Demands, resources, burnout, and work ability in long-term care: A multi-group structural equation model comparing residential and home care

BACKGROUND: Demands and resources significantly influence burnout and work ability, which are critical outcomes in nursing workforce health research. Burnout is a multidimensional construct comprising emotional exhaustion, depersonalization, and reduced personal accomplishment due to prolonged work-related stress, while work ability describes a worker's capacity to meet job demands given their health, skills, and mental resources. Evidence suggests that the extent of burnout and work ability varies across different care settings. However, research on the relationships between demands, resources, burnout dimensions, and work ability in the context of long-term care remains limited. OBJECTIVE: To test a modified version of the Job Demands-Resources model by assessing measurement invariance and examining the relationships between demands, resources, burnout dimensions, and work ability, as well as comparing these relationships across residential long-term care and home care settings. DESIGN: A Multi-group Structural Equation Modelling approach. PARTICIPANTS: 301 employees working in German residential long-term care and home care facilities. METHODS: Data from two cross-sectional studies conducted in residential care (November-December 2019) and home care (September-October 2020) were analyzed using a multi-group structural equation model. Measurement invariance testing was applied to validate the model across both settings and to identify setting-specific differences. RESULTS: The modified Job Demands-Resources model demonstrated measurement invariance across residential and home care settings, confirming its applicability in both long-term care settings. High demands were linked to increased emotional exhaustion and depersonalisation, while resources were positively related to personal accomplishment in both settings. Statistically significant group differences were observed: emotional exhaustion was negatively associated with work ability only in home care (β = -0.58, p = .016), and paths from depersonalisation (p < .001) and personal accomplishment (p < .001) to work ability differed between settings. CONCLUSIONS: Demands and resources shape burnout dimensions among long-term care employees. Similarities point to the potential of generic interventions, whereas differences in the relationships between burnout dimensions and work ability across settings underscore the need for setting-specific approaches. Further research should identify additional demands and resources and confirm these findings through longitudinal studies.