Barriers to providing long-term care insurance services by direct care workers: a qualitative study in Shandong Province, China

Background China's long-term care insurance (LTCI) system plays a crucial role in addressing the challenges posed by an aging population, while simultaneously placing higher demands on the quantity and quality of long-term care (LTC) services. However, LTCI-designated facilities still face challenges in terms of recruiting and retaining care workers. There is limited knowledge regarding the barriers to service delivery for direct care workers in the context of LTCI. Objectives To analyze the barriers faced by direct care workers in providing LTC services from their perspectives and to explore possible reasons. Methods Based on Herzberg's two-factor theory, face-to-face semi-structured interviews were conducted with 31 direct care workers. Thematic framework analysis method was used to generate qualitative codes and identify themes. Results Direct care workers in designated LTCI facilities faced barriers to meeting motivation and hygiene factors. The motivation factors included three themes: intense and difficult work, tedious and boring work content, and difficulty in gaining recognition and fulfillment at work. Hygiene factors included four themes: difficulty communicating with patients or family members, depressing work environments, incomplete service processes, and inadequate safety measures for home care. Conclusions The conditions of people with disabilities or dementia covered by LTCI are complicated, which causes many difficulties and obstacles to the work of direct care workers. We recommend that in the development of the LTCI system, more emphasis should be placed on service providers as the mainstay of policy practice so that both the hygiene and motivation factors of direct care workers are met and put into effect together. Systems related to LTCI assessment and service provision should be optimized to alleviate the stress of direct care workers and eliminate barriers to their work.