Why live-in care staff are at high risk of modern slavery

Poor working conditions, insecure employment and imbalances of power all contribute to the risk of labour exploitation for live-in staff, finds research

Portrait of sad lonely girl at home looking through window.
Photo posed by model (credit: zigres/Adobe Stock)

By Dr Caroline Emberson

Over the past 18 months, I have been collaborating with other researchers to investigate the vulnerability of paid, migrant, live-in care workers in London to modern slavery.

Most live-in care workers in the UK are migrants, and a high proportion travel to and from their home countries between client placements.

Understanding the factors that exacerbate these workers’ vulnerability to exploitation is important because it enables the development of the most appropriate policy responses to minimise risk and harm.

Our research is timely, given the commitment made by the UK government to extend to public sector bodies, including local authorities, the organisational duty to report on the steps that they have taken to eradicate modern slavery from their supply chains.

Local authorities are major purchasers of many different types of home care, which are often delivered through a fragmented network of organisational partners and agencies.

With a new Modern Slavery Bill promised in this year’s Queens Speech, social workers and other local authority staff can have an important part to play in spotting the signs of exploitation and eradicating this form of abuse among the hidden workforce of live-in care workers.

Risk factors for live-in carers

Our findings show five factors that create the conditions for exploitation:

  1. Live-in care workers’ employment status and the business models of live-in care and the role of intermediaries.
  2. The information asymmetry that exists between live-in care workers and the agencies who match them to their clients.
  3. The pressures of live-in care work.
  4. Barriers to exercising rights at work.
  5. Factors related to individual risk and resilience.

Less experienced live-in care workers seem to be at particular risk of exploitation.

Agencies, including introductory agencies, have near-total control of matching care workers and clients, and can hold – or withhold – key information. Our participants described how companies took advantage of care workers perceived as less experienced – often migrant workers who had recently moved to the UK or had been specifically recruited to work as a live-in care worker.

It was common for live-in care workers to find themselves in difficult or even hazardous situations when starting a new placement.

Inherent risks of role

There are also particular features about the role of a live-in care worker that can lead to exploitation.

Participants identified various types of emotional pressure associated with being closely involved in the everyday lives of their clients and families.

Although to an extent these were seen as “part of the job”, they can become significant and have a long-term impact on care workers, contributing to burnout and mental health problems.

Inappropriate behaviours, including sexual harassment and racism/xenophobia, were also mentioned by many participants.”

Being asked to run errands

Sleep deprivation, especially, was noted to be a major challenge. Live-in care workers are required to be constantly present and available – apart from a short daily break.

A number of participants spoke about the difficulty of getting the break to which they were entitled, or their breaks being used to run errands for clients.

Being asked to carry out non-care related tasks was also a common experience and many live-in care workers felt, or were, pressured to go beyond supporting activities of daily living and to carry out a range of domestic tasks, often for the whole family, such as cleaning, cooking and gardening.

Health and safety risks

Inadequate working and living conditions were often mentioned by participants that amounted to health and safety risks. These could include unsanitary working conditions, lack of equipment for safe handling and moving, and inadequate food provision.

When clients are hospitalised or pass away suddenly – not uncommon considering the age and needs of this population – live-in carers do not tend to enjoy employment protections.

They are often asked to leave at short notice with no compensation for lost earnings, or are allowed to stay and wait for their flight with no pay, or must take up a new placement without having time to grieve or rest.

How to make things better

We make 11 specific recommendations for policy. These include:

  • providing carers with greater freedom to change employer without risk to their immigration status;
  • introducing a registration system for recruitment agencies;
  • an expanded role for the Care Quality Commission in ensuring carers’ employment rights are respected;
  • local authorities to carry out regular audits of live-in carers’ working conditions.

You can find the full recommendations in the report. Three of our recommendations were generated by peer researchers who were, or had been, live-in care workers themselves.

All of our participants expressed a sense of agency and an awareness of the risks and drivers of exploitation. Many had critically reflected on their personal situation and the broader, structural factors that are creating the conditions for widespread exploitation and labour abuse.

Raising awareness of the risks of exploitation in live-in care work among social care professionals will help in its eradication.

About the research

The vulnerability of paid live-in care workers in London to modern slavery was published in August 2022 by the Rights Lab at the University of Nottingham, and was funded by charitable foundation Trust for London. The authors are:

  • Meri Ahlberg, Focus on Labour Exploitation (FLEX)
  • Caroline Emberson, Rights Lab, University of Nottingham
  • Lucila Granada, Focus on Labour Exploitation (FLEX)
  • Shereen Hussein, London School of Tropical Hygiene and Medicine
  • Agnes Turnpenny, Institute of Public Care, Oxford Brookes University


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11 Responses to Why live-in care staff are at high risk of modern slavery

  1. Mel August 8, 2022 at 10:46 pm #

    What would an audit of working conditions even look like though?

  2. GW August 11, 2022 at 12:59 pm #

    A large number of live in care work are either in person arrangements or facilitated by ‘agents’ in overseas countries. Our government are well aware of the potential for exploration and violence which also drives the recruitment of live in carers. In the claimed committment to tackle modrn day slavery the lead is taken by the Home Office. Why? Because our Governmet sees this as an immigration issue not one of safeguarding. I used to work as an AMHP in Soho where I witnessed this first hand. To my shame I also in my naivete over the good will of the authorities, participated in the supposed freeing of women from brothels who were then deported as being “illegal entrants to the UK.” Criminalising migrants while pretending to tackle modern day slavery is a double aggression.

  3. John August 12, 2022 at 9:36 am #

    I am Director of a specialist live-in care agency. I wholeheartedly support reforms to the sector.
    We are CQC-registered and provide a fully managed care service for the clients and the carers peace of mind.
    I wish all our competition could say the same – it should be a requirement of being in business to be CQC registered (like timed dom-care companies) but unregistered ‘introductory agents’ are allowed to exist.
    At the same time, this situation is NOT wholly limited to live-in care. I suspect many care homes have foreign migrant staff being exploited – and this is easier to hide within each institution.

  4. Sj August 13, 2022 at 2:07 pm #

    It’s not just the migrants though ! British workers are being abused too ! Hence the small input from British workers ! And then they say the British are lazy ! No it’s because you are expected to work without safety laws ! Even self employed they abuse the situation !Live in carers are NOT 24 hr carers and this is what needs stamping out pronto !

  5. ID August 13, 2022 at 11:40 pm #

    I worked as live-in carer for over 4 years. I think that what clients and their families ask for carers to do is not the whole story. It’s lack of legal regulation for this job that causes a lot of confusion for agencies, carers and clients. When my agency asked me to sign a document stating that I work 10 hours a day, when I was not allowed to leave my work placement for 22 hours a day (during two hours beak was the only time I was allowed to go out) all I dreamt about was to change the job as I felt humiliated.
    I worked with wonderful families, we still communicate and speak about good old days. In my case families never were an issue.
    I was called to the office to have a conversation with managers that this document was required by law. I prepared myself well enough to prove there was no such law. There is a history of cases in high court where carers tried to fight for fair working hours rates, UNISON supported some of them. Unfortunately, nothing has changed. Apparently for this moment there is no legal regulation for live-in job. The dispute is always around if a carer should be paid when sleeping. I feel that when a carer is expected to sleep in a workplace in case a client need help and give the client some comfort of not being alone, and when agencies sell the service of 24h care this should be calculated as working hours. Agencies and the court see it that when carer is sleeping, she/he is not working but at the same time not allowed to sleep away from client’s home because client pays for 24h care and may need help at night. A carer would only be paid when client would wake her/him up. For me it doesn’t make any sense.
    I feel so happy that I’ve managed to move on and change my job. However, some bitterness is still there.

  6. Jolanta August 14, 2022 at 1:17 am #

    Finally someone has touched the subject.
    Live in is a shady area, draining carers emotionally and physically.
    There is pressure to be around for 24 hours, but being told our working hours are maximum 10 hours.
    The pay reflects 10 hours of work, but we are told that down time is not work. Yet we are told to stay in the house,
    What is the worst is that almost all agencies tell us that we are obliged to get up in the night twice for no payment at all.
    Only the third wake up call can be paid. Many times there is no pay.
    How can someone work with a challenging client like dementia/Alzheimer for 10 hours a day and then be expected to get up in the night?
    The breaks are mostly a problem too, if we take them in the house, for nap or rest, we are often disturbed and have no rest as a result.
    Many times we are expected to cook and serve meals for the visiting families.
    One could say – then why don’t you leave?
    We can’t – as the agencies say they have no replacement cover or simply do not pick up their phone. So with a challenging placement we are forced to wait for the mercy of an agency to send a replacement,at the same time to carry on with sleepless nights and a difficult client.
    Personally l or my friends carers have been kicked out onto the street for some ridiculous reason like not being nice enough. It happened in the night, in a village with no buses or taxis available.
    One could write volumes on this job.
    Moreover, l think that agencies purposefully bring overseas migrant workers into the UK as they know the carer has no place to go so they will be unlikely to ask for a different placement as simply they have no place to go.
    The whole sector of live in care needs deep reform as indeed, l see it as modern slavery. It suits agencies and the clients as they have a slave in the house and 1 to 1 care for the elderly for 50% of what they would have to pay in the nursing home
    I have worked in this ungrateful job for nine years and finally l want to change, but my mental and emotional health has been greatly affected, the level of stress is above the norm, l suffer from depression, emotional problems,sleeplessness, autoimmunal illneses – all that appeared while working 24h. Add to that separation from family and friends.
    It is a vicious cycle and it is very hard to break it as one gets entangled into it

  7. Chis Sterry August 14, 2022 at 11:53 am #

    Many believe that slavery was abolished in the late 18th an d early 19th century, https://en.wikipedia.org/wiki/Abolitionism_in_the_United_Kingdom and in effect that concept was, but slavery is still around. Now it is known a modern slavery, https://www.local.gov.uk/topics/community-safety/modern-slavery and is more common than people would expect.

    Modern slavery includes but are not limited to:

    sexual exploitation
    domestic servitude
    forced labour
    criminal exploitation
    other forms of exploitation: organ removal; forced begging; forced benefit fraud; forced marriage and illegal adoption.

    In the UK there is the Modern Slavery Act 2015, but persons affected by Modern Slavery are trafficked, so it is essential that everybody associated with areas where Modern Slavery could be need to ensure all aspects are monitored to minimise modern slavery being there.

    Even when the legitimate employments are known there are no or very little employment rights and this needs addressing, with a register of every known employment and employee being included. But, even then more needs to be done, more inspections with a sufficiently resourced team of investigators. Each employee needs to be reassured that their rights will be respected and this means if there are terminations for any reasons, then other suitable employments need to be found and their immigration status will not be affected.

    Local Authorities need to be fully finance to undertake these responsibilities and the Government and Ministers need to be made accountable and transparent in the dealings with these employments and combatting Modern Slavery.

  8. Linda Elliott August 29, 2022 at 12:24 pm #

    At least the article touches on some of the issues.
    The Agencies have worked the system so well that they make huge profits off the backs of people eager to live in the UK. We are self employed when it suits them and yet they feel they have the right to with hold jobs etc if we dont do exactly as they demand.
    No pensions and no annual leave ( because of the self employed card) it means we work too hard and too long without adequate rest. They advertise 24 hour care and then tell us we only work ten hours a day. As if thats possible. Not an ideal working environment and you never have any privacy. This article is a good start but more research and some definite improvements must be made.
    We are too afraid to speak out more because they don’t listen or care really. Ironic.

  9. Marian Silverman August 30, 2022 at 10:27 am #

    After reading this article i have come to realise that i am heading for burnt out. As a live in carer there are so many interwoven issues that we face. I thought it’s time to get some help for myself. But there doesnt seem to be much. Unless you are registered with a GP, which is difficult when you move around for jobs, there isnt anyone to talk to.
    I spent an hour googlng this morning and am left even more frustrated.

    • Val August 30, 2022 at 11:15 pm #

      There are some supportive Facebook groups for carers that might help.
      One that I belong to has been a lifeline for me.
      Caring can be lonely 🙁

  10. Val August 30, 2022 at 11:12 pm #

    Most clients insist you have insurance so THEY are protected but it’s practically impossible to get loss of earnings cover if anything happens to us as self-employed – and I’ve known of carers being pushed and shoved, hit, especially by clients with dementia, also locked out of the house.
    We often end up with bad backs through being forced into unsafe practices and rubbish beds, not to mention constipated because you don’t have time to go when you need to! …and still smile and try to give your client the best life they can.
    I have had some lovely clients with supportive caring families who realise looking after their carers is looking after their parents too, but there is still a large number who do not treat them with respect e.g.sleeping in a box room stacked with clients’ belongings and nowhere to put their own stuff, being told that “staff” have to eat in the kitchen, not with the client and not allowed to eat the food that they have just lovingly prepared.
    Many young or inexperienced carers are virtually slaves and often not given a true picture of the client they are going to.
    I could go on but it’s late and I have to be up early to let the client’s dog out…