Improved work environments could improve quality of care and quality of life for residents and staff

(Edmonton) – About 80 per cent of nursing home residents in Canada live with some level of cognitive impairment, which means the care needs of this population are increasingly complex.  Missed or rushed care is an on-going concern.

Researchers from Translating Research in Elder Care (TREC) based at the University of Alberta, Faculty of Nursing, interviewed over 4000 care aides from 93 urban nursing homes in Western Canada (BC, Alberta and Manitoba) and published their findings in a recent article in JAMA Network Open.  

Unregulated care aides provide the bulk of direct care (upwards of 90 per cent) to residents in nursing homes. Researchers asked care aides questions, such as: “On your last shift, did you leave mouth care for residents undone because you did not have enough time?”

The study found that 57.4 per cent of care aides reported missing at least one essential care task and 65.4 per cent reported rushing at least one essential care task during their last shift.  Essential care tasks include taking residents for a walk; talking with residents; performing mouth care; toileting; preparing residents for sleep; bathing; feeding; and dressing.

The most common missed task was taking residents for a walk (37.2 per cent of care aides) and the most frequently rushed task was talking with residents (49.2 per cent).  Performing mouth care was missed by 14.1 per cent and rushed by 39.3 per cent.  Other essential care tasks were missed by less than 10 per cent but rushed by more than 30 per cent of care aides.

However, the study also found that care aides on units with more favourable work environments were less likely to miss or rush any care tasks. Factors such as better teamwork, stronger perceptions of sufficient resources to deliver quality care (some buffer in the system) and/or social capital (active connections among people to enable knowledge transfer) contribute to better work environments.  This finding provides a potentially important pathway for change to reduce missed and rushed care in nursing homes.

Dr. Yuting Song, postdoctoral fellow at the University of Alberta (Faculty of Nursing) says, “We found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favourable work environments. The good news is that this means the work environment could be modified to improve nursing home care.”

The study also found that care aides are predominately women (89.1 per cent), 40 years or older (68.7 per cent), and spoke English as an additional language (66.3 per cent).  “They are a hard working, highly motivated and dedicated part of the care team,” says Dr. Carole Estabrooks, Professor, University of Alberta, Faculty of Nursing.  “We need to actively put efforts in place to improve their work environment so that we can enhance both the quality of life and quality of care at Canadian nursing homes.”

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