Long-Term Care Facility Workers' Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care: A Qualitative Study in British Columbia, Canada.

Albert Banerjee,Sage Ponder,Andrew Longhurst,Margaret Mcgregor

doi:10.1017/s071498082100012x

Abstract

Subcontracting long-term care (LTC), whereby facilities contracted with third party agencies to provide care to residents, became widespread in British Columbia after 2002. This qualitative study aimed to understand the impact of subcontracting from the perspective of care workers. We interviewed 11 care workers employed in subcontracted facilities to explore their perceptions of caring and working under these conditions. Our overarching finding was one of loss. Care workers lost wages, benefits, security, and voice. Their working conditions worsened, with workload and turnover increasing, resulting in a loss of experienced staff and a loss of time to provide care. These findings call into question the promises of quality and flexibility that legitimated policies permitting subcontracting, while adding to the mounting evidence that subcontracting LTC harms both workers and residents.

Highlights

This article examines the effects that the subcontracting of care has on the conditions for work and care in long-term care facilities (LTCFs) for older persons
We present a brief overview of privatization in the province of British Columbia, before turning to an examination of workers’ experiences, drawing on interviews with 11 care workers from LTCFs who were subcontracted, some multiple times
In what follows we describe the consequences of subcontracting from the perspective of care workers

Summary

Introduction

This article examines the effects that the subcontracting of care has on the conditions for work and care in long-term care facilities (LTCFs) for older persons. Cost has been of concern, in the context of an aging population wherein the need for long-term care (LTC) is expected to increase. These concerns have come at a time of governmental fiscal restraint and greater reliance on market mechanisms to deliver seniors’ care (Armstrong & Armstrong, 2020b). Facility management were able to end these subcontracts with short notice, allowing management to bust unions and reduce labour costs, a process termed “contract flipping” (Longhurst, Ponder, & McGregor, 2020). The governments’ policy decisions to allow subcontracting were legitimated by claims that such arrangements would ensure financial sustainability, while supporting greater flexibility, responsiveness and quality (British Columbia Ministry of Skills Development, 2003)

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