The cost of caring: poverty and deprivation among residential care workers in the UK
The cost of caring: poverty and deprivation among residential care workers in the UK
11 October 2022
Key points
- Social care workers play a vital role in society. Yet workers in adult social care – who are mostly women – are among the lowest paid in the UK and experience poor working conditions. For many people providing care, work is not a reliable route out of poverty.
- We analysed national survey data from 2017/18 to 2019/20 to understand rates of poverty and deprivation among residential care workers in the UK and compare them to other sectors – including health, retail, hospitality, administration, and all workers.
- We found over a quarter of the UK’s residential care workers lived in, or were on the brink of, poverty. Nearly 1 in 10 experienced food insecurity. And around 1 in 8 children of residential care workers were ‘materially deprived’, meaning they may not have access to essential resources such as fresh fruit and vegetables or adequate winter clothing.
- The prevalence of poverty and deprivation in residential care is similar to hospitality, retail and administration. But residential care workers experienced much higher rates than most workers – and were at least twice as likely to experience poverty and food insecurity than health workers. Their dependent children were nearly four times as likely to experience material deprivation than children of health workers.
- Our analysis covers up to April 2020. Since then, a grim cocktail of factors has affected the social care system and its staff – including COVID-19, Brexit, recruitment challenges, and now the cost-of-living crisis. The poorest households in the UK are being disproportionately affected by sharp rises in inflation and poverty is set to increase.
- Low pay in social care reflects political choices. Sustained underfunding of social care by central government limits the ability of care providers to increase pay. Devolved governments in the UK have taken some steps to address workforce problems in social care. Yet in England, 13 years have passed since the publication of a national workforce plan for social care and plans for reform include nothing to increase staff pay.
- Ensuring people are rewarded fairly in social care must be a priority for the new government. Increasing pay will require additional investment and action to ensure funding reaches staff. A mix of policy options should be considered – such as introducing a sector-specific wage for social care – as part of a comprehensive workforce plan.
- Broader policy action is also needed to improve living conditions and reduce the burden of poverty on the nation’s health – including investment in housing, education and training, and social security. Government has recently provided considerable support to help people cope with soaring energy bills. But without further targeted support for poorer households, life will get even harder for social care workers in the UK.
About this analysis
Here, we use national survey data to compare rates of poverty and deprivation among residential care workers to workers in other UK sectors. Our analysis covers the period before the pandemic and the cost-of-living crisis. The rising price of fuel, food and utilities is likely to put people at even greater risk of poverty and deprivation.15
We begin by summarising the context for our analysis – describing national workforce policy and employment conditions in adult social care, and existing evidence on in-work poverty and deprivation in the UK and among social care workers. We then describe the findings of our analysis on poverty and deprivation among residential care workers and explore some of the factors affecting these. Finally, we discuss the policy implications of our findings for tackling poverty and deprivation among social care workers.
We explored poverty and deprivation among residential care workers in the UK, compared with workers in health, retail, hospitality, administration, and the overall working population. Sectors were chosen for comparison since they compete for a similar workforce16 and, in the case of health, work closely with social care. We used data from the Households Below Average Income (HBAI)17 and the Family Resources Survey (FRS)18 from 2017/18 to 2019/20.
In our analysis, we used the standard UK measure of poverty, defined as having a household income below 60% of the median household income after housing costs. We also looked at people with household incomes below 50% and 70% of the median household income. To explore deprivation among workers, we used a measure for combined low income (70% of median income) and material deprivation among children in their households. The latter is a score-based measure based on questions about dependent children’s access to 21 different goods and services, such as a warm winter coat.17 We also used a measure of household food insecurity based on responses about buying and preparing food.18
We looked at a range of other variables in our analysis to explore the complex relationship between employment and poverty (see Factors affecting poverty and deprivation). These included income distribution, benefit receipt, family economic structure and age.
The analysis is mostly based on individuals aged 16 and older, compared with the overall UK income distribution for poverty. 3 years of data are pooled to increase the sample size (except for food insecurity as this measure was introduced in 2019/20). For 2017/18 to 2019/20, the sample size for residential care workers is 1,488.
People working in adult social care provide support with daily living to adults with a range of care needs, mostly because of disabilities and ill health. For example, someone might need help visiting friends, washing, taking medicine, or staying in work. A breadth of skills and experience is needed to care for people. While most care in the UK is provided unpaid by families, the social care sector is a large source of employment. Estimates vary but it is likely that the sector employs at least 1 million people in the UK.7
In 2018, workers in residential long-term care in the UK earned 71% of average national earnings, compared with 79% of average earnings for residential long-term care workers in EU member states.7 In England, the full-time equivalent mean annual pay rate for staff providing direct care in independent residential care settings was £16,800 in 2019/20, compared with £30,400 for all full-time jobs in the UK.49,50 Social care workers also experience poor-quality work. Care workers are more likely to be on zero-hours contracts and carry out shift and night work than other low-paid workers.7
Just as people’s care needs are diverse, so is social care work. Our analysis looks at workers in residential care, mostly in nursing and care homes and assisted-living housing. Pay is similar for all direct care staff in social care but employment conditions vary by role and setting. For example, residential care workers are less likely to be on zero-hours contracts than domiciliary care workers (see Limitations).
Low pay and poor conditions in social care contribute to chronic staffing problems. Vacancies in England alone stood at 112,000 in 2019/20 and have since risen.8,49 Turnover rates are high – standing at 30% in England in 2019/20.49 Care providers and people who employ their own carers report increasing difficulties recruiting staff, with fewer applicants for jobs making it hard to find the right person for a role and affecting quality of care.51
Beyond the national living wage, government has more influence on pay in social care compared to other low pay sectors such as retail and hospitality.52 Government spending on social care affects what social care employers can pay their staff. Care providers are less able to increase prices to cover wage increases in the way a restaurant might, since local government, or health and social care trusts in Northern Ireland, may not be able afford the costs of people’s care without more funding. To make up for the low fees paid by local authorities, providers may resort to charging higher fees to people who pay for their own care or by cutting services.
National policy on pay for care workers varies across the UK, since social care is a devolved matter. The Welsh and Scottish governments introduced funded minimum wages for direct care staff set at the real living wage rate (in 2022 and 2016 respectively). And in the past year, the Scottish government has increased the minimum pay rate for social care workers above the real living wage.7 There is no sector-specific minimum pay rate in England and Northern Ireland. During the pandemic, social care staff in Scotland, Wales, and Northern Ireland received bonus payments but those in England did not.53
Figure 1
We also explored the proportion of workers living just above the poverty line, looking at those in households with between 60% and 70% of contemporary median income after housing costs. We found that around a further 8.5% of residential care workers were living just above the poverty line, compared with 5% of all workers. So, over a quarter of residential care workers were living in or close to poverty.
Health is a large sector in the UK with varied roles from consultant surgeons to receptionists, so there are still many health workers living in poverty. But health workers were less likely to do so than the average worker and residential care workers. Looking at the distribution of workers’ household incomes can help us explore this further. Just over half (51.2%) of residential care workers were in the bottom 50% of households for income, compared with 35.8% of all workers (Figure 2). By comparison, nearly three-quarters (72.7%) of health workers lived in the top half of households by income in the UK. This is likely to reflect the availability of higher paid roles and more secure employment conditions in health, as well as the incomes of other family members.
Figure 2
While most household income comes from employment, it also includes state support such as Universal Credit (UC) – support for people on a low income, out of work or who cannot work. We found that 19.6% of the residential care workforce drew on UC and legacy benefits, compared with 9.8% of all workers and 6.6% of health workers. Benefits receipt is underestimated in these survey data, partly due to underreporting by respondents.54 But it is likely that residential care workers were more likely to receive means-tested state support than average, relying on state support to supplement low income from employment.
Deprivation
We analysed residential care workers’ experiences of deprivation, first looking at child material deprivation (Figure 3), where families cannot afford to provide their children with essentials such as fresh fruit and vegetables or a warm winter coat. Around a third of all residential care workers have children – a similar proportion to the rest of the working population. Among them, the rate of child material deprivation was around 12.6%, which was higher than for all UK workers (5.1%) and those working in health (3.1%).
Figure 3
We also looked at marginal, low and very low food security among UK workers before the pandemic (Figure 4). Families experiencing low and very low food security are classed as ‘food insecure’ and lack, or risk lacking, access to enough food.18 For example, they might often skip meals because they cannot afford food. We found that 1 in 10 (9.6%) residential care workers experienced food insecurity. A further 8.4% experienced marginal food security, meaning that they sometimes had problems accessing sufficient food. The rate of food insecurity for residential care workers was higher than for all workers (4.8%) and health workers (3.9%).
Figure 4
Factors affecting poverty and deprivation
Several factors affect the likelihood of experiencing in-work poverty and deprivation. Working part-time increases the risk of poverty, particularly for low-paid workers.55 Looking at hours worked per week among UK workers in employment from 2017/18 to 2019/20, we found that residential care workers were more likely to work part-time than average. Just over 40% of staff in residential care worked less than 35 hours a week, compared with 30% of all workers.
We looked at how the household composition and employment statuses of residential care workers’ families compare to all working families in the UK. Residential care workers were disproportionately likely to have only part-time workers in their families (Figure 5), substantially increasing their risk of living in poverty. We also found that 38.2% of residential care workers were in single adult households, compared with 30.5% of all workers.
Figure 5
People may not work full-time for many reasons, including caring responsibilities or their own health problems.56 In our analysis, a similar proportion of residential care workers had children to the overall working population. But more residential care workers (around one-third) lived in families where someone has a disability, compared with under a quarter of all workers in the UK. This suggests that residential care workers may be more likely to have caring responsibilities. We also found that they were more likely to experience long-term ill health: one-third of residential care workers had a longstanding illness, compared with less than a quarter of the total working population.
Experiences of poverty and deprivation are shaped by gender, ethnicity and other factors (see Why do people experience poverty and deprivation?). Mostly, we find that the residential care workforce has a similar demographic profile to what we might expect for a group more likely to experience poverty and deprivation – for example, women and black people are disproportionately represented. But this is not the case when we look at age.
The risk of living in poverty and deprivation tends to diminish with age. But nearly half of residential care workers employed in the UK from 2017/18 to 2019/20 were 45 and older (Figure 6). Residential care workers are older than the overall working population and much older than workers in sectors with similar levels of poverty and deprivation. They have a similar age profile to health workers, who experience lower levels of poverty and deprivation. For their age, residential care workers are at particularly high risk of living in poverty and deprivation.
We also found that half of residential care workers (49.5%) lived in rented housing, compared with less than a third (28.2%) of health workers. Only the hospitality sector had more workers in rented accommodation (63.3%). Again, this is high for their age and increases the risk of poverty.
Figure 6
Our analysis has several limitations. First, FRS is a large survey but sample sizes for each sector of employment are small. The sample size for material deprivation in children is smallest since only around one-third of households have children. We pooled 3 years of data to account for this, except for food insecurity since there are only 1 year of data available. We include confidence intervals and only report statistically significant differences.
Our analysis focuses only on individuals aged 16 and older working in residential care – long-term care for people who live in a residential setting other than their (or their family’s) home. This includes nursing homes, care homes, and assisted-living housing for older and disabled people. A small proportion (less than 10%) of those included in the ‘residential care’ sector work in children’s residential care, including orphanages. People working in other adult social care settings – such as people’s own homes and day care services – are not included. We did this to restrict our analysis to mostly adult social care workers, given limitations with the other groupings used for employment sectors in the data (for example, the category of social work activities without accommodation includes nurseries and child adoption activities).57
This means that our findings may not be reflective of the wider social care workforce, since residential care workers make up only around 40% of the adult social care workforce in the UK.58 As a result, our analysis may understate rates of poverty and deprivation in the care sector. Skills for Care data for England show that people providing direct care are paid similarly in all settings, but problems with insecure employment and hours are heightened for some groups. For example, 4 in 10 domiciliary care workers are on zero-hours contracts, compared with 1 in 10 residential care workers.49 And domiciliary care staff may not be paid when travelling between people’s homes or staying overnight.7
There are further limitations because of how employment sectors are defined in the surveys we used (using the UK Standard Industrial Classification). All sectors include a mix of occupations with a range of employment conditions. For example, not all health workers are employed in the NHS. And support and ancillary staff are included in each sector, so people who are not directly involved in providing care are included in health and residential care.
Finally, our analysis uses data from 2019/20 and does not cover the period of the pandemic and cost-of-living crisis. We did not use the latest data from 2020/21 since these have a reduced sample size, and furlough and other pandemic measures affecting income and living standards make the data complex to interpret. For example, they suggest poverty fell in 2020/2159 – likely down to temporary increases in benefits and a drop in the median income because of furlough and job losses. And the impact of pandemic restrictions on questions used to measure deprivation mean that these estimates are not comparable and may be unreliable.60
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