Experience of Systematic Deficits in Healthcare During SARS-CoV-2: A Rapid-Response Survey of Healthcare Assistants

Abstract

Aim
To describe Irish Healthcare Assistants’/carers’ (HCAs) working conditions and wellbeing during COVID-19 Wave 1 and examine associations between PPE access and infection-related outcomes.

Methods
A 24-hour rapid-response, mixed-method survey (23/04/2020) of HCAs/carers in Ireland (456) across care settings. Quantitative data (sector/setting, PPE, training, redeployment, pay, sick leave/isolation) were analysed in SPSS; free-text responses underwent thematic analysis (manual and N-Vivo12). Full PPE followed the HSE HPSC definition.

Results
Most respondents worked in the private sector (255, 56%) and in community/homecare (201, 44%). PPE access was variable: unlimited (104, 22.8%), limited (96, 21.0%), reasonable (105, 23.0%), and none (14, 3.1%). COVID-19 sick leave/isolation was reported at 80 (17.5%). Minimal COVID-19 training was reported at 173 (38%) and supportive management at 150 (33%). Movement between locations occurred in 167(36.6%); 252 respondents would decline nursing-home redeployment even with incentives. Full PPE access was associated with lower COVID-19 positivity (2.6%, p=0.031) and fewer close-contact identifications (0.9% vs 9.4%, p=0.022). Qualitative themes emphasised fear of infection, anxiety about transmitting COVID-19 to family, and poor real-time guidance.

Discussion
Wave 1 exposed persistent gaps in PPE, training, leadership communication, and support for HCAs. Standardised PPE access, consistent IPC training, improved managerial communication, mental health supports, and stronger regulation/professional recognition remain priorities.