Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death.

Emma K Tsui,Sherry Baron,Marita Lamonica,Paul Landsbergis,Maryam Hyder,Jennifer Zelnick

doi:10.3390/ijerph19010367

Abstract

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides’ use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides’ extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides’ efforts to cultivate support stemming from their home-based work environments. Home care aides’ work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.

Highlights

Non-standard work—including temporary, agency-based, contract, and gig work—is increasing [1], with urgent implications for how we conceptualize worker support
In the sections that follow, we describe in detail the sources of support that aides used to navigate client death
Focusing on a single work-based stressor that has both emotional and financial dimensions, we have shown that home care aides draw heavily on their own internal resources and personal social networks in order to address work stress

Summary

Introduction

Non-standard work—including temporary, agency-based, contract, and gig work—is increasing [1], with urgent implications for how we conceptualize worker support. Home care aides, including personal care aides, home health aides, and home-based nursing assistants, comprise one of the fastest growing job sectors in the United States due to the increasing older adult population and ongoing deinstitutionalization of care [2]. They provide services that help older adults and disabled individuals to remain in their homes. They support clients’ activities of daily living, such as eating, toileting, bathing, and moving around, and engage in meaningful and complex relational work with clients and their families [3,4].

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Results

Discussion

Conclusion