Labor force participation and work during the COVID-19 pandemic in the healthcare sector – an investigation using the representative lidA cohort study

Status:

completed 12/2025

Aims:

This project used the first four waves of the lidA study to examine how the subjective employment motivation is manifested among older employees in the healthcare sector.

As part of the project, a focused and sector-specific supplementary module on the COVID-19 pandemic for healthcare employees was also developed and integrated into the fourth survey wave of the lidA study.

The aim of the subsequent project, "Labor force participation and work during the COVID-19 pandemic in the healthcare sector – an investigation using the representative lidA cohort study" is to expand and deepen the preceding project. It includes the scientific investigation of the following questions:

1. Why older employees in the healthcare sector intend to leave working life prematurely.
2. What effects the COVID-19 pandemic has on employees in the healthcare sector.
3. How older employees in the healthcare sector can be retained in employment through workplace measures (Stay at Work) and reintegrated into work (Return to Work).

Activities/Methods:

The lidA study (www.lida-studie.de), which has been running since 2009, is one of around ten representative cohort studies worldwide focusing on work, aging, health, and labor force participation.

Within lidA, various indicators relating to work, health, and labor force participation, as well as private and social contextual conditions, are collected. Due to its cohort-sequential design, large number of participants, and high level of representativeness, lidA enables differentiated analyses of the long-term effects of work on health and labor force participation in an aging workforce. For this purpose, socially insured employees from the German baby boomer cohorts, specifically those born in 1959 and 1965, were interviewed personally at home at intervals of three to four years (N(2011) = 6,585; N(2014) = 4,244; N(2018) = 3,586; N(2022/23) = 8,884). To answer the research questions, both cross-sectional and longitudinal analyses were conducted. To identify employees in the healthcare sector, the German Classification of Occupations (Klassifikation der Berufe, KldB 2010, 3-digit level) was used. As occupations in the healthcare sector cover a wide range of activities, five occupational groups were selected for more detailed analyses and compared with each other. For data protection reasons, the occupational groups included in the cross-section of the fourth survey wave had to comprise at least 80 participants. The following five occupational groups were included in the analyses: Nursing (health and general nursing), Geriatric nursing, Curative education and family care, Medical and practice assistants, Medical laboratory and pharmacy occupations.

Results:

Topic A: Employees in nursing occupations stand out because they wish to work for a shorter period than employees of the same age in general and those in other social occupations. At the same time, employees appear to adjust the age until which they would like to work over time. On average, as they grow older, they indicate that they would like to work longer than they previously intended. This shift is particularly pronounced among employees in geriatric nursing. A large proportion of geriatric nurses report that they would like to work longer, while an equally large proportion indicate that they would like to work for a shorter period than they did four years earlier. However, it should be noted that employees in geriatric nursing, on average, plan to work longer than they report being able to work (Hasselhorn & Borchart, 2025). This indicates that continuing to work is not entirely voluntary; rather, it suggests that financial necessity plays a role for many in this group – despite the health limitations they report (Hasselhorn & Rohrbacher, 2025).

Topic B: Employees in the healthcare sector were particularly affected by the COVID-19 pandemic. During the pandemic, they reported markedly increased stress, reduced well-being, and declines in mental health and work ability.

Topic C: The analyses revealed the so-called "prevention dilemma" in occupational safety and health. This means that those who – based on their level of exposure – actually need the most supportive measures receive the least support. At the same time, they rate the measures they do receive as helpful less often and express the least desire for additional measures.

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