Characteristics and Work Life Quality of Nursing Home Care Aides in Canada

This cross-sectional study describes care aides’ characteristics and quality of work life in Western Canadian nursing homes.


Introduction
The need for profound, systemic change in the nursing home sector has been clear for decades. 1 The coronavirus disease 2019 pandemic has exacerbated existing deficiencies in the sector. 2,3 Care aides (called certified nursing assistants in the US) provide up to 90% of direct care in Canadian nursing homes. 4 They are both a neglected and socioeconomically disadvantaged workforce, as well as a critical source of emotional and social support for residents. 4,5 Our objective is to describe care aides' characteristics and quality of work life in Western Canadian nursing homes.

Methods
This is a cross-sectional analysis of care aide survey data collected between September 3, 2019, and Care aides were from urban facilities, selected according to stratified random sampling (health region, owner-operator, and bed size). Trained interviewers collected data using structured interviews. 4 Eligible care aides had worked in a facility more than 3 months, could identify a unit where they worked for at least 50% of their time, and had worked on that unit for 6 or more shifts in the past month.  a A high risk for burnout is indicated by 1 or more of the following: emotional exhaustion score of greater than 3.00, cynicism score greater than 2.33, and efficacy score less than 3.30. A low risk for burnout is indicated by 1 or more of the following: emotional exhaustion score less than 1.67, cynicism score less than 1.00, and efficacy score greater than 4.00. The score range for emotional exhaustion, cynicism, and efficacy is 0 (never) to 6 (daily), with higher scores indicating higher levels of all 3.
b The score range for job satisfaction is 1 (strongly disagree) to 5 (strongly agree), with a higher score indicating a higher level of job satisfaction.
c Psychological empowerment reflects an active orientation in which an individual wishes and feels able to shape their work role and context. The score range is 1 (strongly disagree) to 5 (strongly agree) with a higher score indicating a higher level of psychological empowerment.

Discussion
Most care aides are middle-aged to older women who speak English as an additional language.
Although they are highly satisfied with their jobs, they work in a resource-constrained environment (eg, often had to rush or miss care tasks). These findings, compared with our previous report, 4 suggest that these prepandemic conditions were stable over a relatively long period (2009-2020).
However, despite stability, our findings indicate a workforce under strain-an at-risk group caring for an even more at-risk resident group 5 -a perfect storm for crisis, as the world has observed. 2,3 Care aides are uniquely positioned to make significant contributions to improving resident care quality and quality of life. Our ongoing work demonstrates that care aide-led improvement programs achieve sustained positive impact on residents' clinical outcomes, including pain, mobility, and responsive behaviors. 6 As one care aide said, "The nurses listen to all the ideas instead of going straight to medication when a simple touch or letting them sleep would have solved the problem.
There is more interaction. Some little things can help instead of having to resort to medications." 6 Generalizations of these findings to care aides with characteristics different from those in urban areas of Western Canada should be made with caution. Survey responses are subject to the usual cautions when interpreting findings (e.g., self-report biases).