Understanding the experience of employees in assisted living facilities during the COVID-19 pandemic: A qualitative case study

The COVID-19 pandemic significantly impacted older adults, with assisted living facilities (ALFs) emerging as critical focal points for the spread and management of the virus in the United States. This study examines the challenges faced by workers in assisted living facilities during the pandemic and explores how the state policy impacted their professional and personal lives. The research team conducted semi-structured Zoom and in-person interviews with 29 employees at "Harmony House" in Oregon with the goal of understanding how they balanced federal and state guidelines for COVID-19 with the expectations of residents and their family members. An iterative thematic analysis based on grounded theory was adopted to analyze the transcripts of the 29 audio-recorded interviews. Nearly all participants reported facing a dilemma during the pandemic: they had to police the residents and their families and themselves during the pandemic to ensure the safety of the residents and to comply with the state policies, despite this approach conflicting with their professional training. This role conflict significantly increased their stress, impacting both their professional and personal lives. The findings highlight the complex role dynamics that ALF workers had to navigate, balancing their identity as compassionate caregivers with the unexpected and often distressing role of enforcer. By acknowledging and addressing these dual role demands, ALFs can improve not only the well-being of their staff but also the overall quality of care for their residents, ensuring better outcomes during and beyond public health crises.