Burnout Among Direct Care Workers in Chinese Long-term Care Facilities: A Multilevel Analysis Integrating the Stress Process and Job Demands–Resources Models

Abstract

This study investigates burnout among direct care workers (DCWs) in Chinese long-term care (LTC) facilities, guided by the Stress Process Model and the Job Demands–Resources Model. Using hierarchical linear modeling, the research analyzed data from 217 DCWs, 288 residents with cognitive impairment, and 22 facilities in Hubei Province, China. Major findings reveal that higher resilience, formal support, informal support, and positive attitudes toward dementia significantly reduce burnout, while higher work intensity, secondary traumatic stress, and resident aggression increase burnout. Facility-level analyses identified safer, discreet entrances as protective against burnout, whereas greater social and outdoor accessibility was linked to increased burnout, likely due to heightened caregiving demands. The study concludes that comprehensive, multilevel interventions addressing individual resilience, support structures, and optimized environmental design are critical for reducing DCW burnout and enhancing care quality in Chinese LTC settings.