Challenges to Wellbeing of Frontline Healthcare Employees During COVID-19: A USC Research Study

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Your Voice can help provide the data needed to drive change

Cynthia Baker

Cynthia Baker, MSW, LCSW, CSW-Gerontology
Doctoral Candidate- USC -2022

Since March 2020 when the first COVID-19 cases were identified in Missouri, I have worked inside healthcare communities as an essential mental health professional, where I have been blessed to work with many amazing healthcare heroes. In 2020 and 2021, I witnessed in the care communities the extreme stress, emotional exhaustion, fatigue, and burnout caused by COVID-19. These direct caregivers were residents’ lifeline and early in the pandemic, these masked faces were often the only individuals residents felt a connection to. I will NEVER forget how miserable the situation was–the #1 goal during the safety quarantine and isolation was to not catch COVID and survive. While providing therapy to residents, the staff seemed to talk only about “corona” – understandable, as the regulations were changing weekly requiring constant pivoting and making ongoing and timely communication critical.

In the home, when residents passed away, a few of us would hold a private vigil and talk about grieving. In one case, I held a CNA because she was so exhausted and upset about her life in that moment. Several of us would let out verbal sighs behind our masks, hoping things would get better soon. We also laughed and cheered together – as the safety quarantine regulations loosened, when residents slowly became more like their prior self, when the building was COVID-free, or to simply blow off steam. The resilience and vigilance of long term care (LTC) leaders and employees who continue to work through the pandemic is something to be admired and appreciated. For individuals like myself, working in supportive positions, I doubt the experience is even a third of what it is for direct care staff.  Even so, it is my experience that informs my objective here – that drives me to want to make a difference through my work.

The research literature reports that the pandemic created high levels of occupational stress for direct care staff, resulting in emotional exhaustion, fatigue and burnout. This in turn led to reduced job satisfaction, high turnover, and crisis level staffing shortages in long term care nursing homes (American Health Care Association [AHCA], 2021; Carey et al., 2020; Lee-Baggley & Thakrar, 2020). For direct care staff with unmediated contact with Covid-19, work/life pressure factors and demands are at critical levels and turnover is skyrocketing, and the staffing problem is predicted to worsen.

Even before COVID, the need for individuals to work in direct care positions in LTC was increasing due to a growing aging population worldwide. Administration on Aging (AOA) (2021) predicts that the number of adults over age 65 (43.1 million in 2012) will almost double to 83.7 million by 2050, with twenty-seven million people requiring some kind of LTC services. Salsberg and Martiniano (2018) projected that by 2026, there will be a 14.3% increase in demand for direct care workers in LTC, with more than 260,000 personal care aides, 135,000 Registered Nurses, and 113,000 Certified Nurse Assistants needed annually to fill new or vacant positions.

As the need grows for essential direct care staff, these individuals face many obstacles in their day-to-day jobs which are linked to high turnover rates, which in turn impact quality of care, increase resident challenging behaviors, and elevate poor quality of life indicators (Dreher et al., 2018; Eaton et al., (2019); Lerner et al., 2014).  This information points to the need for more information and to identify what has been learned during COVID-19 that will be useful in overcoming talent acquisition and retention challenges.

As the principal investigator for this wellbeing study in LTC, I want to draw attention to this significant problem impacting organizations, direct care employees and residents. This study data and recommendations will not only inform us about the direct care employee’s beliefs about emotional exhaustion, fatigue, burnout, which are all contributors to employee wellbeing; but also, the direct care employee’s perspective about what supportive policies and practices are most helpful for improving their wellbeing during the pandemic.

Recognizing the need for data to help drive the change we know is needed, I invite you to be a part of this study by completing The Qualtrics survey.  It is anonymous, and it takes less than 10 minutes to complete. Thank you in advance and please distribute to nursing staff that are currently working on the frontlines in a nursing home. Thank you in advance for your help.


Wellbeing and Long Term Care Research Study Information for Participants

Cynthia Baker has been a Licensed Clinical Social Worker for 18 years and for the last eight years provided mental health assessment and evidenced based treatment services to residents in nursing as assisted living communities in several states. She has been a senior leadership member for Deer Oaks Behavioral Health, a member of numerous inter disciplinary resident support and care teams, provides staff and organization wide consultation and education for 100’s of care facilities, serves on the MC-5 state board, published several articles on LTC related topics, is a frequent educator and presenter at state and national conferences on LTC mental health and related issues.

One comment on “Challenges to Wellbeing of Frontline Healthcare Employees During COVID-19: A USC Research Study

  1. donna k woodward on

    I no longer work as a CNA. But I can say that even before the pandemic, direct-care workers had a huge amount of stress in their lives: residents and patients to whom they could not give the quality of care they aspired to give, because of short-staffing; families they were trying to support on sub-standard salaries; back-breaking work day in and day out, year after year; lack of respect (and compensation) for the skills and talents needed to look after the diverse populations with a spectrum of illness and frailty. We can only imagine how the stress has been exacerbated by COVID work.

    Thank you for taking up this cause.

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