The Impact of the COVID-19 Pandemic on Care Aides’ Job Satisfaction in Long-Term Care Facilities in Northern British Columbia: A Qualitative Study

Abstract

Background: The COVID-19 pandemic placed unprecedented strain on long-term care facilities (LTCFs), disproportionately affecting care aides who provide essential frontline support. This study explored the impact of the pandemic on care aides’ job satisfaction in LTCFs across Northern British Columbia, a geographically and structurally underserved region. Methods: Eight care aides participated in semi-structured virtual interviews, and data were analyzed using Braun and Clarke’s thematic analysis. Results: Five key themes emerged: (1) work environment and staffing conditions, (2) emotional and psychological burden, (3) communication and team dynamics, (4) resident care and safety, and (5) effects of evolving COVID-19-related policies. Participants consistently described emotional exhaustion, policy fatigue, grief from resident deaths, communication breakdowns, and uncertainty stemming from frequent procedural changes. These stressors were compounded by staffing shortages and limited access to mental health support, especially in rural settings. Conclusion: The findings highlight the urgent need for structural and psychological supports, including responsive leadership, accessible mental health resources, and stable employment policies, to protect care aides’ well-being and ensure quality of care in future public health emergencies.

1. Introduction

The COVID-19 pandemic disrupted healthcare systems globally, exposing long-standing vulnerabilities and placing immense strain on care delivery across all sectors. LTCFs were particularly impacted due to the high-risk nature of their resident populations and systemic challenges in staffing and resources. The disease, caused by the novel coronavirus SARS-CoV-2, was first detected in late 2019 as cases of unexplained pneumonia. The World Health Organization (WHO) declared COVID-19 a public health emergency of international concern on 30 January 2020, and a global pandemic on 11 March 2020 [1]. While clinical presentations of COVID-19 range from mild symptoms to severe viral pneumonia, acute respiratory distress syndrome, and death, its indirect consequences extended far beyond physical illness, impacting mental health, workforce capacity, and healthcare infrastructure.

In Canada, provincial and federal governments implemented a series of stringent public health measures, including stay-at-home orders, social distancing mandates, and widespread masking [2]. While these measures were essential for infection control, they also disrupted routine healthcare services and social systems. LTCFs as of 2021—home to over 198,000 Canadians aged 65 and older—were among the most affected institutions, facing outbreaks, visitation restrictions, and staffing crises [3,4].

LTCFs provide essential care for individuals with chronic illnesses, disabilities, and age-related conditions, often involving complex physical and emotional needs [5]. Care is delivered by interdisciplinary teams that include physicians, nurses, therapists, social workers, and care aides. Among these, care aides—also referred to as personal support workers or healthcare assistants—are responsible for providing direct, hands-on care such as assistance with daily living, medication support, hygiene, and companionship [6]. Despite their frontline role, care aides are frequently under-recognized, underpaid, and overworked. Pre-pandemic research already highlighted the challenges they face, including limited organizational support, heavy workloads, emotional labor, and high levels of burnout and turnover [7,8,9].

During the pandemic, these challenges intensified. Care aides encountered increased workloads, staff shortages due to illness or quarantine, heightened emotional demands, and stricter safety protocols that complicated care routines. Care aides also assumed new responsibilities, including facilitating virtual communication between residents and families and providing end-of-life support in the absence of visitors [10,11]. Recent Canadian studies have echoed these concerns, documenting emotional exhaustion, mental health distress, and inconsistent organizational support across long-term care settings [8,12,13,14]. These findings point to persistent gaps in staffing structures, mental health resources, and crisis response preparedness for this essential workforce.

Although there is growing attention to the experiences of healthcare workers during the COVID-19 pandemic, the literature remains limited regarding the perspectives of care aides, particularly in rural and northern regions. Northern British Columbia presents unique challenges, including limited access to specialized care, greater distances between facilities, and heightened staff recruitment and retention difficulties. Little is known about care aides’ job satisfaction in rural Canadian LTCFs during the COVID-19 pandemic, leaving a gap in understanding how frontline staff experienced and responded to the challenges of this public health crisis. Understanding how care aides in these settings experienced the pandemic can help inform tailored workforce support strategies and contribute to the development of resilient long-term care systems.

This study explores how the COVID-19 pandemic affected care aides’ job satisfaction in long-term care facilities in Northern British Columbia, with the goal of informing supportive policies and practices that enhance staff well-being and care quality.

2. Materials and Methods

This qualitative study explored the impact of the COVID-19 pandemic on care aides’ job satisfaction in LTCFs in Northern British Columbia, Canada. The study design incorporated a scoping review of existing literature which provided contextual background and to identify existing knowledge gaps and has been published elsewhere [15].

This study is based on a secondary analysis of semi-structured interviews—qualitative interviews that follow a guiding framework of open-ended questions while allowing flexibility to explore participants’ experiences in greater depth—with eight care aides employed in LTCFs across Northern British Columbia. The interviews were originally conducted by research team members S.F., D.B, and T.K-R., as part of a larger project examining the broader impact of the COVID-19 pandemic on LTCF settings in northern British Columbia. The present analysis was conducted using de-identified transcripts; no new data were collected by the authors, and there were no prior relationships between the interviewers and participants. The use of secondary data allowed for ethical rigor while preserving participant confidentiality. Ethical approval for both the original study and the secondary analysis was obtained from the University of British Columbia Research Ethics Board (H21-01883).

Participants were selected using purposive sampling to ensure variation in age, gender, years of experience, and facility type. Facility types were categorized following Canadian Institute for Health Information (CIHI) guidelines: small (1–29 beds), medium (30–99 beds), and large (100+ beds). The sampling aimed to capture a cross-section of experiences across diverse geographic and operational contexts.

All interviews were conducted virtually and audio-recorded with participant consent. The sample size of eight participants was deemed appropriate for the scope of this in-depth qualitative inquiry and aligns with recommendations for thematic saturation in reflexive thematic analysis. The original study confirmed thematic saturation as no new insights emerged in later interviews, and this was reconfirmed during the secondary analysis through thematic redundancy.

Interview transcripts were analyzed using Braun and Clarke’s (2006) [16] thematic analysis framework. Themes were generated inductively through a data-driven process, consistent with Braun and Clarke’s reflexive thematic analysis. While the scoping review [15] informed the broader research focus and helped contextualize the interview questions in the original study, it did not influence the coding or theme development in the present secondary analysis. Data were coded inductively, and recurring patterns were grouped into five major themes: (1) Work Environment and Conditions, (2) Emotional and Psychological Impact, (3) Communication and Team Dynamics, (4) Resident Care and Safety, and (5) Impact of Policies. Analytical rigor was maintained through iterative coding and peer debriefing within the research team. The research team comprised members with backgrounds in nursing, health sciences, and aging, including clinical and academic expertise in long-term care. This interdisciplinary lens supported reflexive engagement with the data and enriched the interpretation of care aides’ experiences in LTC settings.

Ethical approval was obtained from the University of Northern British Columbia Research Ethics Board (Approval Code: H21-00831). Written informed consent was received from all participants, and data were anonymized to protect confidentiality.

Due to the sensitive nature of the qualitative data and confidentiality agreements with participants, the raw transcripts are not publicly available. However, de-identified data summaries and coding frameworks may be provided upon reasonable request to the corresponding author.

No generative artificial intelligence tools were used in the design, data collection, analysis, or interpretation of this study. All processes were completed manually by the research team.

3. Results

Thematic analysis of interview data revealed five overarching themes reflecting the multifaceted impact of the COVID-19 pandemic on care aides’ job satisfaction in LTCFs in Northern British Columbia: (1) Work Environment and Conditions, (2) Emotional and Psychological Impact, (3) Communication and Team Dynamics, (4) Resident Care and Safety, and (5) Impact of Policies. These themes are detailed below (see

Table 1. Participant Demographics.

Participant ID	Gender	Age Group	Years of Experience	LTCF Size
P1	Female	20–29	1–5 years	Small
P2	Female	40–49	Over 20 years	Medium
P3	Female	40–49	15–20 years	Small
P4	Female	50–59	15–20 years	Large
P5	Male	50–59	10–15 years	Large
P6	Female	40–49	10–15 years	Large
P7	Male	30–39	1–5 years	Medium
P8	Female	30–39	1–5 years	Medium

for participant demographics).

3.1. Impact of Facility Characteristics and Employment Conditions

3.1.1. Facility Size and Design

Participants consistently emphasized that the physical environment of LTCFs greatly influenced their work experiences. Participants working in newer or larger facilities described enhanced infection control, improved workflow efficiency, and greater comfort in care delivery. In contrast, aides working in older facilities described difficulties navigating confined spaces, particularly when attempting to adhere to safety guidelines during outbreaks. Environmental design was also noted to affect the ability to foster meaningful interactions with residents, which in turn influenced job satisfaction. Participants in larger or newly built facilities described more stable staffing, enhanced infection control, and greater comfort in delivering care. In contrast, those in smaller or older buildings reported feeling constrained by tight layouts and limited resources, which complicated adherence to safety protocols during outbreaks:

“[LTCF’s name] is a newer facility, it’s a much bigger space and the staff is stable there it’s a nice looking environment… The building layout is very pleasing, it’s homey, sort of. It’s not quite so facility looking, like a hospital and that. I’ve worked elsewhere and it’s much more, ya, home environment focused so that makes it a little more comfortable at least. The people seem to enjoy it more.”

(P5 male, aged 50–59, 10–15 years of experience, large-sized LTCF)

3.1.2. Employment Status and Work Stability

Job satisfaction was closely linked to employment status. Full-time aides described more stability, access to benefits, and routine scheduling, while casual and part-time workers expressed concerns about financial insecurity and inconsistent work hours. Full-time staff described more predictable schedules and access to benefits, which they associated with reduced stress and higher job satisfaction. Conversely, casual workers—especially in smaller facilities—expressed concern about inconsistent shifts and financial instability, which compounded their emotional strain during the pandemic:

“I work as a care aide in a long-term care at our local hospital. Currently I’m in a casual position there but I used to be in the past a part-time care aide and I’m also training on the acute ward. Our hospital is small so I’m also training on the acute ward as well… So I’ve been with the [name of the hospital] for 18 years but not always, not all those years I have been working many hours. Some years I have been working quite a bit less.”

(P3 female, aged 40–49, 15–20 years of experience, small-sized LTCF)

Even when flexible scheduling was available in theory, staff shortages often limited its feasibility, adding to stress and dissatisfaction.

3.2. Emotional and Psychological Impact

The emotional toll of the pandemic was a recurring theme across all interviews. Participants reported high levels of stress, anxiety, and emotional exhaustion, largely driven by increased workloads, fear of infection, and repeated exposure to resident deaths. The inability of families to visit residents during end-of-life care placed additional emotional demands on care aides, who often became surrogate family members. Many described experiencing grief, helplessness, and a perceived lack of emotional support from leadership, further compounding their distress:

“We had like probably close to three of them, I’m pretty sure died of a broken heart cause they just couldn’t see their family. The isolation was too much for them to bear, and it was heartbreaking to witness. It was devastating to see them deteriorate because of loneliness, and it made our job feel even more overwhelming.”

(P8 female, aged 30–39, 1–5 years of experience, medium-sized LTCF)

“We didn’t feel supported by our manager. There were days when we were extremely short-staffed, and she didn’t even come out of her office to check on us or see how we were doing. It was really demoralizing… Like there’s no, we’re working, we’re short-staffed…”

(P2 female, aged 40–49, more than 20 years of experience, medium-sized LTCF)

“There hasn’t been much presence, like our manager doesn’t come around or anything like that…Some kind of support would’ve been nice. Emotionally supportive would’ve been nice. Would’ve been helpful. Ya, everybody is feeling the crush and some of us are getting it a little more than others. And we haven’t had any support, I believe. There should’ve been something done for the staff, some sign of appreciation that we’re just killing ourselves here, but every time I turn around I’m getting a slap in the face. I’m getting it from management, I’m getting that I’m not doing my job, I’m not doing enough and we’re doing ten times more than we ever did before and we’re getting ridiculed for it…Our manager literally told us to deal with it ourselves, in our staff meeting. If we have any way that we want to work on our team, there’s no direction, there’s no guidelines, we just do whatever we want to do. We’ve been told that directly.”

(P5 male, aged 50–59, 10–15 years of experience, large-sized LTCF)

“COVID nowadays we’re all very burned out by it, we’re annoyed by wearing the masks, despite having to get the vaccinations we have to wear the masks and we’re just sort of slogging along sort of regarding COVID as it’s going to be the new flu.”

(P4 female, aged 50–59, 15–20 years of experience, large-sized LTCF)

“It’s mentally exhausting cause the residents are unhappy cause there’s activities not being done, you know, like I said there’s no haircuts happening, the foot care isn’t being done. So then they’re not happy. Well, when they’re not happy they take it out on us. Because we’re the ones that are there.”

(P6 female, aged 40–49, 10–15 years of experience, large-sized LTCF)

Amid these difficulties, some aides found strength in their role and the recognition from residents and families:

“Despite everything, I feel more motivated because I know how important my role is in keeping the residents safe and healthy. It’s satisfying to see the residents happy and well-cared for, especially during such a challenging time…Seeing the residents happy when they could finally see their children again made me feel that all the effort was worth it. It was a tough time, but knowing we made a difference was rewarding.”

(P1 female, 20–29, 1–5 years of experience, small-sized LTCF)

3.3. Communication and Team Dynamics

The pandemic substantially disrupted communication and team cohesion. Social distancing protocols and staffing fluctuations hindered both formal and informal communication among team members. The transition to virtual meetings and written updates often led to information gaps and misunderstandings. While some teams demonstrated increased solidarity under pressure, others experienced interpersonal tension and reduced morale, particularly in the absence of consistent managerial support:

“In the pandemic, it’s not a like team, we work in a team cause they were, we were only communicating by a phone or video calls at that time, right, cause we couldn’t get together and all can come and join the meeting at once because we were not allowed to get together at that…”

(P1 female, aged 20–29, 1–5 years of experience, small-sized LTCF)

“Communication during the pandemic was challenging. We had to rely more on phone calls and video meetings because we couldn’t gather in person. It wasn’t the same, and it made teamwork more difficult…There was a lot of confusion because of the constantly changing policies. We’d get emails and updates, but not everyone checked their email regularly, so sometimes people were out of the loop. It made it hard to stay on the same page…We had to write notes and leave them for the next shift, which wasn’t as effective as having a face-to-face handover. Important information sometimes got missed or misunderstood.”

(P2 female, aged 40–49, more than 20 years of experience, medium-sized LTCF)

3.4. Resident Care and Safety

Participants expressed concern over their ability to maintain quality of care during the pandemic. Increased workloads, staff turnover, and the onboarding of inexperienced replacement staff were cited as barriers to delivering person-centered care. Many care aides reported feeling frustrated by the limited time available to engage meaningfully with residents. In addition, visitor restrictions and the suspension of group activities contributed to resident isolation and emotional decline, which care aides were often ill-equipped to address under the strained conditions:

“COVID didn’t help for sure. I would say a lot of elderly are struggling, right, with loneliness, anxiety, other issues…the masking it has been unreal. They don’t know who is coming. It doesn’t matter we have a name tag, like they cannot read sometimes, right. Like it’s hard, that’s definitely, you know, patients becoming violent, right, because they have dementia already and they don’t know what the heck is going on…”

(P3 female, aged 40–49, 15–20 years of experience, small-sized LTCF)

“It’s been really hard and it seems to be just getting harder. The residents don’t get to see our faces at all right now so I mean then they can’t hear us half the time. So we’re either having to talk quite a bit louder than we normally we would or we have to pull the mask down cause some of them they use your lips to also help.”

(P6 female, aged 40–49, 10–15 years of experience, large-sized LTCF)

“I had to serve dinner, I have to feed people. I have to get people ready for bed. I have to toilet these people. There’s so much that you need to do and you’re by yourself and they’re not all easy people to work with. You’ve got all different sizes, you know, slings, non-slings, it’s a lot to try and do for [number of residents which is more than 15] people by yourself. And things aren’t going to get done 100%, it’s just not possible, cause you just can’t do that…You don’t really get to have a nice conversation. You’re rushing. So okay, wash your face, ya do this quickly and I don’t like that. But how else do you get everything done before you go home? Like cause you’re trying to, cause you’ve got all these people who like to go to bed early. They don’t want to wait until 8, 9:00 at night. They want to go to bed early.”

(P6 female, aged 40–49, 10–15 years of experience, large-sized LTCF)

3.5. Impact of COVID-19 Policies

Rapidly evolving health policies introduced during the pandemic had both protective and disruptive effects on care aides’ roles. Vaccination mandates, while reassuring to some, generated tension among staff and led to resignations in certain facilities, exacerbating existing staffing challenges. Visitor restrictions, though necessary for infection control, increased the emotional labor required of care aides. Furthermore, frequent changes in policy created confusion and uncertainty, with several participants highlighting a lack of clear communication from facility leadership regarding new procedures and expectations.

“It was very stressful because policies kept changing. One day we would be told one thing, and the next day it would be completely different. It was hard to keep up with the new guidelines, and it felt like we were always behind. The inconsistency made it challenging to feel confident in what we were doing. On top of that, we were dealing with physical discomfort from wearing masks and goggles all the time. It was really tough.”

(P8 female, aged 30–39, 1–5 years of experience, medium-sized LTCF)

“The masks we were wearing anyways but the face shield and the gown and the gloves typically you don’t always, you know, like approach residents like that and I think it was quite confusing and it was probably frightening for some of the people I would imagine…There were times where we didn’t always have the PPE and so we typically had, I wouldn’t be able to tell you the brand, but we typically had really nice quality gloves and I think this was everywhere, and we got quite a, there was the newer gloves that we got, there was a shortage, they were getting all these different brands of gloves and they’re really bad quality.”

(P7 male, aged 30–39, 1–5 years of experience, medium-sized LTCF)

These themes reflect the complex interplay between environmental, emotional, communicative, and institutional factors that shaped care aides’ job satisfaction during the COVID-19 pandemic (

Table 2. Summary of Themes and Illustrative Subthemes.

Theme	Subthemes	Illustrative Description
Work Environment and Conditions	Facility Size and Design Employment Status and Work Stability	Newer facilities supported better workflows and infection control; casual workers faced instability and uncertainty.
2. Emotional and Psychological Impact	Stress and Anxiety Grief and Emotional Burden	Participants reported burnout, emotional exhaustion, and distress from repeated exposure to death and isolation.
3. Communication and Team Dynamics	Disrupted Communication Channels Changes in Team Cohesion	Communication barriers and staffing instability led to misunderstandings and reduced morale in many LTC settings.
4. Resident Care and Safety	Reduced Capacity for Person-Centered Care Resident Isolation	Staff were unable to provide high-quality care due to time constraints, staff turnover, and lack of family engagement.
5. Impact of Policies	Vaccination and Visitor Policies Policy Confusion and Fatigue	Policy changes caused stress and confusion, and increased the emotional burden of supporting isolated residents.

).

4. Discussion

This study examined the effects of the COVID-19 pandemic on care aides’ job satisfaction in LTCFs in Northern British Columbia. The findings reveal that job satisfaction was shaped by a complex interplay of factors, including facility design, emotional burden, communication dynamics, caregiving challenges, and institutional policies. These results support the original hypothesis that the pandemic amplified existing systemic challenges in LTC settings, thereby affecting the well-being and satisfaction of frontline workers.

These findings can be interpreted through the lens of the Job Demands–Resources (JD-R) Model [17,18], which posits that job strain arises when demands—such as emotional burden, increased workload, and resource scarcity—overwhelm available supports. During the COVID-19 pandemic, the job strain experienced by care aides arose when emotional burden, increased workload, and resource scarcity exceeded the care aides available resources and supports. Care aides reported elevated demands during the COVID-19 pandemic, including emotional exhaustion, grief, and increased responsibility, particularly in the absence of sufficient staffing and managerial support. Simultaneously, limited access to workplace resources—such as clear communication, emotional support, or mental health services—reduced their capacity to cope effectively. In contrast, for some, intrinsic motivators and team solidarity acted as personal and relational resources, temporarily buffering stress. These dynamics highlight the need to address both structural and psychosocial supports to sustain workforce well-being especially during a pandemic context.

The physical environment of LTCFs emerged as a great determinant of staff satisfaction. Participants working in newer or larger facilities described safer, more efficient work conditions, in contrast to those in older facilities who reported barriers to infection control and emotional connection with residents. These observations are consistent with previous findings emphasizing the role of built environments in staff morale and care quality [19,20,21].

Emotional and psychological strain was a central theme. Participants described burnout, grief, and emotional exhaustion, particularly related to witnessing resident deaths and the absence of family support during end-of-life care. These experiences align with the findings of Hoedl et al. (2021) [22] and Voth et al. (2022) [12], which identified the pandemic as a great mental health stressor for LTC workers. The reported lack of emotional support from management further exacerbated these challenges.

Disruptions in communication and teamwork were also reported. Although some participants noted increased solidarity among colleagues, others described fragmentation caused by staffing instability and reduced face-to-face interaction. These dynamics echo research showing that consistent and transparent communication is essential for maintaining team cohesion in crisis conditions [23,24].

The ability to provide high-quality care was compromised by increased workloads, staffing shortages, and the onboarding of inexperienced personnel. Participants expressed concern over the emotional and ethical consequences of delivering rushed or incomplete care. This supports literature calling for more robust staffing and training structures in LTCFs to safeguard both worker well-being and resident outcomes [7].

COVID-19 policies, while necessary, introduced additional stress. Vaccination mandates and visitor restrictions led to staffing disruptions and increased emotional labor. Participants also described "policy fatigue" from rapidly changing guidelines and inconsistent communication—findings corroborated by Titley et al. (2023) [13] and Reynolds et al. (2022) [14].

To address these challenges, long-term structural interventions must be accompanied by concrete, actionable supports. Policies should not only promote stable employment and effective communication but also implement practical initiatives such as on-site peer-support groups, crisis counseling services, and structured communication protocols for use during health emergencies. Embedding these supports into organizational practices can help mitigate emotional distress, reduce role strain, and improve care aides’ overall job satisfaction and retention.

The study’s findings highlight the need for long-term, structural interventions rather than temporary crisis responses. Policies should support stable employment, effective communication, responsive leadership, and access to mental health resources. Additionally, future emergency planning must consider the operational capacity and psychological resilience of frontline LTC staff.

Future research should investigate further the longitudinal effects of the COVID-19 pandemic on care aides’ job satisfaction and mental health, particularly the potential for lasting psychological impacts such as chronic stress, depression, or burnout. Comparative studies across rural and urban LTCFs would also be valuable in identifying how geographic and structural differences influence care aide experiences and outcomes. Such research could inform more tailored and context-specific strategies to support workforce sustainability and enhance resident care in diverse LTCF settings.

Limitations

The findings of this study should be interpreted in light of certain limitations. Because the interviews were conducted with care aides in Northern British Columbia, the results may not be generalizable to all LTCF settings, particularly in urban regions or other jurisdictions with differing health systems and resources. Additionally, although the emotional impact of the pandemic on care aides was explored in depth, the cross-sectional qualitative design did not allow for investigation of long-term psychological effects. Participant validation was not conducted, which may have limited the opportunity to confirm the interpretations with interviewees. Nonetheless, the study provides important insights that can inform context-sensitive improvements to workforce support in LTCFs.

5. Conclusions

This study offers an in-depth account of how the COVID-19 pandemic affected the job satisfaction of care aides in LTCFs in Northern British Columbia. Through qualitative analysis, it reveals that job satisfaction was shaped by a combination of physical work environment, emotional burden, communication barriers, care-delivery challenges, and policy responses.

The findings underscore the importance of creating supportive, well-resourced work environments for care aides. Practical recommendations include strengthening institutional support structures, ensuring stable employment contracts, implementing accessible mental health programs, and establishing clear communication protocols—particularly during crises. These interventions are critical to mitigating burnout, enhancing job satisfaction, and sustaining high-quality care. By centering the lived experiences of care aides, this study contributes meaningful insights for healthcare leaders and policymakers aiming to build more resilient and responsive long-term care systems. It also lays the groundwork for future research into post-pandemic recovery and strategies to improve workforce retention in eldercare settings.