The aching backbone: perceptions and experiences of care aides in long term residential care

Purpose: Care aides provide most of the direct care for residents in long-term residential care (LTRC), and thus hold the greatest potential to improve residents’ quality of life. Two-thirds of residents in these facilities are older adults with dementia. The number of care aides working in LTRC needed to support Canada’s aging population is only expected to increase with time. Like residents in LTRC, care aides are a disenfranchised population. There is little understanding of what are the experiences and perceptions of care aides in LTRC. This doctoral thesis adds to the scarce body of knowledge that sheds light on the experience of care aides in LTRC. This study was informed by the literature on person-centered care and personhood theory, as well as critical gerontology and institutional theory. The purpose of this study was to understand the experiences and perceptions held by care aides in LTRC and to identify their perceived barriers and facilitators toward the delivery of care to residents. Method: The overall methodology for this study was a qualitative design, using ethnographic data-generating methods from one complex-care floor located within a campus of care facility in rural and remote Western Canada. Data sources for this study included the following: semi-structured interviews (70 hours) with 31 care aides, naturalistic observation (170 hours), and reflexive journaling (20,000 words). Thematic analysis was used to examine all data sources. Results: Care aides’ experiences entering and working in LTRC are varied; however, there are common overarching themes, including not being adequately trained for the realities of working as care providers and the scope of practice they are expected to fulfill within LTRC, as well as being under supported in their role. Participants report strong feelings of responsibility and affection for their residents, yet they perceive insurmountable barriers in their role that prevent them from delivering the care they would like to give. These barriers include the following: (i) lack of standardized education and training; (ii) lack of proper equipment; (iii) lack of autonomy over their residents; (iv) politics and bullying within the power hierarchy of LTRC; and (v) chronic unaddressed moral distress among care aides. Suggestions for improvement of care delivery in LTRC include the following: (i) standardization of care aide education and training; (ii) incorporation of reporting measures specifically for care aides; and (iii) increased autonomy of care aides over their residents. Implications: The support and empowerment of care aides in LTRC are fundamental in the delivery of good care to residents. Care aides have expressed that their attitudes toward their job are low because they feel unheard and voiceless within their work environment. Efforts to empower care aides’ voices should be developed and implemented to meet the needs of a large segment of Canada’s population living with dementia—residents in LTRC.