“We feel like we don’t matter”: the work experience of caring for long-term care residents with suspected trauma-related responsive behaviors

BACKGROUND: There is increasing awareness that many long-term care (LTC) residents may have experienced trauma or post-traumatic stress disorder (PTSD) in their lifetimes, conditions that can be comorbid with dementia and/or complex mental health conditions. In Canada, health care aides provide the vast majority of direct care to such residents. This qualitative study explored their experiences working with residents whose responsive behaviors may indicate past trauma or PTSD. METHODS: In Fall 2024, we conducted open-ended interviews with 24 care aides from 6 urban LTC homes in Alberta, Canada. Initial interview topics built on insights from 13 separate interviews conducted in 2023. Questions were iterated throughout data collection and the data analyzed using Braun and Clarke's reflexive thematic analysis approach. RESULTS: Our participants broadly reflected the demographic make-up of Alberta's care aide workforce: 91.7% female, 79.2% from racialized groups and 70.8% speaking English as an additional language. We identified 3 overarching themes in their experiences: (1) care aides regularly suspected some responsive behaviors to be trauma-related but seldom named these as such; (2) their strategies for managing these behaviors and providing personalized care involved adapting existing skills and innovating new ones; and (3) resident care connected to possible past trauma was complex and compounded current workplace challenges and struggles. CONCLUSIONS: Two improvements could help care aides working with residents with suspected trauma backgrounds: greater understanding of trauma and knowledge of trauma terminology, and use of a trauma-informed care framework. Such changes would likely improve resident quality of life by helping care aides better differentiate responsive behaviors, deliver targeted and individualized care, and avoid resident retraumatization. Implementation of trauma-informed care, however, needs to build on existing care aide expertise to facilitate uptake and ensure sustainability.