Cracks in the foundation: The experience of care aides in long‐term care homes during the COVID‐19 pandemic

Abstract

Background Care aides (certified nursing assistants, personal support workers) are the largest workforce in long‐term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well‐being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID‐19 on care aides working in LTC homes during the first year of the pandemic. Methods We conducted semi‐structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis. Results Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full‐time in LTC homes, and 37% worked multiple positions before “one worksite policies” were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID‐19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes. Conclusions These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID‐19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well‐being and adequately resource this workforce. We recommend improved policy guidelines and interventions.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic

“…Resident care needs, previously addressed by caregivers, were still present when visitor restrictions began. Care aides, nurses, and managers in LTC [36][37][38] and AL [17] were overwhelmed by the burden imposed by the pandemic, unable to address the resident care needs previously addressed by caregivers. Therefore, many resident care needs remained unmet with substantial consequences for resident health and well-being [11,18,32].…”

I smittspridningens spår

“…Upplevelserna av arbetssituationen under pandemin kan också tolkas i relation till tidigare forskning som visat att arbetsintensifieringen under smittspridningens första månader manifesterades genom ökade arbetstider, förändrad yrkesroll, ständigt ändrade skiftscheman och arbetsprocesser, svårigheter att uppnå ömsesidig förståelse med patienter och anhöriga samt svårigheter när det gäller intraorganisatoriska olikheter. Dessa organisatoriska förändringar, i kombination med strukturella/sociopolitiska faktorer såsom motstridiga policies ledde sammantaget till ökad stress och i vissa fall psykisk ohälsa (utmattning) bland undersköterskor (Titley et al, 2022), sjuksköterskor (Luceño Moreno et al, 2020 och läkare (Chaudhry et al, 2021), det vill säga på samtliga hierarkiska nivåer. Liknande mönster har också framkommit bland personal på olika typer av boenden inom vård-och omsorgssektorn, såsom äldreboenden eller LSS-boenden.…”

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak

“…As highlighted in other publications from the pandemic period, both nursing-home workers and family members have been involved in caring for older adults, as well as in the possible transmission of infection [ 15 , 17 , 21 , 26 , 83 , 120 , 121 ]. Workers have reported COVID-19 effects related to emotional health and workload due to staff shortages, as well as concerns about severe isolation measures, death of residents, and fear of transmitting the virus to family members [ 122 ]. For their part, family members mentioned great concern about understaffing, as well as the absence of infected workers, limitations in communication between family members and caregivers on the one hand, and family members and residents on the other, due to restrictions and the digital divide [ 26 ].…”