Abstract
Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.
Highlights
Sweden will need to increase the workforce in eldercare by 170 000 by 2035.3 In the U.S, the need of home health aides is estimated to grow by 36% between 2018 and 2028.4 Given this need to expand the workforce in a relatively short time, it is problematic that home care work is associated with an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as perceived stress and high workload.[5,6,7,8,9,10,11,12,13,14]
It is not possible to verify that the staff at the home care units experienced that the changes reported by the first and second line managers did improve the work environment
The results demonstrate that many diverse local initiatives are initiated and carried out with the intention to improve the work environment in the Swedish home care sector
Summary
The need for home care is estimated to increase in many countries as more people are reaching older ages and experience age-related physical and/or cognitive decline that challenges their ability to function without assistance.[1,2] As a consequence, the number of people providing home care services, needs to increase in order to meet the demands of the growing population.[3,4] For example, Sweden will need to increase the workforce in eldercare by 170 000 by 2035.3 In the U.S, the need of home health aides is estimated to grow by 36% between 2018 and 2028.4 Given this need to expand the workforce in a relatively short time, it is problematic that home care work is associated with an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as perceived stress and high workload.[5,6,7,8,9,10,11,12,13,14] In addition, the research suggests that many work environment problems are related to the low status of the home care sector, which, in turn, can be linked to issues of class, gender and ethnicity.[15,16] Care work is mainly carried out by women and is often considered to be low skilled.[17,18,19] The lack of value attributed to home care work can be understood in relation to an overall inequality regime in society.[20] Irrespective of country, work in the home care sector is dominated by women and entails working alone and having low wages.[3,8,21]
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