1 Introduction
2 Older-Adult Personal Support Workers and COVID-19
2.1 Older Adults: Vulnerable But Resilient
2.2 Older-Adult Personal Support Workers in the Individual-Family-Work Triangulation
3 Research Methods
3.1 Research Participants
Participant ID | Gender (M/F) | Age group | Ethnicity background | Immigrant status (Y/N) | Personal support worker experience | Family status (Y/N) | Employment setting: retirement homes (R)/long-term care (LTC) homes | |||
---|---|---|---|---|---|---|---|---|---|---|
55 to 60 | 60+ | Spouse | Children | Older parent | ||||||
1 | M | x | Hong Kong, China | Y | 6 years | Y | Y | N | R | |
2 | F | x | Hong Kong, China | Y | 7–8 years | Y | N | N | R | |
3 | F | x | Korean | Y | 14 years | Y | N | N | R | |
4 | F | x | Chinese | Y | 10+ years | N | N | N | R | |
5 | M | x | Korean | Y | 4 years | Y | N | N | R | |
6 | M | x | Hong Kong, China | Y | 4 years | Y | Y | N | R | |
7 | F | x | Filipino | Y | 10 years | Y | Y | N | R | |
8 | F | x | Filipino | Y | 20+ years | Y | N | N | R | |
9 | F | x | Chinese | Y | 14 years | Y | Y | Y | LTC | |
10 | F | x | Chinese | Y | 20 years | Y | Y | Y | LTC | |
11 | F | x | Chinese | Y | 14 years | Y | Y | N | LTC | |
12 | F | x | Chinese | Y | 15 years | Y | Y | N | LTC | |
13 | F | x | Chinese | Y | 12 years | Y | Y | Y | LTC | |
14 | F | x | Chinese | Y | 10 years | Y | Y | N | LTC | |
15 | F | x | Chinese | Y | 13 years | Y | Y | N | LTC |
3.2 Data Collection
3.3 Data Analysis
4 Findings
4.1 At the Individual Level
4.1.1 Physical Health: Protect Themselves and Protect Others
One R-OAPSW participant highlighted her actions of using PPE.You might know about the SARS outbreak in Toronto in 2003, almost 18 years ago. SARS put me on high alert. When I heard about the COVID-19 outbreak in Wuhan, I knew how serious it would be. I am the breadwinner of my family, and I cannot get sick. I must take good care of myself so that I can take care of my family and my clients. I was trying to buy masks and sanitizer, but at that point, they were out of stock in almost every store. I made cloth masks and shared them [with my family, friends, and co-workers].
These two participants expressed their consideration toward individual physical health, not only for themselves but also for their family and their clients. This consideration was reflected in their willingness to reduce the burden on others and better fulfill their private (family) and public (work) responsibilities.I know I have a high risk of getting infected due to my age. I doubled my masks every day when I heard the confirmed cases were reported in my community. I do not care about other people’s thoughts about wearing a mask. I am cautious, and do not want to get sick because all my clients are high-risk people. If I got sick, no one would help them.
4.1.2 Mental Health: Keeping Positive and Showing Positivity to Others
The risk of the community spread of the virus made some clients reduce or even cancel their regular service. This had economic impacts on the participants and triggered their anxiety and stress. The following two R-OAPSWs illustrated that focusing on their public responsibilities helped them deal with adverse mental health outcomes and enabled them to continually serve their clients. One R-OAPSW illustrated his strategies of applying positive thinking to deal with negative attitudes toward the mental and economic impacts.[Before the pandemic], I went to gym almost every day. I felt so good because [workout] took the stress away. But now I can’t do that because I am afraid if I get infected, my colleagues, my clients, and my family would be at risk. When I felt stressed, I would play with my doggie and take him for a walk.
Another R-OAPSW shared that when her mood was low, she always put her clients first, which helped her deal with some negative thoughts.I am workaholic. I feel uncomfortable about not working. Everyone is afraid, but there is someone who has to work. Otherwise, who can take care of the clients [older adults]? Although my hours have decreased, the market will resume because of the large aging population.
Unlike R-OAPSWs, the mental health-related issues of L-OAPSWs were primarily triggered by their work-related consideration. One L-OAPSW participant hid her sadness and worries and always showed joyous smiles to others.I heard a lot of my co-workers quit their jobs during COVID-19. Although I am only one of them, if I quit my job or am unable to work, they might need to look for a replacement.
These participants identified different coping strategies to reduce the negative impacts on their mental health. These coping strategies were upheld by their feelings of commitment and responsibility toward their clients, colleagues, and family. Their effort in maintaining mental well-being confirms their contributions to the entire society.I am afraid of checking my cell phone because of widespread bad news, such as there was a breakout in LTCs, how many older adults got infected, and how many died. I am so worried that it will happen in my organization. I lived in the hotel alone for two weeks. I felt hopeless, but I told myself that I needed to be strong because the residents needed me, my co-workers needed me, my practicum students needed me, and my family needed me. Although we wore masks, I always smiled at them and said, “Everything will be fine.”
4.1.3 Overall Well-Being: Adjusted Social Activities
One L-OAPSW used virtual yoga to encourage her friends and family to keep active so that their well-being was supported.I used to join line-dance classes and singing classes weekly and frequently have parties with my friends. During the pandemic, all these activities were canceled, and we had to stay home. I felt depressed and bored, but I think I must change. So I asked my friends to move [our activities] online. We have virtual meetings, parties, and singing together. More and more of my friends joined these [activities], and they felt better as well.
These two participants became proactive to stay grounded by adjusting their usual activities. The individual experiences enabled them to understand that people around them experienced the same challenges. Hence, they shared their strategies to support others.I love yoga, especially hot yoga. I usually went to the morning yoga class after my night shift. [During the closure of the yoga studio], I followed the tutorial on YouTube to do that at home. I also introduced the online yoga class to my friends. I know they felt depressed, and yoga could help. We did the online yoga together, recorded it, and shared the recordings with other friends and family. Of course, more people joined us.
4.2 At the Work Level
4.2.1 Workplace Environment: Reducing the Spread of Coronavirus
An R-OAPSW working in a group home for people with developmental (dis)Abilities shared that because the residents did not understand the situation, she had to protect the residents and herself.When I entered my client’s home, I immediately did a screening by observing if [my client] had any symptoms. Then I checked their temperature. If [my client] had a fever or any flu symptoms, I would not provide service and reported the situation to my agency immediately. It is essential to avoid getting infected by the clients and to ensure the safety of all my other clients. I encourage my other co-workers to do the same, protecting themselves and others. I know the young people do not care, but I do; it is my duty.
Another R-OAPSW appreciated the COVID-19 training her agency provided. She advocated this type of training for her co-workers to protect themselves, their clients, and others.When you help them [residents] put on masks, they immediately take them away. Other PSWs might not care about that. So lucky they [residents] had me. I made a distance for each resident, and I wore the [facial] shield when I was in contact with them.
In the long-term care facilities, extra mitigation strategies were applied, such as COVID-19 testing of residents and staff and restricting to essential visitors only (Slick and Wu 2022). One L-OAPSW mentioned that although the process was exhausting, it was worth it.My company offered paid training in English, Cantonese, and Mandarin for all the staff. The latest training was on how to observe a client when we provide service. We learned how to determine the wellness of a client by observing their behaviors and speech. All my co-workers should receive this training.
Four OAPSWs demonstrated their significant role in contributing to the prevention of the spread of the virus while providing essential care to clients. They highlighted that it was their responsibility to protect themselves so that they were able to protect and serve their clients. As the first OAPSW mentioned, he also educated other OAPSWs to feel obligated to follow the COVID-19 precaution practice.COVID-19 put everyone in my agency on high alert. Although there were no confirmed cases [in my workplace], I always encouraged everyone to follow the requirements. I understand that it is not easy to serve residents while wearing PPE. The guidelines have increased extra hours [for us to prepare before and after serving the residents], but we have to follow the guidelines to complete all the screening and cleaning steps because any oversight would cause huge mistakes.
4.2.2 Serving Residents/Clients: Managing Clients’ Challenging Behaviors and Supporting Their Mental Health
One L-OAPSW explained her willingness to take on extra responsibilities.The residents used to go out to participate in some day programs every day. But they couldn’t go anymore [during COVID-19]. Their behaviors have changed a lot. I explained the situation, but they still did not understand and became more agitated, more anxious, and sometimes, cannot control their emotions. Even though they have virtual [mental health] programs, it’s not enough for them to take off their stress. It is not my job, but I explained to them again and again, talked with them, and tried to have a little fun with them to make them feel at ease.
These OAPSWs illustrated their willingness to take on extra work to deal with clients’ unfavorable behaviors and support their mental health. Other participants also showed their understanding of their clients/residents’ situation and used their knowledge and skills to provide more support.When LTCs did not allow family visits, most of the residents felt very lonely and became very upset. I had to be careful when I did the screening. Some residents got upset when I asked them questions about their symptoms. I also kept quiet. After completing my work, I always stayed a little bit longer and talked with them. I always told them that the pandemic would be over very soon, and they could see their families soon. There was a resident who passed away during the lockdown. My co-worker and I acted as her family to help her clean and dress up [for funeral].
4.2.3 Co-workers: Providing Mutual Support
Another L-OAPSW considered that all her team members were overwhelmed, so she did not take her non-COVID-19-related sick leave.We have been collaborating in a team very well for a long time. Sometimes, just an eye expression from my co-worker, we know what we should do. [This was very important] because we all wore PPE and could only see the eye’s expression. Although we had extra work during COVID-19, everyone just completed the work with no complaints at all. I supervised a new colleague during COVID-19, and I requested other team members to be more patient with [the new colleague]. We went through the most challenging period together, and no one on my floor got COVID-19.
Another L-OAPSW shared her hand-made PPE with her co-workers and their families.I was planning to take a sick leave due to my back pain, but COVID-19 disrupted the plan. You might know that a lot of PSWs quit their job and my husband asked me to stay at home too. But I decided not to do that because it was tough to find someone to take my position. Otherwise, all my work would be shared by my co-workers, who were overwhelmed as well. Even if a new person could be hired, the new person needs a while to become familiar with all the logistics, so that my co-workers can collaborate well. We were a team, and I could not be so selfish. My co-workers did the same as well.
Compared to the L-OAPSWs, the R-OAPSWs might not have powerful collegial connections. However, they collaborated to advocate for better PPE and showed empathy among them. One R-OAPSW shared that they requested enough and better PPE, in order for all the staff to have access to enough and better equipment.I had a sewing machine. I made masks, hats, and gowns and shared them with my co-workers. All my co-workers were very proud of me. You knew those things were sold out almost everywhere. They [co-workers] also shared the extra masks, hats, and gowns I made with other PSWs in other long-term care facilities because we were colleagues. When we heard that [some LTCs’] situations were horrible, we all donated our PPE to them.
The OAPSWs faced extra challenges at work during the pandemic but their contributions improved the working environment, provided extra support to their clients/residents, and helped their co-workers in their agencies and beyond.[At the beginning of the pandemic], there was a shortage of PPE [almost everywhere]. We only received one level-one mask per day, no extra to replace, and the level-one mask does not provide enough protection [when we were in direct contact with clients]. My co-workers teamed in different groups. Each group made complaints to the agency and asked for better PPE. After several complaints, we started to receive more and better PPE.
4.3 At the Family Level
4.3.1 Committed to Protecting Their Nuclear Families
Another L-OAPSW explained that she stayed in a hotel in order to protect her family.When I got home [every afternoon], I took off all the dirty clothes in the laundry room immediately, which was located beside the garage, took a shower, and put on new clothes. After that, I had dinner with my family.
The OAPSWs’ individual and professional experience prompted them to pay extra attention to their family’s mental health and overall well-being. One L-OAPSW explained that:I stayed in the hotel for two weeks since a confirmed case was identified in my agency. I Facetimed with them [my family] every evening after work. It was tough for me because you lived so close, but you could not have dinner with them. But I know it was the best choice I made.
My daughter’s graduation trip was canceled, she could only socialize with her friends online, and her new job was pending. I realized that these took a hefty toll on her mental health. Hence, on my days off, I always walked with her in our community park. When the travel ban was lifted, we planned a trip immediately.
4.3.2 Supporting Extended Families
One L-OAPSW described her interventions to help her extended family:I took care of my grandsons once a week [before COVID-19]. That became my big concern because they are too young to be vaccinated. I did the antigen test, and I did not have any symptoms, but there was still a possibility that I might bring COVID-19 to them. At that time, I was so upset, but I had no choice, and I needed to cancel their visiting to protect them.
The support given to their extended families always moves beyond their own family circle. The following R-OAPSW explained his reasons for maintaining his employment during the COVID-19 pandemic so that he would help other people in need to benefit from the government’s social benefits.All my children have their own families, and we live very close. They all worked from home [during COVID-19]. Since I had to go outside to work every night, I asked them what they needed so that I could prepare the next day. Every morning after work, I purchased groceries and dropped them off at their houses. COVID-19 increased our workload, and I always had colleagues get sick, and I had to cover their responsibilities. I was exhausted after work since COVID-19. But I still did all these things so that my family did not have to go out.
My wife suggested that I should quit my job and take the EI [employment insurance] or CERB [Canada Emergency Response Benefit]. We have some savings, so we would be OK. So many people, like my children, lost their jobs. They might not have enough experience, and they could not find a new one soon. Although many of my clients canceled their service, I was lucky, and I still had a job to survive. So I decided to work and give the opportunities [EI or CERB] to my children and others.