Aged Care Workers Research Articles

Qualitative exploration of intentions, concerns and information needs of vaccine‐hesitant adults initially prioritised to receive COVID‐19 vaccines in Australia

ObjectiveTailored communication is necessary to address COVID‐19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID‐19 vaccination of people prioritised, but hesitant to receive the vaccine. MethodIn this qualitative study in Victoria, Australia (February‐May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18‐69 with comorbidities or aged ≥70 years (‘prioritised adults’; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. ResultsPrioritised adults and health and aged care workers had short‐ and long‐term safety concerns specific to personal circumstances, and felt like “guinea pigs”. They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implicationsEleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID‐19 vaccines.

Everyday racism and the denial of migrant African women’s good caring in aged care work

AbstractThere is, in the global north, a “care crisis,” a shortfall in the capacity to provide care for an aging population. Migrant care workers have been positioned as a solution to this crisis, but this positioning sits in tension with research highlighting the widespread racism that questions or denies the skills and commitment of migrant care workers. This study draws on the experiences of 30 migrant African women working in the Australian aged care sector to interrogate the implications of this tension. The authors describe how everyday racism perpetrated by clients and colleagues denied the possibility that migrant African women carers were able or welcome to undertake “good caring.” Applying Tronto's conceptualization of caring as relational, the authors argue that everyday racism symbolically denies African migrant women's participation in key phases of the caring process: “caring about,” “caregiving,” and “care‐receiving.” Everyday racism thus rejects migrant African women's care work at the individual level and reinforces care as a set of practices and dispositions that are unavailable to them.

COVID “death pits”: US nursing homes, racial capitalism, and the urgency of antiracist eldercare

Rampant COVID-19 outbreaks in US nursing homes have presented a massive biosecurity problem for the nation, bringing into stark relief the racialized stratification of eldercare administration and long-term care. This paper, by foregrounding the ways racial capitalism drives the chronic devaluation of nursing home residents and staff, provides an overview of how racism and ageism operate geographically through political ecologies of COVID in relation to the organization of the nursing home industry, medical scarcity, long-term care labor, and pandemic response to elderly populations. The inventory tracks some of the ways nursing homes condition race-based futures by arranging eldercare populations, workers, and spaces for extraction, abandonment, and blame for the pandemic. In doing so, it demonstrates the need for more equitable forms of aging and more just institutions of eldercare that put the social welfare of the aged, especially that of BIPOC elders and caregivers, above corporate compliance and financial performance that reproduce racial hierarchy and white supremacy in US healthcare. The article concludes by engaging with Black feminist data analytics and several policy efforts that challenge the structurally racist conditions of caregiving, pandemic response, and securitized segregation of the aged.

Disposable kin: Shifting registers of belonging in global care economies

AbstractAs is well discussed in the literature, paid domestic workers become like kin through living with and caring for their employers. Exploring two disparate cases, aging Asian domestic workers in Singapore and African eldercare workers in the United States, the article focuses on two critical junctures when these kin relations are disavowed: the care worker's retirement and the death of a patient. We argue that the flexible registers of kinship that characterize care workers’ relationships with their employers revert, at the end of employment, to fixed notions of kinship based on blood and marriage. These essentialist understandings of kinship arise around inheritance and the worker's care in older age and in illness, enabling employers, states, and private care agencies to avoid post‐employment obligations to domestic workers. The fluctuation between kinship‐as‐doing and kinship‐as‐essence marginalizes domestic workers in a globalized economy as disposable kin, denying their belonging as citizens or social equals.

The Social Construction of Stigma in Aged-Care Work: Implications for Health Professionals' Work Intentions.

Background and ObjectivesAlthough society has cultivated a deeper appreciation for essential health services, societal discourses reinforce a stigma of working in aged care. Drawing on dirty work and Stigma Theory, this study aims to investigate stigma in the context of recruiting health professionals.Research Design and MethodsWe employed a mixed-methods design to examine the nature and implications of the stigma of working in aged care. A path analysis was used to test whether health professionals’ (n = 159) negative perceptions of aged-care work would negatively predict their willingness to work in aged care. A linguistic analysis was conducted to understand how health professionals’ (n = 168) use of language positions themselves toward or away from engaging in aged-care work.ResultsQuantitative findings revealed that perceptions of physical taint directly predicted lower willingness to perform aged-care work. Perceptions of social taint, moral taint, and poor occupational conditions negatively predicted willingness to work in institutional aged care, indirectly via social devaluation. Findings from the linguistic analysis demonstrated that health professionals (re)produce stigma through aligning themselves with devaluing discourses about aged-care workers, work, and institutions.Discussion and ImplicationsThis study provides insight about the role that stigma plays in the aged-care recruitment crisis, with implications for aged-care institutions. Societal discourse may obstruct the employment of health professionals in aged care because it can (re)produce the stigma of working in aged care. Recommendations for ways to reduce the impact of this stigma include public messaging and training.

A Team-level Participatory Approach Aimed at Improving Sustainable Employability of Long-term Elderly Care Workers: Preliminary Results of a Randomised Controlled Trial

A Team-level Participatory Approach Aimed at Improving Sustainable Employability of Long-term Elderly Care Workers: Preliminary Results of a Randomised Controlled Trial

Job Preferences of Aged Care Workers in Australia: Results from a Discrete Choice Experiment

Job Preferences of Aged Care Workers in Australia: Results from a Discrete Choice Experiment

Factors Influencing Australian Healthcare Workers' COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey.

Healthcare workers’ COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February–26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.

Experiences of faculty and staff nurses working with nursing students during clinical placement in residential aged care facilities: a systematic review of qualitative evidence.

The objective of this review was to synthesize evidence on the experiences of faculty and staff nurses working with nursing students in clinical placement in residential aged care facilities. Nursing education helps prepare students to provide quality care to older adults. Nursing programs across the globe are championing the integration of content on the care of older adults into their curricula as well as recognizing the value of clinical placements that focus exclusively on this population. Staff nurses who work in residential aged care facilities often work alongside students. In this role, they can support faculty and mentor students. This review explored faculty and staff experiences of nursing student placements in such facilities. This review considered qualitative studies that address the experiences of faculty and staff nurses working with nursing students in residential aged care facilities. Studies published in English from 1995 onward were included. The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included Proquest Dissertations and Theses and Google searches of the Canadian Nurses Association and American Nurses Association websites. Papers were screened by two reviewers independently against the inclusion criteria. Those meeting the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings from included studies were extracted using a standardized tool and classified as unequivocal, credible, or not supported. This review followed the principles of meta-aggregration in line with the JBI approach. Six studies, published between 2001 and 2017, were included in the review. A total of 32 findings were extracted and aggregated into nine categories. From the nine categories, four synthesized findings were developed: i) students enhance the environment, whereby faculty and staff perceive that student presence enhances the residential aged care work and living environment, ii) effort is required by faculty and staff to make the experience work, reflecting a need for faculty and staff to accept and work with negativities, iii) residential aged care facilities provide rich learning experiences, indicating an appreciation for available learning opportunities, and iv) importance of a residential aged care-academic partnership for a collaborative approach in creating positive experiences for faculty and staff working with students in this setting. Faculty and staff experiences highlight that residential aged care has the potential to provide students with valuable learning experiences, including how to provide comprehensive and quality nursing care to older adults. A lack of resources in residential aged care inspires faculty and staff to be creative in how they work with students. However, working with students can be challenging for faculty who lack interest and expertise in caring for older adults in this setting. Additionally, staff can become frustrated when they perceive that students do not value the learning opportunities that are available or do not appreciate the expertise required to work with older adults. Partnerships between residential aged care facilities and academic programs can ensure that faculty and staff have the support and resources required to optimize the clinical placements for students. PROSPERO CRD42020168698.

Approaching retirement: A qualitative study of older nursing assistants' experiences of work in residential care and late-career planning

In many countries, eldercare workers are approaching retirement. To remain attractive to older and experienced workers, organizations need to understand how employees nearing retirement think about and experience their work situation. This qualitative study investigated how older nursing assistants within residential care for older people experienced aging at work, their psychosocial work environment, and their late-career planning. Semi-structured interviews with eight nursing assistants (aged 55–61 years) in Sweden were analyzed using an Interpretative Phenomenological Analysis approach. The results show that the psychosocial work environment was perceived as stressful and considered a long-term health risk, and that (future) health and work ability were key factors determining nursing assistants' late-career planning. Moreover, personal resources and social support from colleagues seemed protective against job demands. Aspects considered in late-career planning also included personal finances and meaningfulness of work. While these findings may be sample-specific, they still provide insights into the experiences of an important occupational group. This means that the findings can be useful for organizations aiming at promoting successful and sustainable aging-in-workplace and encouraging extended working lives.

COVID-19 outbreaks in aged-care facilities in Australia.

BackgroundAged‐care facilities (ACF’s) provide unique challenges when implementing infection control methods for respiratory outbreaks such as COVID‐19. Research on this highly vulnerable setting is lacking and there was no national reporting data of COVID‐19 cases in ACFs in Australia early in the pandemic. We aimed to estimate the burden of aged‐care worker (ACW) infections and outbreaks of COVID‐19 in Australian aged‐care.MethodsA line list of publicly available aged‐care related COVID‐19 reported cases from January 25 to June 10, 2020 was created and was enhanced by matching data extracted from media reports of aged‐care related COVID‐19 relevant outbreaks and reports. Rate ratios (RR) were used to predict risk of infection in ACW and aged‐care residents, and were calculated independently, by comparing overall cases to ACW and aged‐care residents' cases.ResultsA total of 14 ACFs with COVID‐19 cases were recorded by June 2020 nationwide, with a high case fatality rate (CFR) of 50% (n = 34) and 100% (n = 3) seen in two ACFs. Analysis on the resident risk found that the COVID‐19 risk is 1.27 times higher (unadjusted RR 1.27 95% confidence interval [CI] 1.00 to1.61; P = 0.047) as compared with the risk of infection in the general population. In over 60% of cases identified in ACFs, the source of infection in the index case was unknown. A total of 28 deaths associated within ACFs were reported, accounting for 54.9% of total deaths in New South Wales and 26.9% of total deaths in Australia.ConclusionsThis high‐risk population requires additional prevention and control measures, such as routine testing of all staff and patients regardless of symptoms. Prompt isolation and quarantine as soon as a case is confirmed within a facility is essential.

Positive Turn in Elder-Care Workers’ Views Toward Telecare Robots

Robots have been slowly but steadily introduced to welfare sectors. Our previous observations based on a large-scale survey study on Finnish elder-care workers in 2016 showed that while robots were perceived to be useful in certain telecare tasks, using robots may also prove to be incompatible with the care workers’ personal values. The current study presents the second wave of the survey data from 2020, with the same respondents (N = 190), and shows how these views have changed for the positive, including higher expectations of telecare robotization and decreased concerns over care robots’ compatibility with personal values. In a longitudinal analysis (Phase 1), the positive change in views toward telecare robots was found to be influenced by the care robots’ higher value compatibility. In an additional cross-sectional analysis (Phase 2), focusing on the factors underlying personal values, care robots’ value compatibility was associated with social norms toward care robots, the threat of technological unemployment, and COVID-19 stress. The significance of social norms in robot acceptance came down to more universal ethical standards of care work rather than shared norms in the workplace. COVID-19 stress did not explain the temporal changes in views about robot use in care but had a role in assessments of the compatibility between personal values and care robot use. In conclusion, for care workers to see potential in care robots, the new technology must support ethical standards of care work, such as respectfulness, compassion, and trustworthiness of the nurse–patient interaction. In robotizing care work, personal values are significant predictors of the task values.

The dementia policies in Australia relating to the COVID‐19 pandemic

BackgroundAustralia has a population of 26 million, and on January 28th 2021, 28,794 COVID‐19 infections and 909 deaths. 685 deaths were at residential aged care facilities, and data from the Australian Bureau of Statistics revealed that 72.7% of the people who died of the coronavirus in Australia (up to 31 August 2020) had at least one pre‐existing chronic condition listed on their death certificate, with dementia the most common (noted on 41% of death certificates). This presentation will present and discuss the key Australian dementia policy interventions implemented during the pandemic.MethodA scoping review of published academic, media, policy papers, white papers, and grey literature was conducted. We extracted relevant information pertaining to policies relating to dementia care during the COVID‐19 pandemic.ResultThe Australian government is managing the COVID‐19 outbreak as a health emergency, and have developed and funded a comprehensive response. For the older population and those with ADRD, the key policies include the National Health Plans, specific plans for people with disabilities, telehealth expansions, mental health and wellbeing pandemic response plans, home delivery of prescriptions, the establishment of an Aged Care Health Emergency Response Operations Centre, and a National COVID‐19 Aged Care Plan. In Victoria, the Victorian Aged Care Response Centre was established. The Pfizer/BioNTech vaccine will be given to priority groups from February 2021, which include aged care and disability care residents and workers (people with dementia account for 52% of all residents in aged care facilities). Strict policies were put in place for aged care facility visitations, and for the aged care workforce, such as the use of personal protective equipment and limiting staff to work in only one facility. Advocacy bodies were also key, and Dementia Australia and Dementia Support Australia, for example, developed advice to support people experiencing behavioural and psychological symptoms of dementia during the pandemic.ConclusionThere are currently no active cases in residential aged care in Australia, zero locally acquired cases for several weeks, with the (minimal) new cases emerging from the hotel quarantine system. Health policies have managed to limit the spread of COVID‐19 infection in Australia.

Older assistant workers in intermediate care facilities, and their influence on the physical and mental burden of elderly care staff

BackgroundAs there is a shortage of care staff in elderly care homes, seniors are expected to work as assistants to help the care staff. This study examined the influence of older assistant workers in intermediate elderly care facilities on care staff, specifically focusing on emotional exhaustion which is a sign of burnout. These facilities provide long-term nursing and supportive care to older residents.MethodsData from a mail survey of intermediate elderly care facilities with older assistant workers were analyzed. Care staff were asked about the advantages and disadvantages of introducing older assistant workers in elderly care work, and their degree of emotional exhaustion. We also assessed work self-evaluations of older assistant workers, including the benefits of the work, and physical and mental burdens.ResultsA significantly large number of care staff reported improvements in workload with the employment of older assistant workers. Intermediate elderly care facilities enrolling more older assistant workers showed lower mean emotional exhaustion among care staff, independent of possible covariates. While older assistant workers felt that their work contributed to helping both care users and staff, they also reported a mental burden.ConclusionsOur results suggest that older assistant workers can play a significant role in reducing the physical and mental burden of intermediate elderly care facility staff. Thus, employing older assistant workers can be an effective approach to addressing shortages of care staff in elderly care homes.

HEALTHCARE SCHOOL STUDENTS’ WILLINGNESS TO WORK WITH THE ELDERLY: INFLUENCE OF AGEISM

The purpose of this study is to examine the influence of ageism attitude and the associated factors such as demographics of healthcare school students on willingness to work with elderly after graduation. A cross sectional descriptive study was conducted with a total of 704 vocational healthcare school students. An online questionnaire consisting of socio-economic variables, Ageism Attitude Scale and questions related to willingness to work and live with elderly after graduation was completed by 80% of the entire study population. Data were analyzed by Normality test, Cronbach test, t-test, ANOVA and Scheffe test and Chi-square test. According to the results, willingness to work in elderly care was significantly higher in student groups having higher positive AAS scores. Elderly care willingness and AAS scores of the students showed no significant differences with regard to demographics. Only students whose mothers’ educational level was higher had more positive AAS scores. AAS scores were high in all groups but willingness to work in elderly care was low. The students who have visited a nursing home showed significantly higher willingness to care for the elderly. Participants who had lived with an elderly before were less likely to live with an older adult in the future. The students showed the lowest AAS scores with regard to hiring of the elderly and 55% of them consider people at the age of 55 and over as being old. There is a positive relationship between the low ratio of ageism among young people and the tendency to work in the field of elderly care in the future. In order to encourage young people to work in this field, their concerns should be addressed and their prejudice should be eliminated. Both as part of a state policy and in terms of employment volume, students of universities’ vocational healthcare schools should be encouraged to pursue a career in elderly care after their graduation.

Women’s Equality and the COVID-19 Caregiving Crisis

The COVID-19 pandemic revealed, but did not create, the caregiving crisis in the United States: for most people, it was already a major ordeal to provide reproductive labor. The caregiving crisis was less visible before the pandemic because it was suffered unequally, in part due to the different positions of American women. Some women paid other women to do care work, women received differing sets of benefits from federal and state governments, and some women got far more support from their employers than did others. Pandemic-induced shocks, including the closure of K–12 schools and childcare centers, and reduced access to domestic workers and elder care workers, seemed to have triggered a closer alignment of perspectives and interests among diverse women. Although women’s demands for support seem to have pushed the Biden administration to propose more expansive family policies, stereotypes and norms that marginalize care work and care workers within families and across the economy also need to change to achieve equality for women.

Compassion and person-centred care: Survey development for aged care workers.

With a growing emphasis on personalised care, there is a need for effective workforce training to enable person-centred care (PCC) in aged care practice. The Australian aged care workforce is very diverse; thus, tools to evaluate compassion and PCC training need to reflect an understanding of these concepts relevant to the Australian context. There are currently no tools validated for use in aged care settings in Australia. Two existing compassion and PCC questionnaires were modified for an Australian audience using cognitive interviews with aged care workers. The reliability of the modified questionnaires was assessed. The modified questionnaires were found to have acceptable inter-reliability and test-retest intra-class correlation for the subscales and overall. However, the investigation also found low Cohen's kappa values between the test and retest responses for the individual items, subscales and overall, and had low inter-class correlation for individual items, indicating poor inter-rater agreement. High inter-item correlation scores also suggest the questions encapsulate overly similar constructs. While further investigation of the psychometric properties of the new items is needed, these modified questionnaires may offer a method of assessing and re-assessing compassion and PCC using language that is understandable to the Australian aged care workforce. Tools to accurately measure Australian aged care staff perceptions of compassion and their ability to deliver PCC are important to improve the quality of care provided in aged care and facilitate the delivery of PCC in aged care settings.

Group‐based instant messaging in Finnish residential elder care work: Taming the technology or vice versa?

AbstractAs new communication technologies become embedded in care work, there is a need to understand how they affect its temporal order. This article analyses group‐based mobile instant messaging (IM) in residential elder care work in Finland. The article asks (i) how care workers use group‐based messaging for work; and (ii) how they negotiate the rules for its use. Theoretically, the article draws on science and technology studies focusing on ‘taming’ and ‘unleashing’ (Pols, 2017), and temporality (Wajcman, 2008). Analysis is based on a qualitative interview study of care workers and nurses (n = 25) conducted in 2018. The results showed how the time‐shifting functionality of IM allows employees to ‘tame the technology’ and unleash effective communication practices. However, IM also increases a risk of boundless accessibility and tames its users, pointing to a growing need for time work to manage their work‐life balance in the complex temporal order of care work.

이승 보조 돌봄 작업의 수동 돌봄(Manual Care)과 로봇 돌봄(Robot-aided Care)의 작업부하 비교를 위한 작업부담 평가체계 개발

Objective: The aim of this study was to develop an assessment system for quantitatively comparing the workloads of manual care (MC) and robot-aid care (RC) of the care jobs.<BR>Background: Due to the rapid aging of Korea, the demand for human resources for elderly care tasks has been rapidly increased. Caregivers taking care of the elderly have been under high physical and mental stress due to various types of care work. Recently, many care robots using the technology of the 4th Industrial Revolution have been proposed as a solution to reduce caregiver’s load. However, there is still insufficient research to evaluate the physical and mental load relief effects of caregivers through comprehensive assessment.<BR>Method: The upper index (physical and mental loads) and the lower indexes of each upper index were determined through the literature survey and 42 ergonomic experts’ opinions. Ergonomics experts and caregivers also conducted the Analytic Hierarchy Process (AHP) to determine weights of the upper and lower indexes. Two task types (Bed to Chair and Chair to Bed) and two care types (Manual care and Robot-aid care) were performed to estimate the final work load scores based on the task types and care types in this study.<BR>Results: The results of the AHP analysis showed that the physical load was higher than the mental load for elderly caring tasks. Muscle load was the highest work stress in the physical load, followed by subjective body and posture loads. Safety stress was the most in the mental load, followed by task-difficulty stress and emotional stress, respectively. Robot-aided care showed a lower final workload score, including physical and mental load scores, than manual care in both types of tasks (Bed to Chair, Chair to Bed).<BR>Conclusion: A workload assessment system was developed by selecting assessment indexes of physical and mental loads that reflect the characteristics of transfer assistive care. It was noted that the physical and mental loads might be reduced in robot-aided care compared to manual care based on this study.<BR>Application: The workload assessment system can be used to quantitatively evaluate the reduction of workloads for applying different types of manual care and robot-aided care systems in elderly care work.

The Influence of Nursing Home, Ward, and Eldercare Workers on the Number of Resident Handlings Performed per Shift in Eldercare

The purpose of our study was to investigate which organizational levels and factors determine the number of resident handlings in eldercare. We conducted a multi-level study, stratified on day and evening shifts, including information on four levels: nursing homes (n = 20), wards within nursing homes (day, n = 120; evening, n = 107), eldercare workers within wards (day, n = 619; evening, n = 382), and within eldercare workers (i.e., days within eldercare workers; day, n = 5572; evening, n = 2373). We evaluated the influence of each level on the number of resident handlings using variance components analysis and multivariate generalized linear mixed models. All four levels contributed to the total variance in resident handlings during day and evening shifts, with 13%/20% at “nursing homes”, 21%/33% at “wards within nursing homes”, 25%/31% at “elder-care workers within wards”, and 41%/16% “within eldercare workers”, respectively. The percentage of residents with a higher need for physical assistance, number of residents per shift, occupational position (only within day shifts), and working hours per week (only within day shifts) were significantly associated with the number of resident handlings performed per shift. Interventions aiming to modify number of resident handlings in eldercare ought to target all levels of the eldercare organization.