Understanding resilience among workers in elderly care: insights from a mixed-methods study

Workers in elderly care face demanding conditions that may affect both staff well-being and quality of care. Resilience has been identified as a protective factor in this context; however, evidence on its predictors in elderly care settings remains limited. This study investigated the personal-level and organizational-level predictors of individual resilience among healthcare workers employed in residential facilities for older adults and people with disabilities. As part of the European Horizon 2020 project Support4Resilience, a cross-sectional mixed-methods study was conducted among healthcare professionals working in residential care facilities in Italy. Quantitative data were collected from 231 workers through an online questionnaire including validated measures of individual resilience, mental well-being, burnout, organizational resilience capacity, intention to leave, and self-rated health. Pearson correlations and multivariate linear regression analyses were performed, controlling for sociodemographic characteristics. To contextualize and expand the quantitative findings, four focus groups involving 16 healthcare workers and leaders were conducted. Qualitative data explored experiences related to workload, teamwork, professional responsibility, and relational aspects of care. Findings were integrated using a joint display mixed-methods approach. In multivariate analyses, mental well-being emerged as the strongest predictor of individual resilience. Organizational resilience capacity was also positively associated with individual resilience. Burnout, intention to leave, and self-rated health were not significantly associated with resilience. Qualitative findings converged with and enriched the quantitative results across four main themes. Relational meaning in care emerged as a key source of psychological reward and professional fulfilment, consistent with the strong association between mental well-being and resilience. Teamwork and coordination illustrated how organizational resilience is enacted through collaborative practices and structured communication. Workload and fatigue highlighted the structural pressures and moral burden associated with staffing shortages. Finally, a strong sense of professional responsibility toward residents, including emotional self-regulation and collective commitment, appeared to sustain engagement despite challenging working conditions. Interventions aimed at strengthening teamwork, coordination, and organizational support, while promoting mental well-being, may help sustain a resilient workforce and support high-quality care for older adults and people with disabilities.