A Qualitative Investigation of Professionals’ Perceptions of Working in Senior Care Organizations During the First Year of the COVID-19 Pandemic

Abstract

Senior care organizations were some of the hardest hit by COVID-19 infections and deaths early in the pandemic, both for those receiving care as well as staff; 22% of COVID-19-related deaths through March, April, and May of 2020 occurred in the senior care facility population. Professionals in senior care are an important population to understand as they have had to navigate a constantly changing work environment, increasing workloads, less support to safely and effectively conduct their work, and an ever-evolving communication environment. Semi-structured interviews were conducted with seven professionals employed by a variety of senior care organizations across the United States. Inductive thematic analysis revealed four themes related to perceptions of organizational functioning in response to the COVID-19 pandemic. The themes indicate that similar issues were encountered by professionals working in senior care, however, job type impacted the perceptions of those issues. Structuration theory is applied to the findings to explain how structure and agency are created and reinforced in the social systems of senior care organizations.

Introduction

Professionals in senior care organizations (e.g., long-term care facilities, assisted living, nursing homes, dementia care units, rehabilitation, day centers) were forced into a difficult situation as the SARS-COV-2 virus spread across the United States in March 2020. With so little information about the virus, effectively responding to the pandemic became an especially daunting challenge for healthcare workers. In addition to not having access to enough personal protective equipment (PPE; Murray & Friedman, 2020), those working in senior care were also dealing with lockdown protocols implemented by federal and state organizations that impacted organizational functioning. Senior care organizations also became an early hotspot for COVID-19 infection and mortality; deaths that occurred in nursing homes or long-term care facilities accounted for 22% of all COVID-19 deaths in the United States between May 1 and August 31, 2020 (Gold et al., 2020).

Working in senior care can be a rewarding experience, but it can also be a stressful work environment (Hasson & Arnetz, 2008; Honda et al., 2022; Miranda et al., 2015; Stacey, 2005; Xiao et al., 2021; Zimmerman et al., 2005), affected by organizational culture and leadership (Banaszak-Holl et al., 2015; Chu et al., 2014), high effort and low reward (Jirkovská & Janečková, 2019), low wages and job insecurity (Pelissier et al., 2015), and increased risk for stress-related illness (Testad et al., 2010), leading to high rates of worker burnout and turnover (Wiener et al., 2009; Woodhead et al., 2016). Just prior to the COVID-19 pandemic, nursing home staffing was found to be highly variable during each day of the week, with significant staffing shortages on weekends, and overall, well below the expectations set by the Centers for Medicare and Medicaid Services (Geng et al., 2019).

In addition to insufficient staffing, caregivers report that shortages in staffing have a negative impact on the ability to provide quality care (Etherton-Beer et al., 2013; Scott-Cawiezell et al., 2004). Senior care organizations are notoriously underfunded and are lacking adequate resources for workers to engage in high-quality care practices (Choe & Kang, 2017; U.S. GAO, 2021a, 2021b; Werner et al., 2020). For example, Barba et al.’s (2011) study found numerous obstacles to providing quality care for older adults in long-term care facilities including insufficient staffing, time constraints, financial pressures to expedite care, excluding patients in care decisions, lack of training in best care practices for older adults, and disagreements between departments about care plans.

The aforementioned issues have only been further exacerbated by the COVID-19 pandemic (American Geriatrics Society, 2020). Safety issues, such as PPE shortages as well as limited availability of COVID-19 testing, have been directly tied to the record rates that workers have left, and are leaving, senior care (Chatterjee, 2022; U.S. Department of Health & Human Services, 2021). Moreover, restricting access to all outside visitors and limiting contact between the older adults living in or using organizational facilities in an attempt to guard against infection and spread of COVID-19 created a crisis of solitude and loneliness (Chu et al., 2020) which subsequently increased the burden of being a professional in senior care.

Decades of research have demonstrated that both formal and informal social structures within an organization are vital to the cohesion and functioning of the organization (for a review see Flap et al., 1998). Organizational processes, identified as leadership, communication, and teamwork (Forbes-Thompson et al., 2006; Unruh & Wan, 2004), are at the center of formal and informal organizational structures. Leadership and communication are vital components of organizational culture (Bond & Fiedler, 1999; Caspar et al., 2016; Cramm et al., 2012; Etherton-Beer et al., 2013; Scott-Cawiezell et al., 2004), and are essential to facilitating positive health outcomes of patients (Henriksen & Dayton, 2006; Spence Laschinger & Leiter, 2006). Within the field of senior care specifically, poor leadership and communication have been identified as sources of frustration (Scott-Cawiezell et al., 2004) and impediments to achieving collaboration and teamwork (Etherton-Beer et al., 2013). Teamwork is a fundamental organizational process that, when effective, can help to increase long-term staff retention and decrease burnout (Bowers et al., 2003; Tourangeau et al., 2010). The quality of organizational processes in senior care directly impacts the physical and psychological well-being of the older adults whom they serve (Caspar & O’Rourke, 2008; Scott-Cawiezell et al., 2004). In addition to understanding the organizational-level responses to the pandemic, it is important to understand the experiences of individual professionals working in senior care during the first year of the COVID-19 pandemic since they have been in the proverbial “eye of the storm” from the beginning.

This phenomenological study was inherently exploratory in nature due to the fact that senior care facilities have never had to endure a global pandemic. In an effort to explore a variety of topics related to working conditions, internal and external forces, organizational processes, formal and informal social networks, caring for the physical and psychosocial needs of older adults, and maintaining connections with family members barred from visiting, this research was guided by the following general inquiry:

• RQ: What are the experiences and perceptions of professionals working in senior care during the first year of the COVID-19 pandemic?

Method

Procedures

Following approval from the Institutional Review Board, participants were recruited using a snowball sampling technique. Recruitment emails were sent to senior care professionals that were acquaintances of the researcher. Once potential participants indicated interest in being interviewed, the researcher provided an informed consent form and asked for a day and time that worked best for the participant.

Qualitative semi-structured interviews were conducted to understand the experience of working for senior care organizations during the first year of the COVID-19 pandemic from the perspective of each participant. Open-ended interview questions were developed based upon previous research related to senior care workers, news reports about senior care facilities during the COVID-19 pandemic, and early published research and academic commentary about senior care during the COVID-19 pandemic. Open-ended questions covered topics including routines in work and work interactions prior to and during the COVID-19 pandemic, challenges at work resulting from the pandemic, changes in work due to the pandemic, communication patterns with residents and their families during the first year of the pandemic, and technology use prior to and during the first year of the pandemic.

Due to COVID-19, as well as the various geographical locations of each participant, six interviews were conducted via video chat platforms (Zoom, Google Meets, WebEx), and one was conducted over the phone. Interviews lasted between 41 minutes and 1 hour 22 minutes and were digitally voice recorded. Interviews took place between 9 months to 1 year after the initial lockdowns occurred in March 2020. At the end of the interview, the researcher asked if the participant was willing to recommend anyone else who worked in senior care to be interviewed, resulting in an additional three participants. All interviews were audio recorded and transcribed verbatim.

Participants

A total of seven professionals participated in semi-structured interviews between November 2020 and March 2021. All participants worked for a senior care organization during the first year of the COVID-19 pandemic, the sole inclusion criteria for this study, and all participants identified as female. The organizations where the participants were employed varied in the type of care they provided for older adults ranging from center-based services for community-dwelling older adults and short-term rehabilitation, to assisted living and dementia care units. The organizations were located across three different states in the continental U.S. Participant’s job types varied between direct interaction with and care for older adults to management and leadership positions. The job titles for the participants were transportation and activities (Terry; assisted living; direct services), certified nursing assistant (Nanda; dementia care; direct services), social worker (Ally; short-term rehabilitation and long-term care; direct services), director of social work (Celia; short-term rehabilitation; direct services), admissions and marketing (Sonja; dementia care; direct services), center manager (Natalie; center-based care services; leadership), and director of operations (Anna; center-based care services; leadership). Job types were categorized based on the level of contact and communication they have with patients/clients and family members; positions categorized as leadership had limited direct contact with the patients/clients and their family members, whereas positions categorized as direct services had consistent and significant interactions with patients/clients and their family members.

Data Analysis

Data were inductively analyzed using the six-step process of thematic analysis described by Braun and Clark (2006) to identify and categorize patterns in the data. Thematic analysis was chosen as the most appropriate method of analysis due to its usefulness in “examining the perspectives of different participants, highlighting similarities and differences, and generating unanticipated insights” (Nowell et al., 2017, p. 2). The researcher started by reading through the interview transcriptions and becoming familiarized with the data. Common topics appeared to the researcher during these initial readings and were noted on the transcripts. Next, the researcher began to code the data and organize it into initial, meaningful groups. The researcher continued to review the codes within their initial groups before forming the codes into themes. After initial themes were created, the author reviewed the themes as they related to the data extracts, followed by the overall data set to ensure the themes were coherent and accurate in their reflection of the entirety of the data. This iterative process aided in refining the definitions and labels of the themes. The themes presented in this article were found across all interviews, indicating data saturation. Additional validity for the results of this article were established by following the “15-point checklist of criteria for good thematic analysis” by Braun and Clark (2006, p. 96).

Results

Themes identified in the data illustrate how organizations and their employees adapted to the external and internal changes forced by the COVID-19 pandemic. Analyses revealed four interrelated themes that illustrate how organizations and the individuals working in them responded to a global pandemic: (1) ability to reorganize and transition, (2) efficacy and efficiency of the organization, (3) organizational communication networks, and (4) communicating COVID-protocol changes.

Organizations and their employees had to manage constantly changing mandates from national, state, and local health agencies and the impact those changes had on the ability of the organization to function. The pandemic also altered organizational communication patterns and flow of pandemic-related information in dealing with changes. Although participants talked about similar topics, there were clear differences in the perception of those topics based on the role of the individual within the organization for three of the four themes: efficacy and efficiency of the organization, organizational communication networks, and communicating COVID-protocol changes. Explanations of the themes are presented below with excerpts from the interviews. All identifying information has been changed to pseudonyms or removed completely to ensure confidentiality.

Ability to Reorganize and Transition

One major theme that participants perceived similarly was the speed at which they were having to make changes, not only across the organization, but also with their job responsibilities. Guidelines and protocols were in constant flux at the national, state, and local levels as more understanding of the SARS-COV-2 virus emerged and as infection rates fluctuated nationally and locally. Every participant discussed how health and safety protocols were constantly changing within their organization due to mandates being released from external organizations such as the Centers for Disease Control, Centers for Medicare and Medicaid Services, as well as from more regional organizations such as State and County Health Departments. Participants talked about how quickly things could change, sometimes with multiple changes happening in a single day.

But one of the other hardest things has been, every day it seemed like, for the first two months—and I’m not kidding. And it kept coming, but it was, a little less frequent as far as, like, seriously, there would be a directive that we would get from the CDC and the [State] health department and whoever else was involved for. . . how we’re gonna move forward with X, Y, and Z. And that same day, it would change. (Celia—Direct Services)

Changes being mandated could be significant or minimal, but even minimal changes required a lot of redoing of work and additional communication. Daily job responsibilities changed very little for some working in senior care, but even if the responsibilities did not change, the amount of time to complete everything was increased either due to having more iterations of the same task, such as having to contact families every day instead of once every 2 weeks, or because of staff quitting and acquiring those workloads in addition to their own. These changes had significant impacts on the day-to-day operations of the organizations and the work being done by the professionals.

My role has changed quite a bit because. . . I’m still helping the families. Um, most of that’s being done virtually. . .I’m spending a lot of my time helping our residents stay connected with their loved ones. (Sonja—Direct Services)

Professionals indicated that although the changes could be difficult, they felt they were capable and impressed with the ability of the organization to shift so quickly. Both leadership and direct service workers discussed the massive increase in technology utilization for intra- and inter-organizational meetings, as well as for residents/clients to receive telehealth check-ups and to maintain social connection to family and friends. Job responsibilities fluctuated as protocols continued changing, giving some employees more tasks to complete and others experiencing significant reductions in responsibilities. To utilize all of the help available, a “job board” was created so tasks could be completed by whoever was available. Organizations also had to reorganize the physical settings of their organizations to cater to different situations including turning an entire wing of the facility into a COVID unit to deal with the overflow from hospitals; another turned their building into an end-of-life center so families could visit their loved ones before they passed from COVID-19, even though at the time such a set-up was against state mandates.

I learned that we can do hard things, and we can do ‘em well. And we can change fast. We had to. We-we got that urgent response team together, and we made a lot of changes really quickly, and we did it. And maybe it wasn’t perfect, but we did it, and so I know we can do it. (Anna—Leadership)

The above quote from Anna leads us to the next theme of efficacy and efficiency within the organization. This quote illustrates that organizations and their employees had to make a lot of changes and often very quickly; however, it also illustrates, from the perspective of a person in a leadership position, that although she and her organization could make hard changes quickly, it did not always mean those changes were implemented well.

Efficacy and Efficiency Within the Organization

Professionals in senior care noted that although they were able to make changes quite quickly, those changes did not always result in efficiency or effectiveness within the organization. Participants talked about the ability of the work of the organization to be done, the resources available to do the work, and being as productive as possible without wasted efforts. All the examples that fell under this theme were related to the changes in the organization resulting from the pandemic as well as the ability to staff the organization. Most participants indicated that there was a significant decrease in the efficacy and efficiency with which the organization could provide care and services for the patients/clients.

Perceptions of resource allocation that could impact efficacy and efficiency were split between direct services professionals, who had more direct contact with patients/clients and their families, and leadership and management professionals. Those in leadership positions were able to recognize and ameliorate inefficiencies in their own and other higher-level positions within the organization. They had a much easier time transitioning to the new responsibilities of their jobs because most of their work could be done remotely, such as running meetings, writing policies and procedures for how to run business operations, or sending emails to internal and external stakeholders about updated changes at the organization. If leadership and management did talk about reduced efficacy and efficiency, it was in relation to others’ positions related to direct services.

For example, our physical therapist. Where they could normally see, I don’t know. . . 12 people in a day because they all come down to the gym. Now that person—that PT has to go to each of their homes and drive in between. And there’s just no way to see 12 people in a day. (Natalie—Leadership)

Conversely, professionals whose jobs required them to be interacting with residents or clients faced a lot of obstacles in being able to conduct their responsibilities, many of the obstacles stemming from the policies and procedures being created by those in leadership positions to meet external agency guidelines. Impediments to job accomplishment included being unable to bring any patient charting technology or documents into the room for contamination reasons, new management implementing different charting procedures that were less efficient than prior procedures, donning and doffing full PPE for each resident, not having enough time to speak with residents or clients outside of basic care activities, work equipment being taken away because of expense even though tasks requiring the use of the equipment increased, and insufficient staffing to care for residents or clients that resulted in mistakes, accidents, and abuse.

So none of the routine, so to speak, changed. It was just longer hours and more time spent on the phone trying to update families. . . day-to-day, kind of stayed the same during normal work hours, and then after work hours was then doing a lot more phone calls. I added on an hour and a half or two hours to phone calls every day. (Ally—Direct Services)

When I was on my vacation. . . the third person in social services quit. So, when I got back, there was just an assumption I took over all those 20 long-term cares, which I’ve known most of them, it’s not a big deal, but it is a big deal. (Celia—Direct Services)

When there’s three of us and, I think, 40 dementia residents. . . watching the care decline was difficult to witness and be a part of, ‘cause it just got harder and harder to provide the same quality of care. Like the burnout was really true. (Nanda—Direct Services)

This accumulation of additional responsibilities coupled with the growing sparsity of human resources led to a general perception that the quality of care that the direct service professionals could provide had quickly depreciated while the potential for burnout and turnover increased.

Organizational Communication Networks

Communication experiences with internal and external stakeholders were expressed across the participants and were clearly delineated by job type. Participants in leadership positions experienced communication that was mostly limited to the management directly beneath them and did not differ much from what it was like prior to the pandemic, with the exception of more virtual meetings. They had a small group of other leaders or managers that required two-way interaction. Most communication outside of those small groups was mainly one-way communication and top-down, typically via email messages or newsletters. Information in those communications mainly focused on updating residents, clients, and families about changes taking place at the facility in response to new information about the COVID-19 pandemic and updating employees about corresponding changes to work-related protocols.

The people that report to me are my four center managers, so the person who leads each of the four centers. Then I have a quality manager and a compliance manager. So, those are my people that I talk to the most often. Most interactions are via Webex here. (Anna—Leadership)

Participants in direct services positions reported significant increases in the number of interactions they were engaging in on a daily basis. They reported increased communication with residents/clients, varying departments within the organization, external agencies, and family members of the residents/clients. These increases in communication involved both proactive, staff-initiated efforts to transmit developing information about the SARS-COV-2 virus, associated changes in required health precaution protocols, and their impact on care plans. They were also fielding and responding to an increase in the volume of questions and concerns initiated by residents/clients and their family members. Although this is typical of positions like these, the pandemic increased the difficulty of reaching important parties, responding to inquiries and returning calls, coordinating necessary health equipment or appointments for the resident/client, and completing all of the coordination in a timely manner.

All of those people. Everyone. There’d be multiple meetings in a day. I’d be talking to my administrator, my director of rehab, my director of nursing, my nursing managers, the nurses, the CNAs, the patients, the patients’ family members. . . home healthcare. . . CME companies, insurance agencies. I mean, I—everyone. (Celia—Direct Services)

Communication networks in the senior care organizations where the participants worked were essentially unchanged during the first year of the COVID-19 pandemic. The notable difference in communication networks was demonstrated in the experiences of direct care workers who had significant increases in the day-to-day interactions in an effort to successfully attend to the care of their residents/clients. These significant increases in communication responsibilities due to worker turnover in the facilities as well as increased reporting to multiple stakeholders such as clients/residents and their family members placed a substantial additional burden on the direct care providers.

Communicating COVID-Protocol Changes

With protocols changing as regularly as they did in senior care, the dissemination of pandemic-related information was important for everyone to do their jobs within regulations. Participants who were in leadership spoke much differently about the dissemination of pandemic-related information within the organization than those in direct services. Leadership focused on what pandemic-related information was being provided and how it was being communicated as they were responsible for writing and disseminating information for the organization. Their perceptions of information flow were based upon how they took the information from the external agencies, translated it into protocols for their organization, and then shared that information with the necessary parties.

Distancing, hygiene, screening, and so we’ve been doing all those things and have ways and methods of tracking those things. And then I send out a weekly report to staff to, um, just show them how we’re doing. (Anna—Leadership)

So, everyone worked from home. Every morning we’d login and do a team’s IDT call and kind of see what needed to be done then. (Natalie—Leadership)

Participants in direct services roles talked about information dissemination and the impact it had on their ability to do their job, often leading to increases in workload, inefficiencies, and abuses of power. They perceived information sharing as much less organized, with many participants reporting instances where it was unclear who had the necessary information to answer questions or meet the needs of a resident/client and ultimately became an issue of “passing the buck.”

And she was, “Do you just get calls from every unit? Like do people not know where to transfer them to? Like why are you constantly called about people that are not yours?” This is a thing. . . because they evidently don’t get the communication they need from others. (Celia—Direct Service)

Information sharing was also used as a means of power and exclusion; some direct services professionals found themselves not knowing that changes had been issued or how changes were to be implemented in their own work because colleagues were intentionally not providing the information they had.

The nurse and the administrator, they were so tight-lipped about everything, and clearly, sharing with me so that I have a grain knowledge to share with you, you know, about the day-to-day changes and who is requesting those changes. So that’s a struggle for me to answer because I wasn’t kept informed. (Ally—Direct Service)

Communicating changes in protocols to respond to the ever-changing COVID-19 crisis was a difficult endeavor for all professionals working in senior care during the first year of the pandemic. Leadership professionals were having to manage the protocols being mandated by external agencies, translate that information into workable procedures for their organizations, and then effectively communicate that new information to all affected parties within and outside of the organization. Information sharing for direct service workers was perceived as a challenge due to having to navigate a lack of information, multiple sources of conflicting information, or the withholding of information from coworkers who used it as a form of power-over.

Discussion

Qualitative analysis of professional’s perspectives of their work and senior care organization during the first year of the COVID-19 pandemic highlighted the ways in which professionals at many levels of these organizations experienced similar issues. The perceptions of those issues, however, varied widely depending upon their roles within the organization. The experiences of professionals in senior care organizations conveyed in this research can be further understood with Gidden’s (1984) Structuration theory. This theory focuses on the roles of structure and agency in creating and reproducing social systems. Structure can be conceptualized as the rules and resources within a social system and exist only through routine and interaction by actors within the system. Agency is what people can or cannot do, how they are empowered or constrained in their actions. Structure and agency are perceived of as existing simultaneously, where one does not precede the other. The structure of organizations is reproduced through the rules and resources found in both physical and social environments of an organization and are enacted through daily routines of individual agents (for a complete explanation of Structuration theory, see Giddens, 1984).

The complex duality of the constraints of structures and the empowerment of agency can be applied to how the professionals in this research acted within the social system of their organization. All participants expressed both empowerment and constraint in their positions as it related to the COVID-19 pandemic. Leadership expressed constraint in having to change workflows, protocols, and policies to remain aligned with external agencies’ guidelines, but they were empowered in how they could best fit those guidelines to their organization. They additionally expressed empowerment to reexamine and change current structures that became inefficient and unsafe due to the spread of COVID-19. Previous research examining communication in health organizations has demonstrated that senior care facilities are likely to have strict hierarchies and use top-down communication (Bond & Fiedler, 1999). The findings in this study support communication as originating with leadership and moving to direct service professionals. A top-down communication approach enables agency for those at the top and constraint for those at the bottom.

Direct services professionals expressed much more constraint than agency. Agency for direct service professionals was expressed in the form of rising to the challenge of being flexibile and adapting to the constantly changing needs of not only their clients/residents but also of the organization. The constraints in structure that these professionals perceived are magnifications of constraints that existed in senior care organizations, and were well documented in research, prior to the pandemic (see Bowers et al., 2003; Cadogan et al., 1999; Caspar & O’Rourke, 2008; Caspar et al., 2016; Castle et al., 2006; Kim & Oh, 2016; Sheridan et al., 1992; Zakari et al., 2010). Many of the participants working directly with residents/clients felt constrained by the rules of their positions; what they had to get done according to their job was not necessarily the same as what they felt needed to be done to care for the residents/clients. They also felt constrained in the allocation of the material resources they needed for their job, PPE, or technology, as well as in their ability to command social capital, such as staffing or the sharing of information. Participants discussed their responsibilities, however, in a way that made clear they were acting within the social system to reinforce these structural constraints, such as reinforcing the structure of staff shortages by taking on larger caseloads or following communication hierarchies instead of subverting power dynamics to obtain important safety-related information.

The findings from this study align with previous research on perceptions of organizational processes prior to the pandemic. Senior care facilities have been found to be inherently hierarchical and have strict stratification of personnel (Bowers et al., 2003; Caspar et al., 2016; Kontos et al., 2010). The use of hierarchical communication, or a top-down approach, in senior care organizations has been linked to decreased feelings of agency and increased feelings of constraint in direct service workers (Sheridan et al., 1992; Waxman et al., 1984; Zakari et al., 2010), diminishing perceptions of productive communication, reducing teamwork (Tourangeau et al., 2010), and ultimately resulting in increased staff turnover (Bowers et al., 2003). The perceptions of communication between leadership and direct services professionals are similar to previous research on similar topics. For example, skill level was linked with perceptions of and satisfaction with communication in nursing homes; certified nursing assistants and licensed practical nurses perceived less openness, timeliness, accuracy, and clarity in communication than registered nurses. Numerous studies have found that lower-ranked employees in senior care perceive that their input is unwelcome (Scott-Cawiezell et al., 2004; Waxman et al., 1984) or is not actually requested or taken into consideration by their supervisors (Caspar et al., 2016; Kontos et al., 2010). Comparably, administrative staff were found to have more positive perceptions than direct care staff regarding organizational communication, teamwork, and leadership (Forbes-Thompson et al., 2006). The results of this study indicate that the historical issues in senior care organizations related to the organizational processes of leadership and communication continued to be experienced by the participants working in different levels of the organizations and were amplified by the urgency and novelty of the first year of the SARS-COV-2 pandemic. Formal and informal social networks within the organization were the vehicle by which participants felt a sense of agency or constraint in their positions.

Limitations and Future Research

A strength and limitation of this study is that participants came from a variety of senior care organizations and held multiple different types of roles. Future research should investigate single organizations as well as multiple people in similar job types to look for similarities and differences within and between roles and organizations. Another limitation is the homogeneity of participants related to race and gender and future research should include participants from a variety of genders and races. Finally, the results of the interviews revealed that participants in leadership positions were much more likely to speak positively about their organization and how they responded to the COVID-19 pandemic than those in positions dealing directly with patients/clients. While this finding can be explained by the sense of agency being in a leadership role can provide to individuals and allow them to feel more positively about their organization and role within it, there is a chance that those in leadership positions felt it necessary to represent their organization in a positive light during the interviews and may not be a complete reflection of their personal perspectives. Additional research on how professionals in senior care communicate about and represent their organization, according to job type, could provide important insights into organizational facework.

Conclusion

The COVID-19 pandemic has placed great external and internal strains on the senior care community. Professionals who continued to work in senior care through the first year of the pandemic experienced similar issues within the organization but often had different perceptions of their ability to navigate and deal with those issues based on their organizational role. Organizational functioning and communication were key indicators for how individuals perceived of their organization’s response to the ever-changing COVID-19 guidelines. Structuration theory highlights the social systems and individual actions that create and reinforce structure and agency within organizations.

Author Biography

Katey A. Price is an assistant professor of Communication Studies at Albion College. Her research focuses on health communication in the contexts of aging issues, family and professional caregiving, and Alzheimer’s disease and related dementias.