They take care of elderly or handicapped people at home, cooking and cleaning, assisting with errands, taking them for walks and providing company and 24-hour care. But as Europe has shut its borders to try and bring COVID-19 under control, this is having dire consequences for home care providers who live in one country and work in another.

In Germany, an estimated 300,000 workers from Eastern Europe provide home care to people who are unable to take care of themselves – due to a physical handicap or dementia for example – yet do not live in a nursing or old people's home. The majority of these workers come from Poland.

In neighboring Austria, out of 62,000 home care providers, almost half come from Romania and 35 percent come from Slovakia. The rest come from countries like Hungary, Bulgaria, Croatia and Slovenia.

Home care workers – most often women – are not nurses but they are nevertheless a vital part of the health system. Usually, they commute back and forth, providing live-in care to their patients for a few weeks, then returning home for a few more weeks.

But with borders closed in much of Europe to stem an epidemic that has already claimed over 37,800 lives worldwide, this kind of arrangement is now made difficult.

Border trouble

Over the past few weeks, Slovakia, the Czech Republic and Hungary have closed their borders to Austria. Lithuania has advised against traveling to high-risk countries like Germany. And Poland has ordered that anyone returning from abroad must spend two weeks in quarantine.

In many cases, there are exemptions for border area residents who commute back and forth, as well as for nursing and medical staff.

Still, many home care providers are facing bigger hurdles than usual. The head of one German agency that matches providers and patients told the daily Die Zeit that since the beginning of the epidemic, 30 percent of carers who had jobs lined up in Germany did not make it.

Besides fear of contagion and travel hassles, many worry they could be stranded where they work, unable to return to their families, according to vidaflex, an Austrian trade union. The prospect of lengthy quarantines whenever they go home and come back has also put many off trying.

Rail links have in many cases been entirely suspended, such as between Germany and Poland, and bus connections have been drastically scaled back, rendering travel difficult.

Meanwhile, Hungary has closed its borders to foreigners, meaning Romanians who usually take this route to reach Austria, are no longer allowed to transit through.

Charter planes and volunteers

As a stop gap measure, many home care providers have agreed to extend their stints, for instance from two weeks to four, until a replacement can be arranged.

In some German regions close to the Polish border, local authorities have reportedly been trying to secure accommodation for commuting workers, to entice them to stay a little longer.

Austria is recruiting "Zivildienst" volunteers, who opted to do social service instead of the usual military service, to help provide care on a temporary basis.

Meanwhile, agencies are arranging pick-ups at the border for workers struggling to find alternative travel options.

One Austrian province even chartered two planes to fly in 230 home care workers from Romania and Bulgaria on Monday, covering their costs, including a two-week quarantine on arrival, to prevent a shortage of essential services. These workers are expected to remain on duty for four to six weeks.

But "these are all just partial solutions," Bernd Wachter, head of Caritas Rundum Zuhause betreut, one of Austria's home care associations, told the Wiener Zeitung newspaper.

At governmental level, talks have been ongoing between the different countries to find a sustainable joint solution. Home care associations and agencies are urging, among other things, that workers be allowed easier movement across borders and be given safer transportation options.

In most places, strict border controls were introduced just two weeks ago and for now, agencies say they are making do and are not yet feeling the strain.

But Germany's home care association VHBP has already warned that if the epidemic persists, between 100,000 and 200,000 patients could find themselves without the home care they need, and with hospital and nursing homes overworked.