Association of Work Environment With Missed and Rushed Care Tasks Among Care Aides in Nursing Homes

Abstract

IMPORTANCE In Canada, approximately 81% of residents of nursing homes live with mild to severe cognitive impairment. Care needs of this population are increasingly complex, but resources, such as staffing, for nursing homes continue to be limited. Staff risk missing or rushing care tasks and interfering with quality of care and life. OBJECTIVE To assess the association of work environment with missing and rushing essential care tasks in nursing homes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used survey data collected from a random sample of 93 urban nursing homes in Western Canada, stratified by health region, owneroperator model, and facility size, between May and December 2017. All 5411 eligible care aides were invited to participate, and 4016 care aides agreed and completed structured, computer-assisted interviews in person. Analyses were conducted from July 4, 2018, to February 27, 2019. MAIN OUTCOMES AND MEASURES Self-reported number of essential care tasks missed (range, 0-8) or rushed (range, 0-7) in the most recent shift. Two-level random intercept hurdle regressions controlled for care aide, care unit, and nursing home characteristics. RESULTS Of 4016 care aides, 2757 (68.7%) were 40 years or older, 3574 (89.1%) were women, and 2663 (66.3%) spoke English as an additional language. For their most recent shift, 2306 care aides (57.4%) reported missing at least 1 essential care task and 2628 care aides (65.4%) reported rushing at least 1 essential care task. Care aides on units with more favorable work environments (eg, more effective leadership, better work culture, higher levels of buffering resources) were less likely to miss any care tasks (odds ratio, 1.59; 95% CI, 1.34-1.90; P < .001) and less likely to rush any care task (odds ratio, 1.66; 95% CI, 1.38-1.99; P < .001). CONCLUSIONS AND RELEVANCE This study found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favorable work environments. This finding suggests that work environment should be added to the list of modifiable factors associated with improving nursing home care, as it may be an important pathway for improving quality of care. Further research is needed to understand associations of missed and rushed care and of improving work environments with outcomes among residents of nursing homes.

Restoring trust: COVID-19 and the future of long-term care in Canada

“…• are mainly middle-aged or older women (66%-71%) (Estabrooks et al 2015b) • are often newcomers or immigrants (60% of care aides working in urban areas), with English as their second language (Chamberlain et al 2019b) • are often not required to complete any continuing education and are often not offered it (Estabrooks et al 2015b) • often work in more than one job (25%-30%) and in health care settings other than nursing homes (e.g., hospitals; 15%) (Estabrooks et al 2015b;Hewko et al 2015;Chamberlain et al 2019b;Song et al 2020a;Van Houtven et al 2020;Yinfei et al 2020) • often work short-staffed (Song et al 2020b) • have insufficient time to complete necessary care tasks and must rush essential care (up to 65% of care aides per shift) (Song et al 2020a) • are at worryingly high risk for burnout and physical injury (Estabrooks et al 2015b;Hewko et al 2015;Chamberlain et al 2017Chamberlain et al , 2019b • report feeling that their work is important and has meaning, despite high levels of work-related stress (Estabrooks et al 2015b;Chamberlain et al 2019b;Song et al 2020b) The impact of COVID-19 on psychological health and safety of direct care workers in nursing homes is being added to already worrisome pre-existing trends (Braedley et al 2018). Studies from the 2003 SARS epidemic (Styr et al 2008) and recent studies documenting effects of the COVID-19 pandemic on point-of-care workers in China (Lai et al 2020b) point to severe long-term traumatic impacts on mental health of point-of-care staff.…”

The necessity and possibilities of playfulness in narrative care with older adults

“…Older adults living with dementia and their care providers and caregivers share and co‐compose narratives, which are not part of the biomedical view of dementia. Care providers in long‐term care are often storied as transient (Riggs & Rantz, 2001), disengaged (Ward, Vass, Aggarwal, Garfield, & Cybyk, 2008) and focused on the physical and medical aspects of care (Daly & Szebehely, 2012; Song, Hoben, Norton, & Estabrooks, 2020), and long‐term care settings and facilities are often described as ‘places to die rather than places to live’ (Schoenberg & Coward, 1997), or settings deprived of any or very restricted resources in staffing (Vaismoradi, Wang, Turunen, & Bondas, 2016) and financial resources (National Institute on Ageing, 2019).…”

The Challenges of Improving Nursing Home Quality

“…outcomes. The study by Song et al1 adds to this body of literature in several ways. First, the authors focus on missed and rushed care.…”