Background <p>The turnover intention of elderly care workers affects the quality and costs of social care, worker overload and associated health risks. Preventing the turnover and job-related stress of elderly care workers is essential to effectively support the elderly and ensure high-quality care. This study investigated the relationship between fear of COVID-19 and turnover intention, and job-related stress through burnout.</p> Methods <p>A cross-sectional survey was conducted in Hungary with 269 elderly care workers. Data collection tools included a self-designed demographic questionnaire, the Turnover Intention Scale (TIS-6), Maslach Burnout Inventory (MBI-HSS), Effort-Reward Imbalance (ERI) and Fear of COVID-19 Scale (FCV-19).</p> Results <p>Indirect effects of fear of COVID-19 were observed on the turnover intention (B = 0.092, <i>p</i> = .008), ER ratio (B = 0.009, <i>p</i> = .007), effort (B = 0.070, <i>p</i> = .007), and overcommitment (B = 0.093, <i>p</i> = .006) via emotional exhaustion. Additionally, fear of COVID-19 negatively influenced overcommitment (B = − 0.043, <i>p</i> = .017) through depersonalization. The models explained 26.3% of the variance in effort (R² = 0.263), 3.4% in reward (R² = 0.034), 23.9% in overcommitment (R² = 0.239), and 25.8% in the ER ratio (R² = 0.258).</p> Conclusions <p>The mediating role of emotional exhaustion and depersonalization in the relationship between pandemic-related fear and turnover intention and job-related stress underscores the need for targeted interventions in Hungary’s elderly care sector. These should focus on early detection of burnout symptoms, especially emotional exhaustion, and implement systematic strategies such as regular monitoring, stress management training, supportive supervision, and team-based peer support to mitigate the impact of chronic occupational stress.</p> Trial registration <p>The study protocol was registered on ClinicalTrials.gov before the start of the study, on 02/08/2022 (identifier: NCT05487157).</p>