Job Characteristics and Well-Being of Personal Care Workers in Long-Term Care Facilities: A Mixed Methods Systematic Review and Narrative Synthesis

Background: Personal care workers (PCWs), also known as direct care workers, care aides, and nursing assistants, are the “eyes and ears” of the Long-Term Care (LTC) system, accounting for over 70% of the LTC workforce across OECD countries and providing essential daily support to maintain the quality of life of older people in LTC facilities (LTCFs). As paraprofessional health care workers whose care labors are socially devalued, PCWs in LTCFs deliver meaningful and rewarding care work, but their work is physically and emotionally challenging. There is a need to develop a theory-driven, systematic synthesis of the job characteristics and well-being outcomes specific to this occupational group.

Purpose: To draw upon the job demand-resource (JD-R) model and conceptualize the occupation-specific job characteristics and well-being outcomes of PCWs in LTCFs.

Methods: Mixed methods systematic review (MMSR) following the JBI approach to MMSR and the PRISMA protocol. The study protocol was registered on PROSPERO. A convergent synthesis approach was conducted using a content analysis method combining both deductive and inductive analysis.

Results: Nineteen articles were included. Empirical evidence on the job characteristics and well-being of PCWs as paraprofessional workers in LTCFs is underdeveloped compared to the vast body of research focusing on professional health care workers and LTC workers as a whole. A Personal Care Worker JD-R (PCWJD-R) model of worker well-being in LTCFs was developed to identify job demands, job resources, and personal characteristics specific to PCWs. Nineteen well-being and two secondary work-related outcomes, 22 job demands in six domains, 30 job resources in nine domains, and 37 personal characteristics in five domains were identified and included in the model. The review evidence supports the JD-R model’s propositions about the health impairment and motivational process that underlies the relationships between job demands, job resources, and well-being outcomes. A comprehensive evaluation of the job characteristics, personal characteristics, and well-being of PCWs indicated a spiral of vulnerabilities characterized by a vicious cycle of individual vulnerabilities, poor quality job, and health inequalities among this group of low-wage, devalued workers.

Practice implications: Occupational-specific macro (policy), meso (organization), and micro (worker) level strategies mitigating job demands and nurturing job resources in the PCWJD-R model should be developed to tackle the occupational health disparities faced by PCWs.