Written by Dr Raechel Damarell, Senior Research Fellow, CareSearch and palliAGED
Burnout among healthcare workers in Australia’s residential aged care facilities is a critical issue, impacting both the quality of care for elderly residents and the wellbeing of caregivers. It is generally characterised as having three components: emotional exhaustion, negative, detached attitudes towards the work, and a reduced sense of one’s competence and abilities.
Research conducted by Dr Raechel Damarell and the team from RePaDD sheds light on the multifaceted nature of this problem. Off the back of this research, the Knowledge and Implementation Hub of ARIIA (Aged Care Research & Industry Innovation Australia) has created information resources for the aged care sector. These products highlight the issue for service providers and workforce and offer suggestions based on evidence for preventing or mitigating burnout.
Through an exhaustive scoping review, the prevalence of burnout was first identified, sitting as high as 30-50% for the residential and home care workforce across countries with aged care systems similar to that in Australia. While excessive workloads, lack of time to provide care, and high staff turnover rates contribute significantly to the problem universally, there were several less expected findings from the research. These include burnout risk factors such as having to work outside one’s professional scope of practice—often seen in rural/remote areas—and having no voice in workplace problem-solving.
Not having access to the material resources to do the work required was also an important factor, exacerbated during the COVID-19 crisis in aged care when gloves, masks, and vaccines were hard to procure. Constant exposure to resident deaths is also a strong precondition for staff burnout when not dealt with by the organisation. Again, this experience intensified during the COVID-19 pandemic and was made more complex by staff feelings of moral distress at what they were witnessing.
The emotional toll also often goes unrecognised when a patient dies. Aged care staff are far from dispassionate about their work. The research shows that the emotional toll from caring for elderly residents, many of whom have complex health issues, is significant. It may not be obvious that staff can develop long-term relationships with the people they care for. When they die, they experience real grief which may go unacknowledged by colleagues and their organisations. Staff might suppress their grief responses to not appear unprofessional. This distress has been shown to lead to emotional exhaustion – a key factor in burnout.
Acknowledging staff grief by providing bereavement support is one action organisations might take to prevent distress-based burnout. This tells the worker that their organisation has valued the compassionate end-of-life care they provided. In fact, staff who are supported to see the meaning in their work and who are acknowledged as having ‘made a difference’ are shown to be less likely to experience burnout.
Lack of managerial and peer support in general further contribute to burnout. Systemic issues like lack of staff and inadequate remuneration might not be fixable in the short term, but the research suggests that services can mitigate the risk of staff burnout by establishing a supportive workplace culture.
Aged care staff across multiple studies express feelings of isolation in their work life, especially those in the home care sector. In environments where workers feel isolated or undervalued—or worse, bullied–stress levels can rise. Organisations can remedy this by proactively creating psychologically safe spaces and opportunities for staff to voice their experiences, concerns, and stresses.
Inadequate training also leaves workers feeling unprepared for the demands of their roles. The evidence suggests that regular training programs and opportunities for career advancement increase job satisfaction and preparedness, protecting against staff burnout.
The consequences of staff burnout for the worker are significant and include physical health issues such as sleep disorders, anxiety, and depression. Burnout has even been linked to long-term chronic health problems such as heart disease and type 2 diabetes. For the organisation, there is the loss of productivity that comes through high rates of staff turnover and absenteeism. However, burnout also has serious implications for quality of care. It has been associated with higher rates of tube-feeding, pressure ulcers, and reduced support for people to engage in activities, including eating and bathing.
Several strategies within the organisation’s immediate control may help staff as telling staff to take care of themselves isn’t enough. Research on burnout in aged care shows that to prevent burnout, we need to protect and nurture their sense of professional accomplishment. This involves providing the necessary resources—whether it’s time, training, or materials—so they can deliver the best care possible. It’s also crucial to acknowledge and appreciate their efforts.
This research was presented at the 2024 Palliative Care Nurses Australia Conference in July where the abstract, Burnout in providing end-of-life care within aged care: Balancing individual and organisational factors and responses, won the Vivien Bullwinkel Award for Best Abstract. It is also currently being prepared for publication.
