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

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.