Coping in crisis: a qualitative study of stress and resilience in Ontario's long-term care workforce

Abstract

Background – The global long-term care (LTC) sector is increasingly strained by entrenched structural vulnerabilities, including persistent workforce shortages, constrained resources, high resident-to-staff ratios, and rising clinical complexity, all of which compromise the delivery of safe, high-quality care. In Canada, these challenges are particularly acute, placing substantial psychological, emotional, and ethical strain on LTC workers. Despite this, empirical insight into their lived experiences, particularly within Ontario remains limited. Objective – This study explores the lived experiences of LTC staff and leaders in Ontario, Canada, examining work-related stressors and coping strategies across the acute and post-acute phases of the COVID-19 pandemic through the lens of Lazarus and Folkman's (2008) Transactional Model of Stress and Coping to inform interventions that support workforce well-being and strengthen care delivery. Methods – A qualitative co-design approach was employed using purposive and convenience sampling. Twenty-four LTC staff, including personal support workers, registered nurses, and administrators, participated in eleven focus group discussions. Guided by Experience-Based Co-Design (EBCD) principles, participants were engaged as co-researchers, contributing as collaborative partners in identifying emotionally salient “touchpoints” and jointly reflecting on workplace stressors and coping strategies. Data were thematically analyzed and subsequently mapped onto the Transactional Model of Stress and Coping, including problem-focused, emotion-focused, and meaning-focused coping strategies. Results – Five themes were identified, each reflecting an emotionally salient touchpoint and its corresponding coping response: (i) Together in exhaustion: solidarity through emotion-focused coping; (ii) Silent in grief: shared healing and meaning-focused coping; (iii) Living in a prolonged emergency: coping within institutional constraints; (iv) Care as connection: relational resilience through meaning-focused coping; and (v) Reclaiming control through redefined boundaries: problem-focused coping. Across themes, coping emerged as dynamic, relational, and co-constructed, supported by team cohesion, relational validation, and participatory leadership. Discussion – This study illuminates how LTC workers navigate emotionally salient touchpoints and systemic constraints while sustaining compassionate care through coping processes that are relational, co-constructed, and shaped by supportive interpersonal and organizational contexts. By integrating the Transactional Model with EBCD, it advances methodological and theoretical understanding of coping as a dynamic, context-embedded process rather than an individual response. These insights offer actionable directions for strengthening workforce resilience, enhancing organizational supports, and informing more responsive and relationship-centred models of care within LTC.