Depression Common Among LowWage Nursing Home Staff

It is not just residents who may be depressed!

According to Harvard School of Public Health researcher Cassandra Okechukwu, the prevalence of depression is common among low-wage nursing home workers -- who also experience higher levels of stress than other workers.

"The high burden of work-family stress and depression in this group has important public health implications for the workers and their families as well as for the quality of care delivered to nursing home residents," said Okechukwu.

452 workers, mostly women, were surveyed to investigate the link between depression and stress at home and work. Participants were asked about stressors such as financial hardships, lack of food and whether they worried about work-related issues during non-work hours. Investigators found that these stressors were double the rate in nursing home workers than other professions.

According to the report, nursing home workers are a growing part of the workforce who may face higher rates of household food insufficiency, financial strain, and work-family spillover. Among nursing assistants-the biggest work group in nursing homes, and among the lowest paid-the proportion of women is estimated to be 80% to 90%; most are single mothers and are thus the primary wage earners for their families. Nursing home workers are more likely to be recent immigrants who may not be aware of or eligible for government benefits. A majority of these low-wage earners are also members of racial/ethnic minority groups.

The implications are serious.

Depression leads to absenteeism and turnover among workers, which in turn translates to poorer care for residents in direct care settings. Because improvement in care quality at nursing homes is an important public health priority, reducing workers' depressive symptoms and their associated effects may have positive results for both workers and nursing home residents.

Food insufficiency is a household-level stressor that has been associated with overweight, behavioral problems, and poor mental health in children and adolescents. This has further implications for obesity in this group because several studies have reported a seemingly paradoxical relation between food insufficiency and obesity whereby those who report food insufficiency also report obesity. My guess, people resort to dollar meals at fast food restaurants, which is typically an unhealthy choice.

Financial strain, food insufficiency, and symptoms of depression were common in our multi-ethnic sample of nursing home workers. For primary wage earners, household food insufficiency was associated with tripled odds of depressive symptoms-the leading cause of disability worldwide.

I have often said that the resident experience starts with the employee experience. And an employee cannot just be viewed in the context of how we know them at work. Progressive organizations take the time to really know their employees. And when they do, they uncover the real issues that are affecting the work environment. They then seek to address them at the very least instilling self-esteem in workers that can carry back to the home.

We talk about being culturally sensitive to long-term care residents. It would seem we first need to do that with employees.

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