Woman holding senior woman's hand on bed
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Preparing assisted living direct care workers for the emotional effects of losing a resident in their care could improve job satisfaction for them and quality of end-of-life care for residents, according to the results of an award-winning study.

Assisted living communities are becoming a common place for end-of-life care, with two-thirds of the settings allowing residents to enroll in hospice care to age in place. But researchers from Emory University and Georgia State University found that a lack of training about death among caregivers contributed to fear and misunderstanding in how to support resident quality of life. Their study appeared in the Journal of Aging Studies and recently received a Silver 2023 Mather Institute Innovative Research on Aging Award.

The five-year study, conducted between 2016 and 2020, involved in-depth interviews and observations with 38 direct care workers and 27 administrators at seven metropolitan Atlanta assisted living communities. The investigators said they found that the emotional work involved in caring for dying residents, along with ambiguity about appropriate ways to grieve, placed further stress on the workers, which could further exacerbate burnout and staff turnover.

Research has shown that many workers are drawn to assisted living because they expect to see fewer deaths and a more home-like environment, suggesting that some may be ill-prepared to manage their emotions when residents die, the authors said.

By acknowledging the normalcy of death and dying, the senior living industry can better prepare its workforce to meet the needs of residents and workers, according to researchers.

The study laid out some practical recommendations for the industry: 

  • Openly recognizing assisted living as a play where residents may spend the last days of their lives.
  • Offering meaningful and accessible resources for grief and bereavement for employees.
  • Creating consistent practices that encourage employee self-care, including guidelines about attending services and paid time off for counseling or bereavement.
  • Offering ongoing training about communication about death and dying; the investigators noted a “clear need for training and strategies” on difficult end-of-life conversations with residents, their families and employees. 

Implementing those recommendations, the authors said, could improve job satisfaction and improve quality of end-of-life care for residents. 

During interviews, the researchers noted, workers coped with death by acknowledging it as a normal process, but doing so required emotional effort outside of working hours that had to be developed over time. In the process, the workers needed to learn how to separate their work lives from their home lives. 

Evidence showed that direct care workers can see death as a normal part of assisted living and that staff-resident relationships can influence end-of-life experiences, but the lines between formal and informal care can be blurred in the setting, they said. 

Approximately half of the study participants said they relied on religion to guide their perspectives on death, and they said they took comfort in knowing that residents were in a “better place” and were not suffering.