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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Health Serv Res . 2026 Mar 4;26:504. doi: 10.1186/s12913-026-14264-0 Search in PMC Search in PubMed View in NLM Catalog Add to search Comparative insights into working conditions and care relationships in long-term care facilities in Germany and Türkiye: a qualitative study Sezen Soner Aykut Sezen Soner Aykut 1 Doctoral Program Elderly Health, Institute of Health Sciences, Ege University, Bornova, Izmir 35100 Türkiye Find articles by Sezen Soner Aykut 1 , Asli Kilavuz Asli Kilavuz 2 Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, 5th Floor Bornova, Izmir, 35100 Türkiye Find articles by Asli Kilavuz 2, ✉ Author information Article notes Copyright and License information 1 Doctoral Program Elderly Health, Institute of Health Sciences, Ege University, Bornova, Izmir 35100 Türkiye 2 Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, 5th Floor Bornova, Izmir, 35100 Türkiye ✉ Corresponding author. Received 2025 Nov 10; Accepted 2026 Feb 23; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13069720 PMID: 41781960 Abstract Background In institutional long-term care facilities, the care environment and the psychosocial status of the staff are closely associated with the quality of care. The aim of this study is to examine how staff members in long-term care facilities in Germany and Türkiye understand their duties and develop caring relationships. Methods In this qualitative descriptive comparative study, sixteen participants (eight from each country) were interviewed using a sociodemographic form and a semi-structured interview guide. Data were analysed using thematic analysis following Braun and Clarke’s approach. Coding was conducted by the first author and independently reviewed by a second researcher, with differences discussed and resolved through comparison. Results The study suggests that both countries face similar challenges related to staffing needs and the care of residents with cognitive impairments, while also showing differences in organizational structures and care approaches. German participants emphasized the efficiency of fixed schedules and ergonomic aids, while Turkish participants highlighted shift irregularities and dependence on manual handling techniques. In terms of interaction, German staff described using structured dialogue and pragmatic cultural adaptations, while Turkish participants more frequently referred to relational approaches characterized by familial forms of address and religious sensitivity. Furthermore, although emotional rewards were described as outweighing material incentives in both settings, institutional frameworks in Germany were often associated with sustaining motivation, whereas intrinsic personal dedication in Türkiye was frequently mentioned in the context of limited systemic support. Conclusion This study suggests that whilst empathy and respect are fundamental in both contexts, participants in Türkiye more frequently described motivation in relation to social bonds and personal commitment, whereas German participants more often associated motivation with institutional stability and defined professional roles. The comparison further suggests that both systems reflect distinct strengths within their respective contexts and may provide points for reflection in future cross-national discussions on long-term care practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-026-14264-0. Keywords: Aging, Long-term care, Social work, Intercultural comparison, Cultural competence, Qualitative study, Care relationship Background In recent decades, populations around the world have been getting older faster than ever. According to the United Nations World Social Report, about 10% of people globally are now 65 or older. By 2050, this is expected to rise to one in six [ 1 ]. While Türkiye and Germany are among the countries with increasing elderly populations, Germany has a much older population. Both Germany and Türkiye have seen more older adults, but the increase has been much greater in Germany. Statistics from the Turkish Statistical Institute [ 2 ] show that the share of citizens aged 65 and over increased from 9.1% in 2019 to 10.6% in 2024, while in Germany this rate reached from 21.63% in 2019 to 23.20% in 2024 [ 3 ]. Therefore, while Türkiye has a rapidly aging but still relatively young demographic structure, the aging process in Germany has progressed more rapidly. These changes have put more pressure on health and social care systems and made it important to review how care is organized and delivered. In addition to addressing medical needs, institutional long-term care facilities support daily living activities, encourage social interaction, and work to preserve dignity and well-being [ 4 ]. Research consistently demonstrates that the environment where care is provided and the psychosocial state of the staff significantly influence the quality-of-care outcomes [ 5 – 7 ]. Although Germany and Türkiye face similar demographic challenges, their approaches to organizing long-term care differ markedly. Germany operates within a well-established system combining services provided by public, private and non-profit providers, supported by Long-Term Care Insurance (Pflegeversicherung), introduced in 1995 [ 8 , 9 ]. In Türkiye, it stems from a long-standing custom in which families were mostly responsible for providing care, institutional elder care has been developing more slowly. These variations reflect wider cultural attitudes in addition to being based on organizational structures or policy frameworks. While professionalized and institution-based care models are more well-established in Germany, care practices in Türkiye are still heavily influenced by expectations of intergenerational assistance and family duty [ 10 , 11 ]. These differences have an impact on how carers perceive their roles, stay motivated, and interact with senior citizens. Previous studies on elderly care have tended to focus on single-country contexts, leaving limited room for cross-national comparison. For example, Zarzycki et al. [ 12 ] offers comparative data on caregiver motivation across several nations, and Simmons et al. [ 13 ] examine the differences between migrant and native care workers in Austria and Sweden. However, there aren’t many qualitative studies that examine the real-life experiences of care facility employees, especially in Germany and Türkiye. Instead of concentrating only on structural factors, the present research approaches the issue through the lens of cultural competence. In this study, cultural competence is seen as an ongoing and evolving process that depends on institutional support as well as on the gradual refinement of attitudes, knowledge, and practical skills. From this standpoint, care practices become more sensitive to everyday differences in language, religion, and family relations. Looking through this framework also makes it possible to see how care relationships take shape within culturally distinct settings and how these experiences affect perceptions of care quality. As a result, this research examines how personnel working in long-term care institutions in Germany and Türkiye understand their professional roles from an intercultural point of view. It focuses on three interrelated areas: working conditions, the sources of motivation that sustain care work, and the nature of interactions between staff and residents, together with their influence on care quality. Methods Study design In this study, a qualitative descriptive comparative design was used to explore how long-term care staff described and understood their work and caregiving experiences in two national contexts [ 14 ]. The analysis focused on participants’ accounts of emotional, relational, and organisational aspects of caregiving practices in Germany and Türkiye and was guided by a thematic analytic framework. Participants Given the intercultural nature of the study, data were gathered in two metropolitan cities Duisburg, Germany, and Ankara, Türkiye. Facility names are withheld to protect confidentiality. A stratified purposive sampling strategy was employed. First, institutional long-term care facilities were identified as the study setting. Participants were then selected based on variables such as professional role (nurse, social worker, care assistant), gender, and years of employment. This method ensured the inclusion of diverse perspectives and enriched the data [ 15 ]. In total, sixteen individuals participated, with eight individuals from each country. The distribution of roles was symmetrical: three nurses, one social worker, and four care assistants per country, creating a balanced foundation for cross-national comparison. Participants were required to meet two inclusion criteria: (a) at least one year of professional experience in institutional long-term care and (b) voluntary consent to take part in the study. Physicians were excluded because their primary responsibilities center on medical decisions rather than direct daily caregiving, ensuring that the focus remained on staff involved in hands-on care. Data collection continued until no substantially new themes emerged in the interviews. Data collection Data were collected using two separate instruments developed by the researchers based on a comprehensive review of the relevant literature: a sociodemographic information form and a semi-structured interview form. The sociodemographic information form This form was designed to obtain descriptive data regarding the participants. It included items concerning personal characteristics (age, gender, marital status, and educational level) and professional attributes (professional role, years of experience, shift type, and perception of income). Semi-structured interview form To explore the participants’ experiences in depth, a semi-structured interview form was utilised. This approach enabled participants to express their own narratives freely while maintaining focus on the research objectives. During the interview process, directional but flexible questions were used around specific themes. The questions were developed by the researchers. During the development process, expert opinions in the fields of social services and elderly health were consulted, and the language was simplified. The interview form was structured to suit the cross-cultural comparison objective of the study and organized in a way that would allow for an in-depth understanding of both the professional and personal experiences of care center staff. The interview form consists of a total of 11 open-ended questions designed to suit the main purpose of the study (Supplementary Table 1 ). Conducting the study in both Germany and Türkiye provided a comparative perspective on institutional long-term care practices. The study is guided by three main questions: Research Question (RQ) 1. How do long-term care staff in Germany and Türkiye experience and describe their working conditions? RQ2. Which factors do long-term care staff identify as shaping their professional motivation? RQ3. How do care workers describe the influence of their interactions with nursing home residents on the quality of care? By exploring these questions, the research contributes contextually grounded insights to scholarly discussion and policy thinking, addressing a clear gap in comparative qualitative studies of long-term care. The semi-structured interview form, prepared in both Turkish and German, was used to collect data. Because most participants declined audio recording due to the sensitivity of the topic, interviews were documented primarily through detailed near-verbatim written records (field notes) taken during the sessions. These notes focused on capturing participants’ expressions as accurately as possible. Immediately after each interview, the notes were expanded and clarified to ensure completeness and consistency. All interviews took place face-to-face in private areas within the facilities and typically lasted between 30 and 45 min. In German sites, a bilingual staff member (German/Turkish) assisted with translation when necessary. This person’s role was strictly limited to clarifying meaning and promoting participant comfort, without interpreting content. Before each interview, all participants were briefed on the research purpose and signed written informed consent forms confirming voluntary participation. Data analysis The analysis was conducted using thematic analysis as described by Braun and Clarke [ 16 ]. First, the expanded near-verbatim interview notes were read several times to achieve familiarity with the data. While the interview guide was organised around predefined domains, coding was primarily data-driven. To support cross-country comparability, themes were organised in line with the research questions; however, theme content was derived from participants’ accounts rather than being imposed by the interview guide. The three research questions informed the organisation of the final themes: Theme 1 addressed RQ1, Theme 2 addressed RQ2, and Theme 3 addressed RQ3. Data from Germany and Türkiye were analysed separately before being compared to identify both similarities and differences across contexts. Initial coding was conducted by the first author. To strengthen analytical rigour, a portion of the data from both countries was independently reviewed by a second researcher. The researchers compared coding decisions, discussed discrepancies, and refined the thematic structure through discussion. Results In Türkiye, most participants were young adults aged between 21 and 35 years (75.0%, n = 5), with smaller proportions in the 36–50 years (12.5%, n = 2) and over 50 years old (12.5%, n = 1) ranges. The age structure in Germany was a more balanced one-half of the sample were between 21 and 35 years, the other half comprised of 36- to 50-year-olds; there was no respondent above the age of fifty (Table 1 ). Table 1. Sociodemographic characteristics of Turkish and German participants Country Participant Code Age (years) Gender Education Level Marital Status Position Years Working in Institution Perceived Income Level Germany DE1-SW 26 Female University and above graduate Single Social Worker 3 Income > expenditure Germany DE2-CA 46 Female Secondary school graduate Married Care Assistant 18 Income = expenditure Germany DE3-RN 44 Female High school graduate Married Nurse 6 Income = expenditure Germany DE4-RN 42 Female High school graduate Married Nurse 10 Income < expenditure Germany DE5-RN 25 Female High school graduate Single Nurse 3 Income = expenditure Germany DE6-CA 35 Male Secondary school graduate Married Care Assistant 10 Income = expenditure Germany DE7-CA 34 Male Secondary school graduate Single Care Assistant 5 Income = expenditure Germany DE8-CA 38 Female Secondary school graduate Married Care Assistant 2 Income = expenditure Turkey TR1-CA 24 Female High school graduate Single Care Assistant 5 Income < expenditure Turkey TR2-RN 24 Female University and above graduate Single Nurse 1 Income < expenditure Turkey TR3-RN 62 Female High school graduate† Married Nurse 10 Income = expenditure Turkey TR4-SW 34 Female University and above graduate Married Social Worker 8 Income < expenditure Turkey TR5-RN 40 Female High school graduate† Married Nurse 3 Income < expenditure Turkey TR6-CA 22 Male Primary school graduate Married Care Assistant 2 Income < expenditure Turkey TR7-CA 37 Female Primary school graduate Married Care Assistant 7 Income < expenditure Turkey TR8-CA 28 Female Primary school graduate Single Care Assistant 6 Income < expenditure Open in a new tab CA, Care Assistant; RN, Registered Nurse; SW, Social Worker; TR, Türkiye (participant code); DE, Germany (participant code) Women formed the majority in both groups: 87.5% ( n = 7) in Türkiye; 75% ( n = 6) in Germany. Marital status showed an identical distribution across the two samples; in both countries, 62.5% ( n = 5) were married and 37.5% ( n = 3) were single, with no participants reporting divorce or widowhood (Table 1 ). Educational backgrounds revealed clearer contrasts. In Türkiye, primary-school and high-school graduates ( n = 3, n = 3, respectively) represented the largest groups (50%), while in Germany the largest share held secondary-school diplomas (50%, n = 4), followed by high-school graduates (37.5%, n = 3). Such differences in formal education may shape how staff approach care work and the extent of their opportunities for specialization (Table 1 ). Employment stability was notable in both contexts. Most respondents had been working at the same institution for three years or longer 75% ( n = 6) in Türkiye; 87.5% ( n = 7) in Germany. Professional roles were equally distributed across both countries (Table 1 ). The most visible gap concerned perceived income. In Türkiye, 87.5% ( n = 7) of the participants stated that their income was lower than their expenses, whereas in Germany 75% ( n = 6) of the participants described their income as roughly equal to their expenditure. This economic divide is likely to influence overall job satisfaction and motivation; themes explored further in the subsequent sections (Table 1 ). For confidentiality and citation purposes, each quotation in the findings is labeled with a code combining country and occupational identifiers for example, TR1-RN or DE1-SW representing Türkiye or Germany and the participant’s role (TR= Türkiye, DE= Germany, CA = care assistant, RN = nurse, SW = social worker). Three main themes were identified through a qualitative descriptive thematic analysis: working conditions, professional motivation and satisfaction, and care services and relationships with older adults. Together, these themes offer a structured basis for understanding both the convergences and divergences between the two national settings. Theme 1 – Working conditions This theme reflects how participants described their everyday work context—including shift systems, workloads, available equipment, and staffing levels. The findings reveal both structural differences between Türkiye and Germany and shared challenges across the two contexts. In Türkiye, many participants observed that official shift schedules often failed to match real practice because of persistent staff shortages: …We work 24/48 shift. But because of the staff shortage, sometimes we end up working 24/24. I have a small child at home. I go home tired. And there’s work to do at home too—cooking, laundry, dishes… I feel I can’t spend enough time with my child, and that makes me sad. Also, we have many older adults. I try to attend to each one individually. We can’t keep up with all the tasks… Our job description isn’t clear either. We try to handle everything… (TR1-CA). German employees, in contrast, described fixed timetables and clearly defined responsibilities: …Here our working hours are fixed, and our job descriptions are also clear. No one does another person’s work; everyone is responsible for their own duties. Yes, our job is very difficult, and the workload is high. We have many older adults, and there is a lot of paperwork. But I enjoy my work, so it doesn’t feel difficult to me. When I get home, the fatigue goes away, and if we get tired, we take a break… (DE1-CA). Both countries were generally viewed as adequately equipped, though participants evaluated the role of equipment differently. Some Turkish staff noted that proper physical-care techniques could lessen reliance on tools: …Once you learn the correct technique for lifting an older adult, you don’t really need much equipment… (TR5-CA). German workers, by comparison, highlighted the benefit of modern ergonomic aids that reduce physical effort and save time: …Our physical equipment, in other words our work materials, are quite adequate and balanced. Whether it is patient lifts or transfer boards, they all make our job easier… (DE2-CA). Almost all respondents in both scenarios concurred that hiring more staff would enhance service quality. In Germany, this expectation was associated with more individualized and superior care, while in Türkiye it was primarily focused on reducing physical strain. Overall, the stories demonstrate how adequate resources and organizational clarity affect both professional motivation and the quality of treatment, laying the foundation for subsequent themes. Theme 2 – Professional motivation and satisfaction This theme explores what drives or limits employees’ motivation. While moral satisfaction and empathy were central everywhere, the structural conditions supporting them diverged. In Türkiye, motivation largely stemmed from personal dedication and social responsibility, even in the absence of tangible rewards: …This job is a labor of love. It cannot be done otherwise. The financial aspect is not satisfying. Think of the elderly as your own children. Just as they need to be fed, given drinks, and have their nails trimmed, the same applies here. You feel happy when you see them happy. They need you… (TR6-CA). …I love my job. I love the elderly. People even ask me how I can love my job so much. But I just do. Someone who doesn’t love it couldn’t do this job. The work is very hard, and the pay is very low. But those kind words I hear from my elderly… They are worth everything. Sometimes there’s no need for words at all. I clean them, change their sheets, put on fresh clothes, and when I see them looking all neat and clean, that’s enough for me… (TR7-CA). In Germany, a more institutionalized environment supported staff motivation through predictable working conditions, education opportunities, and approachable management: …Here the working conditions are regular, our rights are protected, and our managers are very understanding. If we have a problem, we can immediately talk to them, and they find a solution. They are not too strict while we work and they support education. For example, there are people here who both study and work, and they are supported. I also really enjoy making the elderly happy—spending time with them, talking to them, and getting to know the cultures of those from different backgrounds. Seeing the elderly happy and being able to help them… I always say our job is really hard, but all these things make me more committed to it… (DE3-SW). …The direct communication I establish with people in my profession and the good, meaningful experiences I have increase my motivation, but my working conditions here are great, and this positively affects my professional performance… (DE2-CA). Thus, intrinsic commitment was bolstered by reliable systems in Germany but often substituted for those systems in Türkiye. In both contexts, emotional rewards outweighed material ones, though only in Germany did institutional structures help sustain motivation over time. Theme 3 – Care services and relationships with older adults The third theme focuses on communication and the formation of relationships with residents. In general, participants in Türkiye stated that they had no trouble communicating with older adults, that they had grown accustomed to them over time, and that they had become more adept at establishing relationships. It was observed, nevertheless, that certain illnesses, including schizophrenia and Alzheimer’s disease, as well as traits like stubbornness and irritability, could occasionally make communication more challenging. One participant provided the following summary of the circumstances: …We are actually used to it now; we no longer have difficulty. Even if we do, we accept them as they are and know how to approach them. They are like our mothers and fathers. In fact, we even call them ‘mother’ or ‘father’ when we address them here. We approach them with patience and love. Of course, sometimes those with agitation can be challenging. Communication can be very difficult with them or with those who have schizophrenia. It just takes patience… (TR3-RN). In a similar vein, participants in Germany reported that they had no trouble communicating with older adults and that they had become accustomed to their needs and personality traits as they gained experience. However, it has been observed that communication can occasionally be hampered by circumstances like medication refusal, stubbornness, diminished cognitive ability, and illnesses like Alzheimer’s and dementia. German staff described persuasion and structured dialogue as key tools in daily interaction: …We don’t force them here. Our elderly residents themselves have to be willing. That’s why we find ways to persuade them. We are used to it now. In fact, there are regular mandatory training sessions here, both related to our profession and on other topics. That’s when we also learn [for example, how to communicate with elderly people with Alzheimer’s or how to handle resistance] … (DE4-RN). Work with residents from migrant backgrounds added linguistic and cultural complexity, as explained by one German care assistant: …We also have older adults here from different countries. When talking to them and their relatives, we sometimes have to switch languages very quickly. That can be tiring at times. Also, we have to take their cultures into account and plan according to cultural differences. For example, we have a monthly activity schedule. When preparing these activities, we must consider all cultural differences and adjust the activity language for all our older adults. Of course, this is very challenging… (DE2-CA). When considered collectively, in both situations, minor but important cultural adjustments were found to be essential for establishing trust with senior citizens. In Germany, cultural competence was shown through pragmatic measures like language switching, dietary accommodations, and the culturally sensitive planning of activities for residents with migrant backgrounds. In Türkiye, these adjustments were typified using familial forms of address (e.g., “mother,” “father”) and heightened attention to religious practices. Regarding the alignment between the expectations of residents and their relatives and the working conditions, participants in both countries generally stated that expectations and existing conditions largely overlapped. Regarding areas for improvement, one participant from Türkiye stated: … Families are generally satisfied , but they naturally want one-on-one care. This is very normal , but we try to do our best with the staff we have. If we had more staff , we could provide even better service , but overall our relationships with patients’ relatives are very good … (TR7–CA). A participant from Germany stated: … We try to get to know each family individually. We try to find out what they want. Our communication with all of them is good. Families are generally satisfied. Of course , our work is a team effort. The better our internal coordination is , the more satisfied the families are … (DE5–RN). Overall, both groups emphasized the importance of empathy and respect, but their methods varied—while Türkiye focused on personal connections and moral perspectives, Germany leaned towards structured communication and formal expertise. Families in both environments seemed generally happy, although staff members often pointed out that having better staffing ratios would enable them to provide more personalized care. Discussion This study provides comparative qualitative insights into how the work lives of long-term care facility employees in Germany and Türkiye are influenced by cultural values and organisational structures. It examines how these cultural and structural factors are reflected in participants’ reported experiences of their daily professional practices. The research findings reveal that perceived low wages were a major concern in Türkiye, whereas participants in Germany generally reported moderate income levels, though staffing shortages were seen as a shared challenge across both contexts. Long-term care center employees in Germany are able to focus on care quality and professional development thanks to stable working conditions, guaranteed rights, and clear job descriptions. These findings are consistent with European evidence indicating that stable and well-planned long-term care structures improve working conditions, support job satisfaction, and enhance the capacity of care workers to provide high-quality services [ 17 , 18 ]. Addressing these issues may require structural adjustments in recruitment, training, and compensation policies. Overall, by relating personal motives and difficulties to larger institutional and cultural systems, this study adds to the expanding corpus of comparative qualitative research on long-term care. The findings highlight the significance of cultural competence training, equitable compensation, and supportive work environments as key elements of long-term senior care policies. Synthesis of comparative findings This synthesizes the comparative results of three main themes: (1) working conditions, (2) professional motivation and satisfaction, (3) care services and relationships with older people. The purpose is to examine the cultural and institutional contexts associated with these themes, highlighting common experiences and key differences between the German and Turkish settings. The analysis suggests that similarities and divergences may be associated with broader cultural, organizational, and systemic factors rather than being limited to surface-level differences. From a cultural competence perspective, participants in Türkiye frequently described their motivation in relation to spiritual and socially based obligations, namely care services as a familial or social duty. In Germany, motivation was more frequently described in connection with institutional structures, including structured vocational training, diversity programs, and language resources that support professional caregiving roles. In this sense, the cultural environment appears to influence how motivation is sustained (through personal moral responsibility or institutional recognition) and may also shape how care relationships are conducted. Turkish participants frequently described closeness and affection using family-related terms, whereas German participants tended to emphasise professional boundaries and structured individualisation. Despite these conceptual differences, participants in both contexts highlighted the importance of person-centered care. To show these cross-national patterns more clearly, Table 2 summarizes selected examples from both Germany and Türkiye that reflect experiences within each theme. These expressions not only give examples of empirical findings but also provide a direct window into the daily practice of long-term care staff working within different welfare and cultural systems. Table 2. Illustrative quotations from Germany and Türkiye by theme Theme Germany (Sample Quotation) Türkiye (Sample Quotation) Working Conditions “…Here our working hours are fixed, and our job descriptions are also clear. No one does another person’s work; everyone is responsible for their own duties…” (DE1-CA). “…We work 24/48 shift. But because of the staff shortage, sometimes we end up working 24/24…” (TR1-CA). Professional Motivation & Satisfaction “…Here the working conditions are regular, our rights are protected, and our managers are very understanding. If we have a problem, we can immediately talk to them, and they find a solution. They are not too strict while we work, and they support education…” (DE3-SW). “This job is a labor of love. It cannot be done otherwise. The financial aspect is not satisfying. Think of the elderly as your own children… You feel happy when you see them happy. They need you…” (TR6-CA). Care Services and Relationships with Older Adults “…We don’t force them here. Our elderly residents themselves have to be willing. That’s why we find ways to persuade them…” (DE4-RN). “…They are like our mothers and fathers. In fact, we even call them ‘mother’ or ‘father’ when we address them here…” (TR3-RN). Open in a new tab CA, Care Assistant; RN, Registered Nurse; SW, Social Worker; TR, Türkiye (participant code); DE, Germany (participant code) The sociodemographic profile of participants provides a valuable backdrop for interpreting the qualitative results. Both country examples were designed with the conscious aim of providing balanced representation among the main occupational groups, such as nurses, social workers and care assistants. Even in this composition, there were clear differences in age and education. Participants from Türkiye were mostly aged 21–35, but the German group had a more balanced age distribution. Multiple professional roles gave a diverse structure rather than a uniform educational framework. Participants in Türkiye were younger and had less formal education than German participants, which may partly account for their frequent emphasis on personal commitment and their characterization of care as a “labor of love”. They also described uncertainties such as unclear task boundaries and insufficient staffing. Workers generally fill these institutional gaps with team support, flexibility, and moral satisfaction; this is a model that has been described in previous research on emerging welfare contexts [ 19 ]. The German sample, by contrast, expressed stronger confidence in institutional processes and greater expectations for professional advancement. Together, these contrasts illustrate how individual characteristics intersect with systemic factors to shape motivation and care practices. A further striking feature was the predominance of women, underscoring the ongoing social construction of caregiving as “women’s work.” National findings from Türkiye [ 20 ] similarly show that nursing continues to be gender-typed, influencing both occupational selection and the perceived value of care professions. In Germany, studies report that women still perform a disproportionate share of unpaid domestic and care labor due to persistent gender divisions [ 21 – 23 ]. Seedat et al. [ 24 ] likewise emphasize that such gendered expectations impose additional psychological and structural burdens on women. Taken together, these patterns suggest that care labor continues to be socially and economically feminized within the contexts examined. This demographic structure is broadly consistent with the employment landscape of both countries and provides context for the subsequent discussion of working conditions, where institutional similarities and differences are further explored. Although gender was recorded as part of the sociodemographic information and the majority of participants were women, the interview guide did not specifically explore gender roles or gendered experiences in caregiving. Further research is needed to examine the gendered dimensions of care work more systematically. Theme 1 – Working conditions (Germany – Türkiye comparison) This theme examines how long-term care staff in both countries experience their daily work environment, considering schedules, workload, physical resources, and organizational support. German participants reported generally adequate staffing and equipment but also described stressors such as high resident numbers, staffing gaps, and increasing administrative tasks (e.g., electronic records and quality checks). Similar concerns have been noted in previous qualitative research, suggesting that growing bureaucratic demands and excessive workloads can undermine nurses’ well-being [ 25 ]. In Türkiye, limited personnel and fast-paced routines prevailed. Nevertheless, solidarity within teams served as a coping mechanism. Participants described sharing duties, offering emotional help, and adjusting shifts to support each other behaviors likewise noted in previous research [ 26 , 27 ]. The results suggest that in Türkiye, social bonds and team solidarity serve as a critical buffer in sustaining the working conditions of care personnel. Thus, interpersonal cohesion appears to buffer the impact of scarce resources. As shown in Table 2 , German respondents emphasized fixed hours and explicit responsibilities, reflecting an institutionalized system. Turkish staff pointed to long shifts and insufficient manpower, highlighting systemic constraints. Theme 2 – Professional motivation and satisfaction (Germany – Türkiye comparison) In both countries, the moral satisfactions are described as a central motivator. The thankfulness expressed by residents was seen as a universal reward and was not specific for either country. Other motivational factors differ between Türkiye and Germany. In Türkiye, internal values such as empathy, dedication, and moral responsibility increase motivation and professional commitment, while lower wages, restricted promotion possibilities, and heavy workloads decrease employee motivation. Yalçın [ 28 ] pointed out that Turkish caregivers derive meaning from humane and cultural norms. Organisational factors were described as secondary. By contrast German workers point to structural factors such as administrative support, continuous training, and employment stability. The existence of residents with immigrant backgrounds created challenges for caregivers involving language and culture, but there were differing expectations in this area and caregivers in the two countries had different adaptation skills. Caregivers in Türkiye faced less difficulty with language diversity. But building good relationships depended in both countries on caregivers’ familiarity with different cultures. Roth et al. [ 29 ] found that in Germany, motivation is strongly associated with systemic stability recognition, advancement, and fair conditions while Eurofound [ 6 ] noted that even there, pay remains a source of concern. Turkish participants repeatedly mentioned that their income did not meet living costs; German participants considered their pay more balanced yet still disproportionate to the emotional and physical demands of caregiving. Theme 3 – Care services and relationships with older adults (Germany – Türkiye comparison) In both settings, staff described communication with residents as trusting and positive, though shaped by distinct cultural conventions. In Türkiye, as presented in Table 2 , while communicating with the older adults, familial linguistic such as “mother” and “father” are generally used. Some disorders, such as Alzheimer’s and schizophrenia can make communication challenging, but with gentle language and a persuasive attitude, these difficulties can be overcome. Even personnel shortages, emotional labor and personal attachment are critical for sustaining empathy. These observations are consistent with a previous study relating emotional engagement to quality of care [ 30 ]. German participants reported comparable ease in communication, explaining that experience helped them adjust to varied cognitive levels. Difficulties most often arose from dementia, resistance to medication, or cross-cultural misunderstandings when caring for migrants. Staff used persuasion and structured communication to navigate these challenges, approaches reflected in German literature on person-centered dementia care [ 31 ] and multidisciplinary teamwork [ 32 ]. The comparison also indicates that both systems hold practices that could benefit the other: the relational warmth and strong sense of solidarity seen in Turkey may help strengthen team cohesion in German care environments, while the structured organizational model used in Germany may guide efforts to improve role clarity and working conditions in Turkey. Limitations When interpreting the results of this study, several limitations should be considered. Firstly, because the subjects included institutional issues and personal experiences that participants considered delicate, most participants declined audio recording. As a result, most of the data were gathered using detailed, near-verbatim field notes. The researcher expanded the notes immediately after each interview and incorporated key expressions in the participants’ own words. Nevertheless, the absence of audio recordings may have limited the capture of subtle non-verbal cues, such as tone, hesitation, or emotional nuance. Therefore, the analysis is best interpreted as descriptive and may not capture fine-grained linguistic features of participants’ accounts. The scope of this study was limited to the perspectives of frontline care staff. Conducting systematic field observations or including interviews with relatives and facility managers could have provided additional insights into organizational routines, informal practices, and possible differences between institutional expectations and everyday care delivery. These perspectives were not included, which limits the breadth of contextual interpretation. Secondly, sporadic translation assistance was required during the fieldwork in Germany. Although efforts were made to clarify meanings during interviews, the involvement of bilingual staff may have introduced minor interpretive shifts that cannot be entirely excluded. Thirdly, given the reliance on self-reported data, participants’ descriptions of their work may include elements of subjective interpretation or idealization. Lastly, the findings are not intended for statistical generalization. Rather, the findings offer contextually grounded insights that may inform further discussion and research in long-term care and cross-cultural contexts. Conclusions Findings of this study suggest that empathy, patience, and mutual respect are fundamental to meaningful relationships with older adults in Türkiye and Germany, and these interpersonal qualities remain central to sustaining care quality and worker well-being. However, motivational sources differ: Turkish participants emphasized social relationships, responsibility, and personal sacrifice, while German caregivers highlighted formal working conditions, professional development, and institutional stability. Organizational factors appear to influence care delivery. Turkish participants reported high workload and unclear role expectations, whereas German staff benefited from defined responsibilities and continuous training. These contrasts suggest that predictable working conditions strengthen professional motivation, while strong social bonds foster emotional commitment. Cultural competency emerged as critical, particularly in Germany, where linguistic ability and cultural awareness are essential for serving diverse resident populations with migrant backgrounds. Women constituted the majority of participants in both countries; future research should examine how gender norms shape caregiving roles and working environments. This study suggests that caregiving encompasses both interpersonal and structural dimensions. These findings may inform discussions on policy development, role clarification, and workforce support in long-term care. Rather than offering prescriptive solutions, the study highlights areas where institutional structures, professional development opportunities, and supportive work environments may contribute to sustaining caregiver motivation and care quality. The comparison further suggests that both systems reflect distinct strengths within their respective contexts. While relational closeness and interpersonal solidarity were frequently described by participants in Türkiye, structured organisational practices were more prominently emphasised in Germany. These differences may provide points for reflection in future cross-national discussions on long-term care practices. Recommendations Organizations may consider integrating institutional job definitions and national care plans into daily operations, create employment incentives and supportive work environments to address workforce shortages, and reassess remuneration structures to reflect the social, emotional, and physical demands of care work. Care facilities could expand opportunities for continuous professional development focusing on communication, cultural competency, and dementia care. Clear team responsibilities may help enhance established, and training programs may benefit from incorporating cultural sensitivity, multilingual communication, and evidence-based techniques for supporting residents with cognitive decline. Training programs in social work, nursing, gerontology, and elder care should prioritize communication skills, ethical behavior, and cultural competency. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (15.7KB, docx) Acknowledgements This article is derived from the doctoral thesis titled “Work and Life Experiences of Elderly Care Center Workers: A Cross-Cultural Qualitative Study in Germany and Türkiye” written as part of the Geriatric Health Doctoral Program at the Department of Internal Medicine, Faculty of Medicine, Ege University. We would like to thank the staff of the Long-Term Care Facilities we interviewed during our study for their contributions. Abbreviations TR Türkiye (participant code) DE Germany (participant code) CA Care Assistant RN Registered Nurse SW Social Worker RQ Research Question Author contributions SSA and AK conceived the study. SSA contributed to data collection and program execution. SSA performed the data analyses. SSA and AK drafted the manuscript. All authors (SSA, AK) contributed to data interpretation, critically reviewed manuscript drafts, and approved the final version of the manuscript. Funding None. Data availability The data collected and analyzed in this study are not publicly available because participants did not consent to public data sharing. Aggregated data are available from the corresponding author upon reasonable request. Declarations Ethics approval and consent to participate Ethical approval was granted by the Ethics Committee of Ege University Medical Research (Approval No. 25-5T/95, dated 08 May 2025). Permission was also obtained from the participating institutions, whose names remain confidential. Written informed consent has been obtained from all participants in accordance with the principles of the Helsinki Declaration. In cases where recording was not permitted, comprehensive written notes were taken. All data were anonymized and stored securely. Throughout the research process, the principles of voluntary participation, respect for autonomy, and protection of participants’ rights were strictly observed. Consent for publication Not applicable. 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