This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990–2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.

Public sector reforms have expanded the number of subcontracted nursing homes in Europe. In Sweden, municipalities contract out nursing homes to various providers through procurement documents, while simultaneously striving for equality in care. This has placed increasing demands on caregivers, in hope of improving care recipients' empowerment and well-being. Consequently, this study has two aims: first, to investigate the prerequisites for empowering care recipients and caregivers in Swedish nursing homes, as expressed in procurement documents; second, to compare procurement documents between municipalities, to determine whether they are (dis)similar based on the objective of care equality. In total, we collected 7 procurement documents, with attachments, from three Swedish municipalities, from 2015 to 2020. Deductive content analysis, based on empowerment theory regarding care recipients and caregivers, was used to analyse the documents. The results indicated an emphasis on empowering the care recipients. The procurement documents placed multiple demands on the caregivers but barely touched on staff empowerment. The municipalities differed in how the providers competed to win the procurement. The result highlights a problematic aspect of the marketisation of nursing homes, namely combining the objective of equality with competition between providers.

In the wake of welfare sector reforms and the increasing marketisation of eldercare services, nursing home first-line managers (FLMs) are confronted with escalating work demands within streamlined organisations. Given this background, the aim was to investigate FLMs’ perceptions of their psychosocial work environment and of differences between nursing home ownership types. Nineteen managers from three Swedish municipalities from municipal, outsourced, and private nursing homes participated in semi-structured interviews focused on job demands, job resources, and ownership differences. The FLMs’ perceptions were interpreted as forming two themes. Navigating challenges: striving to cope with demands highlighted various challenges, including recruitment, workload, and lack of organisational support. Key stressors encompassed personnel struggles, time constraints, and complex interactions. Influence of ownership dynamics on the work environment explored variation across ownership types. Private nursing home managers enjoyed more decision-making autonomy but faced more scrutiny than did municipal ones. FLMs in outsourced homes described unique stressors, notably uncertainty and increased workload due to the procurement process. These findings underscore the potential need for tailored systemic changes across different ownership types. The policy implications include enhancing communication and support in municipal homes, reducing the span of control in private homes, and revising the procurement process in outsourced homes. These insights suggest that further research outlining differences between ownership types, particularly private and outsourced nursing homes, is warranted. Such research could aid in formulating specific strategies tailored to each ownership type in order to enhance the psychosocial work environment for FLMs in nursing homes.

BACKGROUND: Marketisation trends have introduced new elements in residential care homes, potentially related to the psychosocial work environment and well-being of care workers. OBJECTIVE: This study examines differences in job demands and resources across public, outsourced, and private residential care home providers and their associations with care workers’ burnout, job satisfaction, and turnover intentions. METHODS: Data from 253 care workers across 19 residential care homes in three municipalities were analysed using a cross-sectional design, with a 45.3% response rate. We applied the Job Demands-Resources theory and the Copenhagen psychosocial questionnaire, conducting analyses of variance to assess differences and multiple regressions using Generalised Estimating Equations, accounting for the nested structure of the data. RESULTS: Our findings were mixed, with job demands and resources differing across provider types. Outsourced care workers reported higher emotional demands than public sector ones, while private providers offered greater autonomy and supervisor support than public ones. Outsourced workers rated higher levels of burnout than those in public settings, although this difference was non-significant after adding other factors to the model. Statistically significant differences in burnout levels were observed between municipalities. Private care workers reported higher job satisfaction than public ones. About 60% of respondents sometimes or more frequently considered leaving their jobs. Public care workers reported higher turnover intentions than those working for for-profit providers. CONCLUSIONS: This study contributes to understanding how provider type, job demands, and resources relate to care workers' well-being. Further comparative research could help clarify the impact of municipal differences versus provider types.