Long-term care workers caught 'between a rock and a hard place'

Dr. Bonnie Lashewicz, PhD, was studying how care workers interact with people who have late-stage dementia and who live in long-term care, when the pandemic hit and caused widespread lockdowns and untold turmoil in long-term care facilities across the country. 

Lashewicz, associate professor in the Department of Community Health Sciences at the Cumming School of Medicine, quickly shifted research focus to emphasize understanding and supporting the mental health of long-term care workers. “Care workers are the lynchpin of the well-being of people with dementia,” she says. “We were struck by what the pandemic meant for care workers and all they had to manage. So we turned our focus.”

Lashewicz and her team are studying worker risks of moral injury, a condition first identified among Vietnam war veterans. “Moral injury is about complex emotions of guilt and shame that result from knowing there is a right thing you want to do but being prevented from doing that owing to circumstances outside of your control,” she says. 

Award-winning research

Lashewicz won a Peak Scholars COVID-19 Innovation Excellence Award for the re-focused project, “Supporting Mental Health and Preventing Moral Injury Among Long-Term Care Workers.” 

As the lockdowns in long-term care facilities took hold across the country, Canadian Institutes for Health Research/Healthcare Excellence Canada put out a call for research that would strengthen pandemic preparedness in long-term care. Lashewicz’s project, which now includes data from nearly 50 audio recorded interviews with long-term care workers, is one of 22 projects awarded across Canada.

Long-term care workers face ever-changing pandemic rules and regulations at work. Further, the residents in their care are disoriented and forced into isolation and residents’ family members are anxious and fearful. The workers face stressors at home too.

There is a whole realm of stress related to what this means for the rest of their life and the people with whom they are in contact; they worry about exposing their loved ones.

“So many collisions between circumstances and feelings can occur and leave workers between a rock and a hard place.”  

Lashewicz’s team is working to develop an app to help support mental health and prevent moral injury among long-term care workers. “This workforce is gendered, racialized, under-recognized and under-paid. Many workers piece together shifts to generate a living wage,” she says. “In all, care workers are at the mercy of systems, processes and structures within which care work has not been highly valued.” 

At the mercy of systems

About a third of the nearly 50 interviews with workers to date have been with people under 30 who have limited life experience and for whom the pandemic is their first major adversity. Younger workers also often have limited financial resources and may have roommates and young children at home, adding to the stress over COVID. And while younger workers, who are building their professional identities, are buoyed by the power of teamwork, they’re also distinctly upset over the negative media attention long-term care has received over the course of the pandemic. 

“To redress imbalances in the respect and value afforded to long-term care workers, we need more profiling of the nature of care work for what it is: relationally demanding pursuits that hold our society together,” says Lashewicz.

“Care work demands deep engagement from people willing to move alongside other people during some of the most profound experiences in human life. This project is a sober illumination of the extraordinary work being done in long-term care and the corresponding need to better support long-term care workers.”