Nearly Three-Quarters of Senior Housing Workers Face Medium, High Levels of ‘Toxic Stress’

Nearly three-quarters of frontline workers in senior housing and care communities face intermediate to high levels of toxic stress between prior traumas and the current working environment.

That’s according to a new survey conducted by digital labor marketplace Kare in collaboration with the National Association of Health Care Assistants (NAHCA). The analysis was based on responses from more than 1,400 certified and licensed healthcare professionals specializing in long-term care.

The survey, released Tuesday, revealed that 34% of those workers are at a high risk of “toxic stress,” which the report’s authors noted was a rate double the general population. Another 39% are at an intermediate risk.


Katie Rhone, senior vice president of employee experience at Kare, said toxic stress responses have been shown to negatively impact mental health, make changes to brain development and poor stress management and coping skills. The survey used the Adverse Childhood Experiences (ACES) methodology.

The survey focuses on past traumas in the care force and how it can manifest in today’s workforce. It is the first of three examining the impact of traumatic events such as the Covid pandemic on the senior living workforce.

“We wanted to look at the prevalence of adverse childhood experiences … and how that compares to the general population,” Rhone told Senior Housing News. “One of the key takeaways that I know we saw from the data is that when you start to look at the number of adverse childhood experiences someone has gone through, it increases their toxic stress levels.”


Registered nurses saw the highest average ACES score compared to other roles with an average of 3.2. The questionnaire indicates a score of one to three puts an individual at an intermediate risk of toxic stress.

The purpose of the first study hopes to raise awareness and understanding regarding ACES and toxic stress among the workforce to senior housing operators, Rhone said.

“We have done past studies through our benefits study where we asked operators and we asked the careforce, ‘What types of benefits do you want?’” Rhone said. “And one of the non-traditional benefits that was rated much higher that caregivers wanted compared to operators was mental health benefits. We also now know that 73% of the workforce is at that intermediate to high risk of toxic stress … how can we help to provide further resources and support around mental health?”

Rhone added she hopes the report can change the lens that leadership in senior housing operators uses to look at mental health within frontline staff to be more trauma informed and understand why people may be responding the way they are.

The remaining two reports will be released in the coming months to build on each other.

“We really wanted … to bring the voice of the careforce to the forefront, and to really understand this is a group of individuals who have dedicated their lives to providing care for seniors. Oftentimes, they have done it and they have become ill,” Rhone said. “They’re resilient individuals. We’re hoping that we’ll be able to see some changes and be able to create some better retention strategies, given the state of the industry right now.”

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