Staff Support / Self-care

Contributing factors unique to residential aged care

There are several factors that make caring for residents in aged care facilities unique.
  • Residents often have multiple and complex needs.
  • Care staff may ‘know’ and care for residents for several years.
  • Care staff are exposed to continual death and dying. [1]
  • Personal carers, cleaners, administration and activity staff often spend significant time with residents.
  • Caring for cognitively impaired residents can be challenging and extremely stressful.
  • Care staff are often asked to assist with palliative care decision making by relatives.
It is not unusual for care staff to view the death of a resident as timely. Care staff may see the death of a resident as a release from suffering, especially if they have cared for the person for a long time. [2] 
Yet the factors listed above are often compounded by the following:
  • untrained staff are less likely to have education about palliative care and how to cope with death, dying, loss and grief than registered nurses [3]
  • care staff often face complex ethical challenges
  • for example, staff views about prognosis and end-of-life care goals are often in conflict with the views and expectations of families
  • care staff are often concerned about the quality of care they are able to provide. They express frustration with a lack of ability to provide the kind of care they feel is appropriate. Lack of time to spend with residents and unrealistic work demands contribute to their frustrations. [4]
  • negative interactions with colleagues as well as residents and families can be further sources of frustration and stress [5]
  • support and debriefing following a residents death is not available, leaving carers fearful of the death experience.
Staff tend to get most frustrated when their care values are at odds with those of their employer. [6] They cite unsupportive management as the most common reason for dissatisfaction with care work. Low staff to resident ratios combined with low salary and status as well as a lack of training, are some of the reasons why registered nurses decide to leave aged care. [7]

Health and well-being

Residential aged care organisations that are proactive about the health of their staff need to consider the following organisational factors associated with well-being of their employees:
  • quality of leadership
  • extent of workload
  • quality of interactions with colleagues. [4]
Some of the stresses faced by staff working in aged care can be mitigated if staff feel supported by facility management. 

Staff value working in organisations where they:
  • are able to access flexible working arrangements
  • are provided opportunities for education
  • feel that both residents and staff are respected as part of the RAC culture. [8]
Care workers gain a greater level of satisfaction with their work if their managers provide opportunities for them to contribute to decisions about care and give staff constructive feedback about their performance. In turn, care workers are more likely to be able to provide quality care of residents. [9]
When care workers and the care they provide are not valued, they are more likely to burnout. In turn, this may lead to defensive behaviours and negative attitudes towards residents resulting in poor care. [10]

Useful strategies for self-care

King, 2012 [6] lists six key factors that can help counter the frustrations of aged careworkers:
  1. “a shared understanding of quality care between staff and the organisation,
  2. autonomy in delivering care services,
  3. a sense of being professional careworkers,
  4. organisational support if problems arise or advice needed,
  5. support to develop emotional resilience; and
  6. recognition from clients of their care worker role and responsibilities”.
Education is also important in helping to counter staff stresses. Staff training can promote job satisfaction. [11]  When staff are educated and feel prepared to care for people with cognitive impairment they report greater satisfaction with their work. [12] Careworkers who are more educated to carry out their work report dementia sensitive attitudes. [13] The CareSearch page Education and Training contains helpful resources for providers of residential aged care and their staff.

Overall, staff reported the following strategies as being helpful in dealing with continuous exposure to death and dying:
  • having clear boundaries between work and home and being able to leave work behind,
  • family and leisure activities,
  • connecting with nature,
  • talking to other people about their experiences and emotions [15], and
  • offering debriefing or counselling.
  • Useful Tip

Many aged care services now provide access to confidential support programs for their employees. These programs are often provided by an independent organisation, at no cost to staff.

  1. Anderson KA. Grief experiences of CNAs: relationships with burnout and turnover. J Gerontol Nurs. 2008 Jan;34(1):42-9.
  2. Spall B, Callis S. Loss, bereavement and grief: a guide to effective caring. Cheltenham, England: Stanley Thornes; 1997.
  3. McInerney F, Ford R, Simpson A, Willison M. Residential aged-care workers and the palliative approach: Tensions in the field. J Hos Pall Nurs. 2009 Nov-Dec;11(6):344-52.
  4. Martin B, King D. Who cares for older Australians? A picture of the residential and community based aged care workforce 2007. Canberra: Department of Health and Aging; 2007. 224 p. Publication No.:P3 -4646.
  5. Rowe MM, Sherlock H. Stress and verbal abuse in nursing: do burned out nurses eat their young? J Nurs Manag. 2005 May;13(3):242-8.
  6. King D. It’s frustrating! Managing emotional dissonance in aged care work. Aust J Soc Iss. 2012;47(1):51-70.
  7. Commonwealth of Australia. Recruitment and retention of nurses in aged care: final report. Canberra: Department of Health; 2002. Chapter 2, Systematic review of the literature: the attrition and recruitment of qualified nurses in aged care; p.5-22.
  8. Chenoweth L, Jeon YH, Merlyn T, Brodaty H. A systematic review of what factors attract and retain nurses in aged and dementia care. J Clin Nurs. 2010 Jan;19(1-2):156-67.
  9. Aronsson G, Astvik W, Thulin AB. Home-care workers: work conditions and occupational exclusion: a comparison between carers on early-retirement and regular pensions. Home Health Care Serv Q. 1998;17(2):71-91.
  10. Lookinland S, Anson K. Perpetuation of ageist attitudes among present and future health care personnel: implications for elder care. J Adv Nurs. 1995 Jan;21(1):47-56.
  11. Gurnik M, Hollis-Sawyer L. Empowering assisted living frontline care staffs to better care for Alzheimer’s and Dementia residents. Ageing Int. 2003;28(1):82-97.
  12. Nay R, Closs B. Recruitment & retention of qualified nursing staff in long term care of older people : interim report. Victoria: Aged Community and Mental Health Care Division, Dept. of Human Services; 1998. 43 p.
  13. Zimmerman S, Williams CS, Reed PS, Boustani M, Preisser JS, Heck E, et al. Attitudes, stress, and satisfaction of staff who care for residents with dementia. Gerontologist. 2005 Oct;45 Spec No 1(1):96-105.
  14. Edvardsson D, Sandman PO, Nay R, Karlsson S. Predictors of job strain in residential dementia care nursing staff. J Nurs Manag. 2009 Jan;17(1):59-65.
  15. Dick HV. ‘Knowing the person is happy that you were there’: The spiritual resources staff in a residential aged care facility use to cope with resident deaths. J Relig Spirit Aging. 2012;24(1-2):164-76.
Last updated 20 March 2019