s spirits up and turned to each other for emotional support.

“It’s a war in a lot of ways,” said one respondent. “We have to stick together then keep moving forward.”

The research team also drew comparisons between their findings and stories of the camaraderie that occurs in the military during wartime. Dr Michelle Beattie, Senior Lecturer at the Department of Nursing and Midwifery at the University of the Highlands and Islands and Research Lead, said the research team was struck by how Balhousie Care staff supported each other through the toughest times the care sector has ever seen.

“They felt like it was a war against the pandemic. There was a sense of ‘we need to pull together and face this together’. You read about that sense of camaraderie in the military and people deploying to war but not that much in healthcare. None of us had seen that before in any previous work,” said Dr Beattie.

The researchers were “blown away” by the personal sacrifices made by staff, which included moving out of their own homes so that they reduced their chances of passing on the virus to care home residents, said Dr Beattie. “Not seeing your children because you want to protect your residents from COVID. To me that’s a whole other level of self-sacrifice,” she said.

In the words of one respondent who took part in the study: “I had said to myself from Day One, I would never not go and care for my residents. That’s just not me. I wouldn’t put myself before them. I’ve been in this job for 10 years, and I’m not going to let some virus take away what my life is. I’ve put my life into this job.”

Care home managers share the extra stress of supporting their teams in an ongoing crisis, while not revealing their own struggles. Coping mechanisms included tears and laughter in equal measure, the study found. “I found myself sneaking off to the toilet to have a wee cry, just to get the emotions out… I never took work home with me, I just left it there,” said one respondent.

“Honestly you have just got to laugh. It’s a very serious job, taking care of people, but you just need to be able to have a laugh and a sing song and get Alexa on. That’s how I’ve coped,” said another.

Dr Beattie said the poignancy of some of the accounts led researchers to find their own coping mechanisms. The research team formed a buddy system so that after interviews with Balhousie staff a researcher was able to debrief and talk to a colleague for support.

Respondents to the study were brutally honest about the difficulties of being under scrutiny from the public, the media and health inspectors whilst dealing with outbreaks of COVID-19 and staff absences. They told of the “unreasonable and unrealistic” demands on them from inspectors. “We’ve not had COVID and here’s the inspector picking me up because I’ve got version two of a poster instead of version three. It’s just ridiculous,” said one respondent. Another concluded: “Sometimes people are forgetting these are residents’ homes.”

One respondent explained their frustration with the public and media focus on the NHS: “Where everybody flocked, again, to the NHS to support and volunteer and the nurse banks flourished, we were again in the dark going ‘Hello, can somebody come and help us?’”

Since the start of the pandemic, Balhousie Care Group has introduced a new employee assistance programme which offers free counselling and advice, and worked with one local authority to create ‘reflective sessions’ for staff to help with their wellbeing during the pandemic. Homes have also set up private chat groups for staff and private Facebook pages for relatives, to aid communication among staff and between care homes and relatives.

Said one respondent in the study: “Those words of support [on our home’s social media page] have been great, and I know that if there’s anything anybody has a problem with or if I had a problem, then we can open up in our group chat.”

The study concludes that there is “a moral obligation to provide psychological support to care home staff” to avoid distress and psychological health problems. It recommends ‘safe spaces’ for healthcare workers to reflect on their pandemic experiences, a “cultural shift” to acknowledge their “unique and high-quality contribution to care”, and care home inspections that are supportive and “avoid a ‘tick box’ mentality.”

The qualitative mixed methods study took place over four months between January and May 2021. Academics surveyed 52 healthcare workers from Balhousie Care Group’s 26 care homes, conducting follow-up interviews with thirteen.

Lindsay Dingwall, a co-author of the study and Clinical Care Quality Manager at Balhousie Care Group, said: “The commonly used word to describe a hero is ‘to show courage’, so we can safely say that since March 2020 care home staff have earned that description. As emotional and raw as this study was for our respondents and the researchers, it was hugely important to be part of it. For the sake of our employees and residents, and in honour of everyone who has lost a life in the last two years, we wanted to help document not only what care workers have gone through, but also their dedication to their jobs. A massive thank you must go to the respondents who took part.”

Scottish Care comments:

“Anyone reading this research cannot but be moved by the stories of dedicated and sacrificial professionalism and compassion shown by frontline carers and nurses. The Covid-19 pandemic has brought about immense challenge to so many thousands of frontline care staff. We have had lots of statistical and academic reports and commentary but the story of frontline carers who were there through thick and thin has rarely been told and this is so valuable.

“However, what is clear from this research is that there has been a distinctive and significant impact upon the mental health and wellbeing of care staff. Witnessing the early deaths of those whom you have cared for over a number of years has left a deep wound for many carers and it is one which is still as raw and real. It is imperative that we develop bespoke and specialist support that appreciates the unique experience of these women and men and the prolonged grief syndrome they are suffering.”

“It is critical that all stakeholders read this report because it could be told a hundred times over up and down Scotland. We have to learn the lessons of disproportionate and unnecessary scrutiny and inspection; of alleged oversight support which has made staff feel devalued and unskilled; of investigations in the name of assurance which has made staff feel culpable; of media commentary which has sought to find blame and scapegoat; and of external governmental intervention, clinical advice and infection, prevention and control (IPC) guidance which has made care at times so challenging and impossible rather than serve to support the skilled professionals in our care homes and to uphold the human rights of residents.”

The full results of the study can be found here: Stress and Coping Experiences of Nurses and Care Workers in a Care Home Setting During the Covid-19 Pandemic (

More about the findings can be heard in a podcast produced by Balhousie Care Group. Listen here.

For more information on Balhousie Care Group visit


Last Updated on 7th March 2022 by Shanice