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Song Y, Iaconi A, Chamberlain SA, et al. Characteristics and Work Life Quality of Nursing Home Care Aides in Canada. JAMA Netw Open. 2020;3(12):e2029121. doi:10.1001/jamanetworkopen.2020.29121
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.
This is a cross-sectional analysis of care aide survey data collected between September 3, 2019, and February 28, 2020.4 The study was approved by research ethics boards at University of Alberta, University of British Columbia, and University of Manitoba. Operational approvals were obtained from participating organizations. Participants completed written informed consent. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
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.
For categorical variables, we calculated the frequencies and percentages. For normally distributed continuous variables, we calculated means and SDs; otherwise, medians and interquartile ranges were calculated. Data analysis was performed from April to May 2020.
Of 5381 eligible care aides in 91 nursing homes, 3765 (69.97%) participated in the study. Care aides were predominantly women (3359 aides [89.22%]), aged 40 years or older (2632 aides [69.91%]), and spoke English as an additional language (2571 aides [68.29%]). Approximately 25% (915 aides [24.30%]) reported working in more than 1 nursing home (Table 1).
More than 70% of care aides reported moderate to high risk for emotional exhaustion (2718 aides [72.19%]) and cynicism (3146 aides [83.56%]), which are 2 core indicators of burnout (Table 2). Approximately one-half of aides (1890 aides [50.20%]) reported that they had to work short-staffed daily or weekly in the past month. They reported frequently rushing and missing essential care tasks in their most recent shift and often experienced responsive behaviors from residents associated with dementia. Less than 30% (960 aides [25.51%]) reported being frequently engaged in team meetings about residents, and less than 5% (179 aides [4.76%]) were frequently engaged in family conferences. Nevertheless, care aides reported feeling satisfied with their jobs. The majority had high levels of professional efficacy and psychological empowerment.
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 group5—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).
Accepted for Publication: October 18, 2020.
Published: December 9, 2020. doi:10.1001/jamanetworkopen.2020.29121
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Song Y et al. JAMA Network Open.
Corresponding Author: Yuting Song, PhD, Faculty of Nursing, University of Alberta, 11405 87 Ave, 5-007D Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada (firstname.lastname@example.org).
Author Contributions: Dr Estabrooks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Song, Iaconi, Cummings, Hoben, Estabrooks.
Acquisition, analysis, or interpretation of data: Song, Iaconi, Chamberlain, Hoben, Norton, Estabrooks.
Drafting of the manuscript: Song, Iaconi, Chamberlain.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Song, Iaconi, Hoben, Estabrooks.
Administrative, technical, or material support: Cummings, Hoben, Norton.
Supervision: Norton, Estabrooks.
Conflict of Interest Disclosures: None reported.
Funding/Support: Funding was provided by the Canadian Institutes of Health Research and partners in the Ministries of Health in British Columbia, Alberta, and Manitoba, as well as regional health authorities in participating British Columbia and Alberta regions.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the Translating Research in Elder Care 2.0 team for its contributions to this study. Janice Keefe, PhD (Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada), R. Colin Reid, PhD (School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada), and Janet Squires, PhD (School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada), contributed to the design of the project and provided constructive feedback on the manuscript. They did not receive compensation for the work. Cathy McPhalen, PhD (thINK Editing Inc, Edmonton, Canada), provided editorial support that was funded by Dr Estabrooks’ CIHR Canada Research Chair, Ottawa, Canada, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).