‘I wouldn't choose this work again’: Perspectives and experiences of care aides in long‐term residential care

Abstract

Aims To provide insight into the everyday realities facing care aides working in long‐term residential care (LTRC), and how they perceive their role in society. Design A qualitative ethnographic case study. Methods Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi‐structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. Results The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections – which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. Conclusion Care aides remain an unsupported workforce that is essential to the provision of high‐quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. Impact What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

Gendered and racial experiences of moral distress: A scoping review

“…Bourne and Epstein (2021, 14) observed that having White participants as a majority might create ethnic bias. In a study investigating the experiences of long‐term care aides in Canada, about 83% of participants were White: this was noted by the authors to be an overrepresentation compared to the demographic of workers in this profession (Booi et al., 2021).…”

“…Gendered power relations in the experience of moral distress were noted to also emanate from interactions with other health care professionals such as male physicians (Addo et al., 2020; Biondi et al., 2019; Boakye et al., 2021; Booi et al., 2021; Langley et al., 2015). One study noted that care aides in British Columbia, Canada, are typically female, over the age of 40 with English as their second language: “The gendered notions of unskilled work, body care and stigma related to this work and the corresponding maltreatment of this workforce is a continuation of the narrative of unvalued predominantly female roles in society” (Booi et al., 2021, p. 13). These studies situate moral distress within the broader context of gender norms which influence how healthcare work is valued and resourced.…”

Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations

“…Despite the increased prevalence, risks and consequences of inadequate food intake, residents are not always provided with optimal mealtime care (Hammar et al, 2016; Lea et al, 2017). Direct care staff, who remain an unsupported and unprepared workforce that is critical to quality care (Booi et al, 2021), report a need for training on the use of resident ‐ and relationship ‐ centred , individualised care approaches integrating management of fluctuating mealtime challenging behaviours to achieve optimal care while minimising risks of inadequate food intake through building relational and emotional connections (Douglas et al, 2021; Li et al, 2021). Effective , multi‐level interventions that optimise mealtime care quality warrant fundamental components , including supportive organisational systems , foundational and interprofessional person‐centred cultures , and adequate staff training ( Brunner et al, 2021; Fazio et al, 2020; Villar et al, 2021).…”

“The Stigma is what you do”: Examining the Relationship Between Occupational Stigma and Worker Outcomes in the Aged Care Context

“…Likewise, aged-care workers may feel greater job dissatisfaction when they accept negative perceptions about their job (Manchha et al, 2021). This psychological distress and job dissatisfaction may also be reflected in greater turnover intention (i.e., intentions to leave their job; Booi et al, 2021). Gao and colleagues (2015) found nursing assistants were more determined to leave aged care when they felt “less than.” Thus, we predict that workers who have internalized the stigma of their work may experience greater psychological distress, job dissatisfaction, and turnover intentions.…”