Skip to main content Accessibility help

Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work Life

  • Stephanie A. Chamberlain (a1), Matthias Hoben (a1), Janet E. Squires (a2) (a3), Greta G. Cummings (a1), Peter Norton (a4) and Carole A. Estabrooks (a1)...


Unregulated care aides provide most of the direct care to nursing home residents. We previously reported the first demographic profile of care aides in Western Canada through the Translating Research in Elder Care (TREC) longitudinal research program (2007–2022) in applied health services. Here we describe demographic, health, and work life characteristics of aides from 91 nursing homes in Western Canada. Demographics and work life varied significantly across health regions and facility owner-operator models. Our longitudinal cohort of aides from Alberta and Winnipeg had higher emotional exhaustion (a negative attribute), professional efficacy (a positive attribute), and experience of dementia-related responsive behaviours from residents. Overall, results indicate little improvement or worsening of care aide health and quality of work life. Coupled with limited provincial or national initiatives for workforce planning and training of these workers, this signals a long-term care system ill-prepared to care effectively for Canada’s aging population.

Les aides-soignants non réglementés fournissent la majorité des soins directs dans les résidences pour personnes âgées. Nos travaux précédents ont rapporté un premier profil démographique des aides-soignants de l’ouest du Canada par le programme de recherche Translating Research in Elder Care (TREC; 2007-2022) visant les services de santé appliqués. Dans cette étude, nous présentons les caractéristiques démographiques, liées à la santé et à la vie professionnelle d’aides-soignants provenant de 91 résidences pour personnes âgées de l’ouest du Canada. Les données démographiques et liées au travail ont significativement varié selon les régions et les modèles de propriété ou d’opération. Notre cohorte longitudinale de l’Alberta et de Winnipeg présentait davantage d’épuisement émotionnel (attribut négatif), d’efficacité professionnelle (attribut positif) et d’expérience avec les comportements réactifs liés à la démence chez les résidents. En général, les résultats indiquent peu d’amélioration ou de détérioration de la santé des aides-soignants et de la qualité de la vie professionnelle. Étant donné que les initiatives provinciales et nationales pour la planification et la formation de la main-d’œuvre dans ce domaine sont limitées, ceci indique que le système des soins de longue durée n’est pas préparé pour soigner efficacement la population canadienne vieillissante.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work Life
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work Life
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work Life
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Carole A. Estabrooks, CM, PhD, RN, FCAHS, FAAN Faculty of Nursing Level 3, Edmonton Clinic Health Academy 11405 87 Avenue University of Alberta Edmonton, AB, T6G 1C9 <>


Hide All

The authors acknowledge the Translating Research in Elder Care (TREC) 2.0 team for its contributions to this study. Funding was provided by the Canadian Institutes of Health Research (CIHR) and partners in the Ministries of Health in British Columbia, Alberta, and Manitoba, as well as regional health authorities in participating BC and AB regions.

S. Chamberlain is supported by an Alzheimer Society of Canada Doctoral Fellowship. M. Hoben is supported by a postdoctoral fellowship from the Translating Research in Elder Care (TREC) program. J. Squires is supported by a CIHR New Investigator award in Knowledge Translation. G. Cummings is supported as a Centennial Professor by the University of Alberta. C. Estabrooks is supported by a Tier 1 CIHR Canada Research Chair in Knowledge Translation.

The authors thank Cathy McPhalen of thINK Editing Inc., Edmonton, Canada, for providing editorial support that was funded by Carole Estabrooks’ Canada Research Chair in accordance with Good Publication Practice (GPP3) guidelines (

No funding agency listed above had a role in the study design, data collection, data analysis, or interpretation of the data.



Hide All
Alberta Health and Wellness. (2000). Strategic directions and future actions: Healthy aging and continuing care in Alberta. Edmonton, AB: Author. Retrieved from
Alberta Health and Wellness. (2008). Continuing care strategy: Aging in the right place. Edmonton, AB: Author. Retrieved from
Andersen, E. (2009). Working in long-term residential care: A qualitative metasummary encompassing roles, working environments, work satisfaction, and factors affecting recruitment and retention of nurse aides. Global Journal of Health Science, 1(2), 241.
Association of Canadian Community Colleges. (2012). Canadian educational standards for personal care providers. Retrieved from
Bakker, A. B., Demerouti, E., & Sanz-Vergel, A. I. (2014). Burnout and work engagement: The JD-R approach. Organizational Psychology and Organizational Behavior, 1, 389411. doi: 10.1146/annurev-orgpsych-031413-091235
Berta, W., Laporte, A., Deber, R., Baumann, A., & Gamble, B. (2013). The evolving role of health care aides in the long-term care and home and community care sectors in Canada. Human Resources for Health, 11(25), 16. doi: 10.1186/1478-4491-11-25
Caspar, S., Ratner, P. A., Phinney, A., & MacKinnon, K. (2016). The influence of organizational systems on information exchange in long-term care facilities: An institutional ethnography. Qualitative Health Research, 26(7), 951965. doi: 10.1177/1049732315619893
Chamberlain, S. A., Gruneir, A., Hoben, M., Squires, J. E., Cummings, G. G., & Estabrooks, C. A. (2017). Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada. International Journal of Nursing Studies, 71, 6069. doi: 10.1016/j.ijnurstu.2017.02.024
Chamberlain, S. A., Hoben, M., Squires, J. E., & Estabrooks, C. A. (2016). Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Services Research, 16, 19. doi: 10.1186/s12913-016-1815-6
Cohen, M., Murphy, J., Nutland, K., & Ostry, A. (2005). Continuing care renewal or retreat? BC residential and home health care restructuring 2001–2004. Vancouver, BC: Canadian Centre for Policy Alternatives, BC office. Retrieved from
Continuing Care Assistant Program. (2016). CCA annual report. Retrieved from
Cooper, S. L., Carleton, H. L., Chamberlain, S. A., Cummings, G. G., Bambrick, W., & Estabrooks, C. A. (2016). Burnout in the nursing home health care aide: A systematic review. Burnout Research, 3(3), 7687.
Cranley, L. A., Hoben, M., Yeung, J., Estabrooks, C. A., Norton, P. G., & Wagg, A. (2018). SCOPEOUT: Sustainability and spread of quality improvement activities in long-term care- a mixed methods approach. BMC Health Services Research, 18, 174. doi: 10.1186/s12913-018-2978-0
Cranley, L. A., Norton, P. G., Cummings, G. G., Barnard, D., Batra-Garga, N., & Estabrooks, C. A. (2012). Identifying resident care areas for a quality improvement intervention in long-term care: A collaborative approach. BMC Geriatrics, 12, 1–5. doi: 10.1186/1471-2318-12-59
Cranley, L. A., Norton, P. G., Cummings, G. G., Barnard, D., & Estabrooks, C. A. (2011). SCOPE: Safer care for older persons (in residential) environments: A study protocol. Implementation Science, 6, 71. doi:10.1186/1748-5908-6-71
de Rooij, A. H. P. M., Luijkx, K. G., Declercq, A. G., Emmerink, P. M. J., & Schols, J. M. G. A. (2012). Professional caregivers’ mental health problems and burnout in small-scale and traditional long term care settings for elderly people with dementia in the Netherlands and Belgium. Journal of the American Medical Directors Association, 13(5), 486.e487-411. doi: 10.1016/j.jamda.2012.01.001
Degenholtz, H., Castle Nicholas, G., & Rosen, J. (2006). Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania. BMC Health Services Research, 6(1), 60. doi: 10.1186/1472-6963-6-60
Edvardsson, D., Sandman, P. O., Nay, R., Karlsson, S., Edvardsson, D., Sandman, P. O., … Karlsson, S. (2008). Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care. International Psychogeriatrics, 20(4), 764776. doi: 10.1017/S1041610208006716
Estabrooks, C. A., Hoben, M., Poss, J. W., Chamberlain, S. A., Thompson, G. N., Silvius, J. L., & Norton, P. G. (2015). Dying in a nursing home: Treatable symptom burden and its link to modifiable features of work context. Journal of the American Medical Directors Association, 16(6), 515520. doi: 10.1016/j.jamda.2015.02.007
Estabrooks, C. A., Hutchinson, A. M., Squires, J. E., Birdsell, J., Cummings, G. G., Degner, L., … Norton, P. G. (2009). Translating research in elder care: An introduction to a study protocol series. Implementation Science, 4, 51. doi: 10.1186/1748-5908-4-51
Estabrooks, C. A., Morgan, D. G., Squires, J. E., Bostrom, A. M., Slaughter, S. E., Cummings, G. G., & Norton, P. G. (2011). The care unit in nursing home research: Evidence in support of a definition. BMC Medical Research Methodology, 11, 46. doi: 10.1186/1471-2288-11-46
Estabrooks, C. A., Poss, J. W., Squires, J. E., Teare, G. F., Morgan, D. G., Stewart, N., … Norton, P. G. (2013). A profile of residents in prairie nursing homes. Canadian Journal on Aging, 32(3), 223231. doi: 10.1017/s0714980813000287
Estabrooks, C. A., Squires, J. E., Carleton, H. L., Cummings, G. G., & Norton, P. G. (2015). Who is looking after mom and dad? Unregulated workers in Canadian long-term care homes. Canadian Journal on Aging, 34(1), 4759. doi: 10.1017/S0714980814000506
Estabrooks, C. A., Squires, J. E., Cummings, G. G., Teare, G. F., & Norton, P. G. (2009). Study protocol for the translating research in elder care (TREC): Building context – An organizational monitoring program in long-term care project (project one). Implementation Science, 4, 52. doi: 10.1186/1748-5908-4-52
Estabrooks, C. A., Squires, J. E., Hayduk, L., Morgan, D., Cummings, G. G., Ginsburg, L., … Norton, P. G. (2015). The influence of organizational context on best practice use by care aides in residential long-term care settings. Journal of the American Medical Directors Association, 16(6), 537.e531-510. doi: 10.1016/j.jamda.2015.03.009
Feldman, H. H., & Estabrooks, C. A. (2017). The Canadian dementia challenge: Ensuring optimal care and services for those at risk or with dementia throughout the country. Canadian Journal of Public Health, 108(1), e95e97. doi: 10.17269/cjph.108.5852
Fujisawa, R., & Colombo, F. (2009). The long-term care workforce: Overview and strategies to adapt supply to a growing demand. Paris, FRA: OECD.
Ginsburg, L., Berta, W., Baumbusch, J., Rohit Dass, A., Laporte, A., Reid, R. C., … Taylor, D. (2016). Measuring work engagement, psychological empowerment, and organizational citizenship behavior among health care aides. The Gerontologist, 56(2), e111. doi: 10.1093/geront/gnv129
Government of Alberta. (2001). Health care aides competency profile. Edmonton, AB: Author. Retrieved from
Government of British Columbia. (2014). B.C. Health care assistants core competency profile. Victoria, BC: Author. Retrieved from
Government of British Columbia. (2017). Residential care staffing review. Victoria, BC: Author. Retrieved from
Government of Canada. (2004). Long-term facilities-based care. Ottawa, ON: Author. Retrieved from
Health Employers Association of BC. (2014). Care aides. Vancouver, BC: Author. Retrieved from
Hewko, S. J., Cooper, S. L., Huynh, H., Spiwek, T. L., Carleton, H. L., Reid, S., & Cummings, G. G. (2015). Invisible no more: A scoping review of the health care aide workforce literature. BMC Nursing, 14(1), 38. doi: 10.1186/s12912-015-0090-x
Hirdes, J. P., Mitchell, L., Maxwell, C. J., & White, N. (2011). Beyond the ‘iron lungs of gerontology’: Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging, 30(3), 371390. doi: 10.1017/s0714980811000304
Hoben, M., Clarke, A., Huynh, K. T., Kobagi, N., Kent, A., Hu, H., … Yoon, M. N. (2017a). Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis. International Journal of Nursing Studies, 73, 3451. doi: 10.1016/j.ijnurstu.2017.05.003
Hoben, M., Knopp-Sihota, J. A., Nesari, M., Chamberlain, S. A., Squires, J. E., Norton, P. G., … Estabrooks, C. A. (2017). Health of health care workers in Canadian nursing homes and pediatric hospitals: A cross-sectional study. CMAJ Open, 5(4), E791E799. doi: 10.9778/cmajo.20170080
Hoben, M., Norton, P. G., Ginsburg, L. R., Anderson, R. A., Cummings, G. G., Lanham, H. J., … Estabrooks, C. A. (2017). Improving nursing home care through feedback on PerfoRMance data (INFORM): Protocol for a cluster-randomized trial. Trials, 18, 9. doi: 10.1186/s13063-016-1748-8
Hogan, D. B., Amuah, J. E., Strain, L. A., Wodchis, W. P., Soo, A., Eliasziw, M., … Maxwell, C. J. (2014). High rates of hospital admission among older residents in assisted living facilities: Opportunities for intervention and impact on acute care. Open Med, 8(1), e33–45.
Hollander, M. J., Miller, J. A., MacAdam, M., Chappell, N., & Pedlar, D. (2009). Increasing value for money in the Canadian healthcare system: New findings and the case for integrated care for seniors. Healthcare Quarterly, 12(1), 3847, 32.
Hunter, P. V., Hadjistavropoulos, T., Thorpe, L., Lix, L. M., & Malloy, D. C. (2016). The influence of individual and organizational factors on person-centred dementia care. Aging & Mental Health, 20(7), 700708. doi: 10.1080/13607863.2015.1056771
Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, D.C.: National Academies Press.
Janes, N., Sidani, S., Cott, C., & Rappolt, S. (2008). Figuring it out in the moment: A theory of unregulated care providers’ knowledge utilization in dementia care settings. Worldviews Evidence Based Nursing, 5(1), 1324. doi: 10.1111/j.1741-6787.2008.00114.x
Jenkins, H., & Allen, C. (1998). The relationship between staff burnout/distress and interactions with residents in two residential homes for older people. International Journal of Geriatric Psychiatry, 13(7), 466472.
Kelly, C., & Bourgeault, I. L. (2015). The personal support worker program standard in Ontario: An alternative to self-regulation? Healthcare Policy, 11(2), 2026.
Khatutsky, G., Wiener, J. M., & Anderson, W. L. (2010). Immigrant and non-immigrant certified nursing assistants in nursing homes: How do they differ? Journal of Aging and Social Policy, 22(3), 267287. doi: 10.1080/08959420.2010.485526
Krueger, C., & Tian, L. (2004). A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biological Research For Nursing, 6(2), 151157. doi: 10.1177/1099800404267682
Manitoba Health. (2006). Manitoba launches new $98-Million long-term care strategy for seniors. Winnipeg, MB: Author. Retrieved from
Marventano, S., Ayala, A., Gonzalez, N., Rodríguez-Blázquez, C., Garcia-Gutierrez, S., & Forjaz, M. J. (2016). Multimorbidity and functional status in institutionalized older adults. European Geriatric Medicine, 7, 3439. doi: 10.1016/j.eurger.2015.10.011
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99113.
Maslach, C., & Jackson, S. E. (1984). Burnout in organizational settings. In Oskamp, S. (Ed.), Applied Social psychology annual: Applications in organizational settings (Vol. 5) (pp. 133153). Beverly Hills, CA: Sage.
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52(1), 397422. doi:10.1146/annurev.psych.52.1.397
McGregor, M. J., Tate, R. B., Ronald, L. A., McGrail, K. M., Cox, M. B., Berta, W., & Broemeling, A.-M. (2010). Trends in long-term care staffing by facility ownership in British Columbia, 1996 to 2006. Health Reports, 21(4), 2733.
Nova Scotia Department of Health and Wellness. (2014). CCA program curriculum standards. Halifax, NS: Author. Retrieved from
Nowrouzi, B., Giddens, E., Gohar, B., Schoenenberger, S., Bautista, M. C., & Casole, J. (2016). The quality of work life of registered nurses in Canada and the United States: A comprehensive literature review. International Journal of Occupational and Environmental Health, 22(4), 341358. doi: 10.1080/10773525.2016.1241920
Ministry of Training, Colleges and Universities, 2014. (2014). Personal support worker program standard. Toronto, ON: Author. Retrieved from
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., & Karagiannidou, M. (2016). Improving healthcare for people living with dementia: coverage, quality and costs now and in the future (World Alzheimer Report 1026). Retrieved from
Prince, M., Wimo, A., Guerchet, M., Wu, Y.-T., & Prina, M. (2015). The global impact of dementia: An analysis of prevalence, incidence, cost and trends (World Alzheimer Report 2015). Retrieved from
Schleicher, D. J., Hansen, D., & Fox, K. E. (2010). Job attitudes and work values. In Zedeck, S. (Ed.), APA handbook of industrial and organizational psychology (Vol. 3) (pp. 137190). Washington, DC: American Psychological Association.
Schmidt, S. G., Dichter, M. N., Bartholomeyczik, S., & Hasselhorn, H. M. (2014). The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes. Geriatric Nursing, 35, 4246. doi: 10.1016/j.gerinurse.2013.09.006
Schüssler, S., & Lohrmann, C. (2015). Change in care dependency and nursing care problems in nursing home residents with and without dementia: A 2-year panel study. PLoS ONE, 10(10), 112. doi: 10.1371/journal.pone.0141653
Singer, J. D. (1998). Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. Journal of Educational and Behavioral Statistics, 23(4), 323355. doi: 10.3102/10769986023004323
Spence Laschinger, H. K., Shamian, J., & Thomson, D. (2001). Impact of magnet hospital characteristics on nurses’ perceptions of trust, burnout, quality of care, and work satisfaction. Nursing Economics, 19(5), 209219.
Squires, J. E., Hutchinson, A. M., Bostrom, A. M., Deis, K., Norton, P. G., Cummings, G. G., & Estabrooks, C. A. (2012). A data quality control program for computer-assisted personal interviews. Nursing Research and Practice, 2012, 303816. doi: 10.1155/2012/303816
Statistics Canada. (2004). Employment trends in nursing. Retrieved from
Statistics Canada. (2012). Kelowna, British Columbia and Canada. Ottawa, ON: Author. Retrieved from
Statistics Canada. (2016). Dwellings in Canada. Ottawa, ON: Author. Retrieved from
Statistics Canada. (2017). A portrait of the population aged 85 and older in 2016 in Canada. Ottawa, ON: Author. Retrieved from
Stone, R. I., & Wiener, J. M. (2001). Who will care for us? Addressing the long-term care workforce crisis. Urban Institute and the American Association of Homes and Services for the Aging. Retrieved from
Ware, J., Kosinski, M., Dewey, J., & Gandek, B. (2001). How to score and interpret single-item health status measures: A manual for users of the SF-8 Health Survey. Lincoln, RI: QualityMetric.
Wong, S. L., Gilmour, H., & Ramage-Morin, P. L. (2016). Health reports: Alzheimer’s disease and other dementias in Canada. Statistics Canada. Retrieved from
Zlomislic, D. (2016). Ontario closes personal support worker registry. Toronto Star. Retrieved from
Zúñiga, F., Ausserhofer, D., Hamers, J. P. H., Engberg, S., Simon, M., & Schwendimann, R. (2015). Are staffing, work environment, work stressors, and rationing of care related to care workers’ perception of quality of care? A cross-sectional study. Journal of the American Medical Directors Association, 16(10), 860866. doi: 10.1016/j.jamda.2015.04.012
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Chamberlain et al. Supplementary Materials
Tables 8-13

 Word (57 KB)
57 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed