Assistive personnel are the primary caregivers in long term residential care (LTRC) and their job autonomy is a major social determinant of health. Our goal is to explore experiences of assistive personnel in six industrialized countries (Canada, Germany, Norway, Sweden, England, and the U.S.), and consider innovations in the LTRC setting that might influence their job autonomy. The methodology is based on on-site observations at nursing homes and interviews with assistive personnel and other relevant LTRC staff in selected nursing homes in all six countries. Previously published statistical material from the study on staff characteristics like pay, formal education, unionization, employment-related benefits and extent of part-time work is employed as relevant context for discussing job autonomy. Our results show that assistive personnel are highly supportive of job autonomy though they interpret autonomy differently and report widely varying levels of job autonomy. Those LTRC organizations that have a reputation for encouraging autonomy of assistive personal, report recruiting is far easier even where there is a shortage. In some countries we were told that “resident-centered” (“person-centered”) care and a leveling of the division of labor, understood as more equal and horizontal division of labor, was on the rise and this could affect autonomy. Job autonomy is welcomed by assistive personnel. The wide variation in job autonomy across nursing homes and across countries is surprising. Within nursing homes variation may reflect imperfect or incomplete implementation of autonomy policies, or differential application of policies. The resident-centered philosophy and the leveling of the division of labor could make for greater autonomy for assistive personnel. These workplace innovations are not universal in all countries and they could be more difficult to apply where resources and commitment are lacking. The increasingly frail population of LTRC facilities and the general trend toward growth of specialized medical treatment within LTRC in some of the countries may support an argument for some limitations to job autonomy in assistive personnel. Autonomy is favored by assistive personnel though not all have it. The workplace innovations of resident-centered care and a leveling of the division of labor in LTRC, could make for a greater degree of autonomy for assistive personnel in the future, while increased demand for highly skilled care could work in the other direction.