University of Nottingham: New report uncovers risks around modern slavery for live-in migrant care workers

A new report by anti-slavery experts at the University of Nottingham has identified the factors that put live-in migrant carers at greater risk of falling victim to modern slavery.

Following an 18-month study into the working conditions of paid, migrant, live-in care workers in London, the researchers from the university’s Rights Lab have recommended policy changes to immigration law to reduce the workers’ vulnerability to labour exploitation, particularly for those with a precarious immigration status.

Crucially, the study involved live-in care workers themselves as peer researchers, giving them the opportunity to talk honestly about their experiences of coming to the UK to work and, for the first time, the chance to have their voices heard in debate around national policy.

Dr Caroline Emberson, who led the research, said: “Female migrant workers take on live-in care roles often as a first point of entry into the UK labour market. Favourable exchange rates can make the salaries promised seem highly attractive.

Caroline Emberson
Live-in carers can easily find themselves isolated in their clients’ homes and dependent upon agencies to ensure that the conditions of their employment are legal. These vulnerabilities can make this form of care work a honey-trap where the unscrupulous may entrap workers in exploitative situations.
Dr Caroline Emberson, study lead, Rights Lab
In the UK, there have been longstanding concerns about severe forms of exploitation in the care sector. Adult social care has been identified by the Director of Labour Market Enforcement as a sector where the danger of labour exploitation is high, with live-in and agency care workers believed to be at particular risk.

Despite this, the working lives of paid, live-in care workers, some of whom are circular migrants and many who are extremely isolated, have remained largely unexamined.

The study involved migrant care workers from Hungary, Poland, South Africa and Zimbabwe, most of whom were on zero hours contracts when they first arrived in the UK and many of whom later went on to become self-employed.

Through interviews conducted by their peers, they identified five main risk factors to exploitation:

Employment status, business models, and the role of intermediaries
Information asymmetry between care workers and intermediaries
The emotionally and physically intensive nature of live-in care work, blurring of boundaries between work and private life
Barriers to exercising rights at work: sick leave, time off, redundancy/notice, health and safety at work
Individual risk and resilience factors.
They painted a vivid picture of difficulties around being able to open bank accounts, payslips that were unclear on the number of hours worked or tax paid and unscrupulous agencies that would deduct pay for accommodation charges, place novice carers with the most difficult clients that others declined to work with and would pay some carers at a higher rate or offer more favourable conditions for doing the same job.

Participants spoke of the emotional pressure associated with being closely involved in the everyday lives of their clients and their families, including sleep deprivation from getting up in the night to offer care, not being able to get the breaks they were entitled to or being asked to run errands for their client in their own time. Others cited inappropriate behaviours including racism/xenophobia and sexual harassment and being made to carry out non-caring duties for the whole family including cooking, cleaning and gardening.

Despite this the participants interviewed all had a sense of awareness of the risks of exploitation and peer support. Being able to draw on advice and help from fellow care worked was highlighted as one of the ways they maintained their resilience in the face of these challenges.

In response, the research team’s suite of recommendations and policy options included:

The UK Visas and Immigration (UKVI) should remove the obligation for care workers to update their visas when they move within the sector to provide greater freedom to move without risk to immigration status; reduce or remove related visa fees for both the worker and the sponsoring employer and ban or regulate the use of exit fees on these visas to make sure that they aren’t used to tie workers
The Home Office to establish a Memorandum of Understanding with labour market enforcement bodies, especially the GLAA, to separate immigration control from labour inspection so that people feel safe about coming forward if they are experiencing labour exploitation without fearing immigration enforcement or deportation.
The GLAA, EASI, or Single Enforcement Body (once established) to introduce the registration and licensing of approved social care recruitment, staffing and immigration agency sponsors.
UKVI to allow live-in care workers or personal assistants to be directly recruited by care users via GLAA accredited recruitment agencies and sponsors
UK Government to legislate for the regularisation of currently undocumented migrant workers, including those in the live-in social care sector.
The Department of Health and Social Care to expand the role of the Care Quality Commission to ensure live-in care workers’ employment rights are respected and that staffing levels and roles enable care workers to take legal rest breaks and rest periods
UK VI to ensure that everyone who is coming in under the new Health and Care Visa scheme has a written contract prior to arrival given to them in their first language, detailing fees and deductions for accommodation charges.
Require business sponsors to show UKVI that employees’ contracts are legal under UK law.
Three further recommendations were also generated through peer researcher-led focus groups:

Agency pay rates that more fairly reflect the nature of the work and skills of the carer
Standardised risk assessments of both the condition of the property and of the care plan, to be conducted by both staffing and introductory agencies
The Health and Safety Executive to review the Working Time Regulations for rest periods and breaks for live-in care workers employed in a domestic setting and issue a separate set of legal guidelines.

The research was conducted in collaboration with Focus on Labour Exploitation (FLEX), the Institute of Public Care, Oxford Brookes University and the London School of Hygiene & Tropical Medicine and was funded by the charitable foundation, Trust for London.

The care ecosystem has been subjected to many shocks, including the pandemic and Brexit, leading to changes in the care landscape with increased demand for live-in care. Live-in care is an area of employment vulnerability and can be challenging to regulate.
Dr Shereen Hussein, Professor of Health and Social Care Policy in the London School of Hygiene & Tropical Medicine
Dr Hussein continued: “Live-in draws on a significant contribution of migrants, mainly women, who usually have many caring and financial responsibilities in their home countries and are likely to accept unfavourable conditions. The structure of this work has many inherent vulnerabilities. This research is vital in understanding these factors to recommend measures to protect all parties as this form of care expands.”

Live-in care workers are the hidden workforce of social care. Many of them come from abroad and they do vital work to support people with extensive and complex needs to live at home. Our report highlights their lived experiences and the challenges they face in their jobs. It is important to listen to these and create safe and dignified conditions for this type of care work.
Dr Agnes Turnpenny, Institute of Public Care at Oxford Brookes University
Meri Ahlberg, from Focus on Labour Exploitation, said: “It is vital for policymakers to listen to the lived experiences of migrant live-in care workers so as to understand and actively mitigate the specific modern slavery risks affecting them.

The need for care, including live-in care, will increase as the UK’s population ages, and much of this indispensable work will be done by people coming from outside the UK. It is our duty to ensure they can help fill these roles without compromising on their rights or safety.
Meri Ahlberg, Focus on Labour Exploitation
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More information is available from Caroline Emberson in the Rights Lab at the University of Nottingham on

The below quotes are from the peer researchers who are (or have been) live-in carers:

Dominque Davis said: “Migrant live-in care workers provide personalized care in private homes. As a peer researcher and care worker myself, there was little that surprised me in the interviews I carried out and the findings in this report. Much of what was shared by interviewees I have experienced myself. A notable finding that resonates with me is the blurring of professional boundaries, sleep deprivation, precarious placements, and how care agencies often take advantage of migrant care workers.

“Taking part in this project taught me about my rights, specifically self-employment rights. It also shocked me to learn that many care workers are not able to register with GPs or gain access to healthcare. This project has highlighted the injustices we experience while caring for vulnerable adults in the comfort of their own homes and recognisable surroundings.”

Natalia Byer said: “Listening to many of the research participants’ stories is soul-breaking, and it will be eye-opening for the public. It should not only spark another debate, as we have had many of them. But unite the society to act against the abuses against workers, regulatory shortcomings, and legal grey areas by directly mounting pressure on the government to make the changes identified because of our research.

“Our research clearly highlights severe shortcomings of the conditions under which live-in carers are employed, as well as the extent of exploitations and lack of remedies that would be easy to put in place. It’s an important milestone in the ongoing discussion of the broken care system. What’s most important for me as an ex-care worker is that our research identifies crucial regulatory and systemic changes that we all need to work on. I think that we should unify the public around this issue to create unbreakable pressure on the government as, one way or another, each of us is affected.”

Suzanne Hewitt said “I’ve realised with our interviewing and observation on social media that carers are almost indifferent towards their exploitation. I wonder, is it out of fear that the demand for “the job” will dwindle if they speak up and ask for change, or do they believe that nothing would change, even if they do? They silently stew in their frustration, because all they want to do is care for the most vulnerable, all the while being vulnerable themselves.”

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