Canada’s primary health care crisis has garnered news headlines and political attention, but an equally alarming crisis is ongoing in long-term care (LTC). More than five years after COVID-19’s deadly sweep through LTC homes, exposing long-standing deficiencies in funding, infrastructure, infection control, staffing and working conditions, many problems remain, driving a critical staffing shortage, burning out workers and impacting resident care. With the need for LTC only expected to grow as Canada’s population ages, it is critical that the federal, provincial and territorial governments work together to fix these issues, starting with developing trauma-informed workplaces to address LTC workers’ mental health.
Most workers in LTC homes are unregulated care aides (personal support workers and nursing assistants). Primarily female immigrants whose first language is not English, care aides provide upwards of 90 percent of the direct care to residents. Although LTC administrators and families rely on them to provide good quality resident care and end-of-life care, their pay is low, they generally have little formal LTC training and they rarely participate in resident care decisions. They often work short-staffed, managing heavy workloads and performing physically and emotionally demanding tasks as they look after residents with complex medical and social needs, including dementia and significant frailty.
These working conditions take a toll on mental health. Research shows that even before the COVID-19 pandemic, care aides reported elevated levels of stress and burnout. When COVID-19 overran LTC homes early in the pandemic, it only exacerbated the problems. Care aides experienced even heavier workloads, more severe staffing shortages and distress due to increased resident deaths, residents’ anguish over facility lockdowns and their own worries about contracting COVID-19 and spreading it to their families. Many suffered significant mental health challenges, including anxiety, depression, and post-traumatic stress disorder, as well as fatigue and sleeping disturbances. Many are still living with the effects of the trauma that they experienced.
A recent study comparing burnout levels for care aides between 2014 and 2024 found that the levels, which were high prior to the pandemic, have not returned to pre-pandemic levels. Care aides’ emotional exhaustion levels increased and their professional efficacy levels decreased. Burnout is a psychological condition marked by cynicism, emotional exhaustion and decreased professional efficacy (confidence in the ability to do the job). In a sector already struggling with significant staffing shortfalls, care aide burnout poses a significant threat. Not only does it contribute to absenteeism and high staff turnover, it also affects job performance, leading to poorer quality of care for residents.
Finding ways to reduce burnout and improve care aides’ mental health is crucial. While LTC is primarily the responsibility of the provinces and territories, there is an important role for the federal government. Just as it is working with provincial and territorial governments to address problems in primary care, its leadership is also essential in finding solutions to the LTC workforce crisis. One important strategy to improve care aides’ mental health, is for governments to adopt and fund policies that support trauma-informed workplaces in LTC.
A trauma-informed workplace recognizes that trauma is pervasive and has a negative impact on individuals, be they older adults or staff. Through policies and practices centered around safety, trustworthiness, transparency, collaboration, empowerment and being mindful of cultural, historical, race and gender issues, trauma-informed workplaces create supportive work environments that prevent or reduce the impact of adverse events. Having a trauma-informed workplace is about a work environment where people are aware of the impact of retraumatizing people, how this occurs and how it can be prevented and where people feel supported and are free from discrimination and microaggressions. It also means addressing structural causes of harm by offering equitable pay and benefits, ensuring manageable workloads, enhancing training and giving staff a meaningful voice in workplace policies and practices. It means implementing effective tools to support employees’ physical and mental health, including giving staff time to practice stress-management techniques like coherent breathing, a technique that calms the nervous system and reduces stress and anxiety.
Trauma-informed care is already recognized as an important component of resident care in LTC; the Health Standards Organization included it in its 2023 LTC standard for LTC homes and Health Canada incorporated it in its 2024 report on consultations on developing a Safe Long Term Care Act. Extending the concept to LTC staff through workplace policies acknowledges trauma and provides a safe and supportive work environment. By prioritizing care aides’ mental health in this way, we can reduce staff burnout and its negative consequences, leading to better outcomes for LTC workers and the vulnerable residents under their care.
Carole Estabrooks is a professor of nursing. Janice M. Keefe is a sociology professor.
