Assisted Living as Hospice: Emotional Impact on Direct Care Workers

Two-thirds of assisted living communities within the United States allow residents to enroll in hospice care in order to age in place. This means that more residents are dying in Assisted Living (AL) and that direct care workers are increasingly being faced with the death of residents. Less is known about how AL direct care workers choose their line of work and the impact that death may have on their own psychological well-being. In this study, which received a Silver 2023 Mather Institute Innovative Research on Aging Award, researchers sought to gain an in-depth understanding on how workers experience resident death.

Analysis was conducted using five years of qualitative data collected between 2016 and 2020  from residents of seven AL communities within the Atlanta area. Data were ultimately collected using 1,593 semi-structured interviews from direct care workers that lasted an average of 86 minutes. During the interviews, respondents were asked basic open-ended questions, which transformed as researchers identified themes that were common among participants. Data were recorded using extensive field notes.

Researchers noted that many direct care workers coped with the death of those receiving care by acknowledging death as a normal process. However, the process of accepting the normality of death required “emotional work” outside of working hours and was developed over time. In the process of conducting emotional work, workers have needed to learn how to separate work from their lives outside of work. In spite of needing to conduct emotional work, some expressed joy in the feeling that they assisted in this part of their residents’ life journey. About half of the staff interviewed relied on religion to guide their perspectives on death, and they took comfort in knowing that residents were not suffering and are now in a “better place.”

Given these findings, researchers recommend that AL needs to be better recognized as a place where residents spend the end days of their lives. This means that direct care workers should receive more support from administrators in coping with the grief of death that they experience on a regular basis.



Bender, A. A., Kemp, C. L., Vandenberg, A. E., Burgess, E. O., & Perkins, M. M. (2022). “You gotta have your cry”: Administrator and direct care worker experiences of death in assisted living. Journal of Aging Studies63, 101072.

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