Antecedents of well-being of home care workers: a mixed-methods systematic review

Demand for home-based care is growing, yet the attractiveness of this sector remains low due to poor working conditions. This threatens the sustainability of this service, which is often preferred by older adults. To address this issue, it is necessary to understand of the home care environment. Thus, the aim of this review is to develop a theory-informed framework that explains how multilevel conditions influence the well-being of home care workers.

A mixed methods systematic review was conducted. The last updated search was conducted on April 8, 2026. Searches covered Jan 2000-April 2026. 2 reviewers independently coded the data, synthesized the findings using a convergent integrated approach, and integrated the evidence using the Job Demands-Resources and Work-Home Resources theories.

Seventy-nine studies were included. High workload volume and intensity and, emotional demands with limited organizational resources were linked to strain, while adequate supervision, information flow, training, access to material resources, and supportive relationships mitigated harm and sustained motivation. The patterns were most pronounced among direct-hire and migrant workers. Negative consequences of the devaluation of care work and the crucial role of legal rights awareness emerged as novel contributions to the field.

This theory-informed review addresses fragmented evidence on home care workers' well-being, identifies where demand rises and resources thin under efficiency pressures, and points decision-makers-especially in direct-hire and migrant-reliant systems-to specific practices for retaining the workforce and safeguarding care quality.