Behind closed doors: a cross-sectional survey on the health and working conditions of migrant live-in care workers in Germany

Despite the vital role migrant live-in care workers play in elder care across Europe, they often confront precarious employment conditions with limited legal protections and low visibility. Quantitative evidence on their work and health has been scarce. This study (i) describes live-in care workers' sociodemographic characteristics and job conditions in German homecare; (ii) compares their job demands, resources and motivational, and health-related outcomes with those of geriatric nurses and the German general working population; and (iii) analyses the extent to which their demands and resources are linked to motivational and health outcomes. The Copenhagen Psychosocial Questionnaire was used to assess the psychosocial working conditions, health-related and motivational outcomes of the participating live-in care workers. The sample comprised 429 migrant live-in care workers, of whom 93% were women and 77% were older than 49 years. Most live-ins originated from Poland (50%), followed by Bulgaria (30%), Croatia (13%), and Romania (4%). Nearly half lack formal contracts. Compared to geriatric nurses and all occupations, they experience higher work-privacy conflicts (d = 0.66; d = 0.93) and emotional demands but lower quantitative and physical demands. They report lower job satisfaction, higher burnout, greater presenteeism, and stronger turnover intentions (d = 0.71; d = 0.81). Job demands and resources are significant predictors of health and motivational outcomes. Our study highlights the importance of work-privacy conflict as a central occupational stressor for live-ins. Policy actions and interventions must improve their working conditions, strengthen job resources and protect their health and well-being.