Abstract

Background: The population in Finland is aging rapidly and the number of older people in need of long-term care is rising. With the emphasis on home care, the residents in assisted living facilities with 24-hour assistance have increasingly higher care needs. Additionally, the shortage of care workforce has increased stress and dissatisfaction among care workers. Information regarding care workers' work and its effects on their wellbeing is important in reference to employee retention and appeal of care work.

Objectives: The aim of this study was to track the work time allocation of care workers in assisted living facilities with 24-hour assistance. Focus was on direct and indirect care time allocated to clients. In addition, we analysed how the demands of the work (as measured by work time allocation) affected workers perceived wellbeing.

Methods: Care workers documented their work time allocation per action for one day using paper forms with special focus on care time with clients. 390 practical nurses and 62 registered nurses from 52 different units of Finnish assisted living facilities with 24-hour assistance took part in the study. The time was divided into 1) direct care time, 2) indirect care time, 3) office-related work, 4) maintenance work (cleaning/laundry/food preparation), and 5) break-time. The care needs of the residents were retrieved from RAI-assessments. Additionally, the care workers filled in an optional questionnaire before and after their workday assessing work stress, time pressure and other stressors. The effects of work time division, characteristics of the workday and other background variables on work stress and time pressure were analysed using logistic regression.

Results: Practical nurses spent 48% of their workdays on direct care and 16% on indirect care allocated to clients. A tenth of the worktime was spent on office-related work and another tenth on maintenance work. Most of the office-work consisted of nursing documentation. Registered nurses spent 47% of their time on direct care and 24% on indirect care. In contrast to practical nurses, registered nurses had more work-related office time.

The number of residents taken care during the day was significantly associated with both perceived stress (p=0.0058) and time pressure of the staff (p=0.0242). The average ADL-score of the care recipients during the day was associated with time pressure (p=0.0281). Additionally, questionnaire items "recovery from strain" and "workday went as planned" were associated with reduced stress and time pressure (p<0.0001). Lastly, the amount of break-time during the work shift was associated with time pressure (p=0.0315). Conclusions: Most of the work time of care workers was allocated to clients, with registered nurses spending more time on indirect care than practical nurses. The number of residents and their average care needs affected the time pressure and perceived stress of workers. The results indicate that sufficient staffing, in addition to ensuring enough break-time and recovery between shifts, can lead to better working conditions for care workers and thus increase workforce retention and appeal in the field. Importantly, the residents' care needs should be considered when planning the staffing level.

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