Community Care Sectors Research Articles

Nurses’ experiences in transitioning to work in the long-term care and home and community care sectors: A phenomenological exploration

BackgroundNurses in long-term care (LTC) and home and community care (HCC) are well acquainted with the high workloads and manifold job stressors that pervade these sectors, making it increasingly difficult to employ and retain a strong workforce. In response, nursing bridging education programs have been proposed to enhance recruitment and retention. While the efficacy of such programs is supported, the transition to practice experience of new nurse graduates is often associated with feelings of under-preparedness. Understanding the lived experience of nurses transitioning into new roles in LTC and HCC after completing a bridging program may highlight areas of emphasis for future retention efforts.MethodsHermeneutic phenomenology was employed to explore the experiences of new graduate Registered Practical Nurses (RPNs) and Registered Nurses (RNs) from a tuition reimbursement program supporting students enrolled in nursing bridging education from Personal Support Worker (PSW) to RPN/RN and/or RPN to RN in Ontario as they transitioned to practice within LTC and HCC. A series of in-depth semi-structured virtual interviews and iterative analysis explored the meaning of everyday experiences for nurse participants.ResultsFrom twenty individual interviews (12 initial, 8 follow-up), the experience was embedded in a sense of fulfillment, further considered through four themes – benevolence; growth, eagerness, and anticipation to learn; building from within; and work-life balance.DiscussionThis is the first phenomenological study to report on the meaning of the experience of transitioning to practice for new graduate nurses from bridging education programs as they (re)enter the workforce in LTC and HCC, offering rich insight into their experiences when moving into new roles.ConclusionsBy illuminating the nuances of this experience, the findings may encourage healthcare leaders to develop helpful policies, strategies, and workplace cultures in LTC and HCC that might better promote the recruitment and retention of nurses in these sectors.

Dementia content and delivery in physiotherapy curricula: an international study of entry level physiotherapy programmes in Ireland the United Kingdom and New Zealand

ObjectivesPhysical impairments associated with dementia include reduced gait speed, and diminished postural control, which can lead to an increase in falls and hip fractures. Physiotherapy can play a key role in many aspects of dementia care, including falls risk prevention, gait re-education and end of life care. However, there is a lack of dementia education in entry level physiotherapy programmes. The aim of this study was to map the dementia content and delivery in the current undergraduate and entry level physiotherapy curricula in Ireland the United Kingdom and New Zealand. DesignThis cross-sectional survey-based study was distributed via the online survey tool Qualtrics XM. The survey was designed using the map of Kern’s curriculum design framework. SettingHigher educational institutes (HEIs) that offered an undergraduate (BSc) and/or MSc (entry level) physiotherapy programmes in Ireland United Kingdom and New Zealand were included. ParticipantsThe academic lead for dementia education in the HEI was invited to participate in the survey. ResultsOf the 69 eligible HEIs contacted, 49 responded, giving a response rate of 71%. Different sources informed curriculum design, including patient and public involvement, published guidelines and policies and expert clinicians. The time allocated to dementia teaching across the curricula varied, with under half of the programmes only allocating two hours. The lack of service user input was seen as a perceived weakness of many programmes as was the non-standardisation and generalisability of teaching. ConclusionWhilst dementia education is included in many HEI programmes, we need to consider more time, a curriculum that meets learner’s needs and include the patient voice. Further research is needed to develop bespoke dementia curricula specific to physiotherapy. Contribution of the Paper•The findings of this study have identified current strengths as well as weaknesses of entry level physiotherapy programmes in dementia care.•This study highlights what is most and least commonly taught at entry level physiotherapy programmes in dementia care.•More time needs to be allocated to dementia teaching, to reflect the clear work-related educational needs of physiotherapists in both the acute and community care sector.

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

BackgroundPerson-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.MethodsWe conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.ResultsWe interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.ConclusionsThe person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Environmental Risk Assessment in Community Care: A Scoping Review.

Community care encompasses inherent risks for both clients and healthcare providers. Maintaining a safe environment for the delivery of care services ensures that any risk of unintentional or intentional personal harm is minimised. The aim of this scoping review is to (a) provide an overview of existing knowledge by summarising the current literature and (b) identify gaps pertaining to understanding and managing environmental risk in community care settings. Guided by the Population/Concept/Context approach and PRISMA guidelines, this paper used two questions to answer how a score-based tool for assessing client suitability in community care is developed and how an environmental screening tool assists with reducing risk to community care workers. Literature searches of CINAHL, PubMed (Medline), Web of Science and PsychINFO databases were conducted between September 2023 and November 2023. We included full text articles published from 2018 to 2023. The following four broad areas were identified as key components in the structure of an environmental screening tool: environmental factors, health factors, socioeconomic factors and cultural factors. The results of this review provide valuable information which can be utilised by care organisations to develop and/or refine tools to ensure the safety and wellbeing of workers within the community care sector.

A Leave of Absence Might Not Be a Bad Thing: Registered Practical Nurses Working in Home Care During the COVID-19 Pandemic.

To describe the resilience and emotional intelligence of Registered Practical Nurses working in Home and Community Care during the COVID-19 pandemic. Specifically, to determine if there was a relationship between resilience and emotional intelligence based on whether a nurse: (1) left the sector, (2) considered leaving, or (3) took a leave of absence during the pandemic. An online cross-sectional survey was used to capture respondents' demographic information and scores on the Connor-Davidson Resilience Scale, Resilience at Work Scale®, and Wong and Law Emotional Intelligence Scale. Registered Practical Nurses working, or who had worked, in Home and Community Care January 2020 to September 2022 were eligible to participate. The Checklist for Reporting Results of Internet E-Surveys was used. The survey was available June to September 2022 and advertised by the Registered Practical Nurses Association of Ontario to approximately 2105 members. Descriptive statistics and independent samples t-tests were used to analyze results at a level of P < .05 was used for all analyses. A total of 672 respondents participated (completion rate = 92.8%). There were no differences on resilience or emotional intelligence scores based on whether a nurse left, or considered leaving, the Home and Community Care sector during the pandemic. However, nurses who took a leave of absence scored significantly higher on resilience and emotional intelligence measures when compared to those who did not. Results suggest that a leave of absence for these nurses during the pandemic may have been a supportive coping strategy.

Increase the Accuracy of Detection of Pathogenic Genes of Breast Cancer using a Graph-Based Approach to the Gene Prioritization Problem

Cancer is one of the most common causes of mortality today. This disease's complications impose many costs on the human community's health, care, and well-being sectors. Solving complex biological problems requires advanced computational methods, and bioinformatics was created to solve such complex problems with the active interaction of several fields of science. Bioinformatics is an interdisciplinary science combining biological sciences, computers, mathematics, and statistics. The issue investigated in this research deals with one of the challenging issues in bioinformatics, namely candidate gene prioritization in breast cancer. Gene prioritization means sorting genes based on their relevance to a specific disease, such as breast cancer. Finally, the genes are checked according to their importance in performing costly experiments. The proposed approach in this research is to present a method based on graph mining for prioritizing genes. The study conducted with ENDEAOUR and DIR methods was compared and evaluated. The evaluation results show that the designed method is more efficient than other compared methods.

Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers' Wage Parity.

The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

Commentary: Minding the Gap - Why Wage Parity Is Crucial for the Care of Older Canadians.

Zagrodney and colleagues (2023) have highlighted the pay differences that exist between those working in the home and community care (HCC) sector and other healthcare sectors. The authors argue that achieving wage parity could significantly mitigate the current HCC human resource crisis, support the overall sustainability of Ontario's healthcare system and improve patient outcomes. We build on their argument by highlighting issues that have contributed to wage disparities within healthcare systems and discuss how addressing them can create more equitable systems for both those receiving and those providing care. We further note how other healthcare systems that have wage parity have demonstrated that it is not a "nice to have" but an essential element of establishing a sustainable health human resources strategy. Finally, the new 10-year bilateral healthcare funding agreements that the federal, provincial and territorial governments are currently announcing will not only provide significant new funding but also an opportunity to decisively address the long-standing issue of wage parity in Canada, once and for all.

Violence, Harassment, and Turnover Intention in Home and Community Care: The Role of Training.

Violence and harassment affect healthcare workers' well-being and career decisions in the home and community care sector. The objective of this study is to assess the role of training in alleviating the relationship between violence and harassment at work and turnover intention among personal support workers (PSWs). Cross-sectional survey data from 1401 PSWs in Ontario, Canada are analyzed with structural equation modeling. Utilizing a resource perspective, the associations between job demands (i.e., violence and harassment at work), personal resources (i.e., self-esteem), job resources (i.e., workplace violence training and challenging task training), stress, and intention to stay among personal support workers (PSWs) are examined. Challenging task training is positively associated with self-esteem and negatively associated with stress, whereas workplace violence training does not have a significant association with either variable. Stress has a negative relationship with intention to stay. Self-esteem is the mediator of both associations between violence and harassment at work and stress and between challenging task training and stress. The results point to varied degrees of training effectiveness that may be shaping turnover decisions of PSWs who experience violence and harassment in home and community care organizations. There seems to be a need to assess and redesign workplace violence training. Home and community care managers might be able to lower the impact of violence and harassment on PSWs' turnover by providing training that is not directly related to workplace violence and harassment.

Workload, workplace violence and harassment, and well-being of personal support workers in home and community care

Demand for home and community care services has continuously increased in Canada and elsewhere in the last few decades due to aging of the population and healthcare policy changes shaped by budgetary limitations. As a result, home and community care organizations are having trouble hiring adequate numbers of healthcare workers to meet the escalating demand, the result being increased workload on these workers. Another stream of literature has shown that care recipients and their family members, frustrated with the limited ability of healthcare workers to provide adequate care because of increased workload, might resort to violence and harassment. Bringing these two streams of literature together, we examined the relationships among three variables : workload ; workplace violence and harassment ; and well-being of personal support workers (PSWs). Using structural equation modeling, we analyzed a 2015 Ontario-wide survey of 1,347 PSWs employed in the home and community care sector. The results indicate that workload is negatively associated with extrinsic and intrinsic job satisfaction, and this relationship is mediated by violence and harassment and by stress. Specifically, workload is positively associated with violence and harassment at work, which in turn is positively associated with stress, which in turn is negatively associated with extrinsic and intrinsic job satisfaction. Our study contributes to the literature by examining the impact of a work environment factor, workload, on the well-being of PSWs. This approach makes it possible to expand the current literature’s focus on psychological processes at the individual level to a more contextual approach. Furthermore, the results have important implications for home and community care organizations as well as for the healthcare sector in general. The well-being of PSWs is critical to retaining them and to ensuring the quality of care they provide their clients. Thus, their workload should be lowered to a more manageable level to help minimize the violence and harassment they experience.

Message from the College President – Dr Neale Fong

Leadership and management spawn numerous catchphrases to assert what is important “right now”. Resilience. Leaning in, or out. Authenticity. Balance. Agility. As a College for health managers and leaders, our clear challenge is to look past the “right now” and create the best platform to support our members through what we hope will be their lengthy career and positive contribution to the health of their communities.&#x0D; In the past year the College has introduced a credentialling approach for health leaders which is inclusive of any and all of the latest leadership theories whilst acknowledging that real and substantial contributions to the health of the community is an iterative process requiring the commitment of individual leaders over long careers spanning decades. Our vision is “Better Leadership. Healthier Communities.” Our body of services is directed at supporting our members to achieve this vision.&#x0D; Why Certification? &#x0D; At the very foundation of the notion of what constitutes a profession is a body of knowledge and skills that requires attainment and continuous improvement. The individual leader is supported by an external body (the College) that describes that body of knowledge and skills and creates a framework for the individual to point to how they personally are committing to lifelong learning and development.&#x0D; In the health sector certification in a profession is an employment currency that has traditionally excluded the leaders and managers. Through the introduction of these credentials, the College supports members and future members to have their body of knowledge and skills recognised and provides the platform for continuing development.&#x0D; The role of consumer expectation plays a role in the need for the College credentialling system. Consumers expect a professional and independent recognition of the capability of the senior people who develop, lead, manage and have responsibility for their health facilities and services.&#x0D; Our Challenge to our CHM’s and CHE’s&#x0D; Implicit in this Certification system is that it is very important that the College’s Certified Health Manager and Certified Health Executives use their postnominals in communications within the health sector, talk about the College’s work in supporting the profession and “live” the vision of committing to lifelong learning as part of a community of leaders.&#x0D; Over the past difficult 18 months the College itself has leaned into this attribute of community which goes beyond the triteness of “we are all in this together”. I have been proud and delighted to see how many of our members stepped up to support each other during this time and have been glad to harness that collegiate good will in developing both free and more importantly more opportunities for members to come together in small and large groups to listen and learn.&#x0D; This journal continues to be an excellent and informative part of health leaders’ journeys. We are thankful for the partnership with SHAPE and commend members’ contributions to this publication; another way to continue the life-long learning that is so necessary in meeting the challenges of the health and community care sectors.

Using administrative health data for palliative and end of life care research in Ireland: potential and challenges.

Background: This study aims to examine the potential of currently available administrative health and social care data for palliative and end-of-life care (PEoLC) research in Ireland. Objectives include to i) identify data sources for PEoLC research ii) describe the challenges and opportunities of using these and iii) evaluate the impact of recent health system reforms and changes to data protection laws. Methods: The 2017 Health Information and Quality Authority catalogue of health and social care datasets was cross-referenced with a recognised list of diseases with associated palliative care needs. Criteria to assess the datasets included population coverage, data collected, data dictionary and data model availability, and mechanisms for data access. Results: Nine datasets with potential for PEoLC research were identified, including death certificate data, hospital episode data, pharmacy claims data, one national survey, four disease registries (cancer, cystic fibrosis, motor neurone and interstitial lung disease) and a national renal transplant registry. The ad hoc development of the health system in Ireland has resulted in i) a fragmented information infrastructure resulting in gaps in data collections particularly in the primary and community care sector where much palliative care is delivered, ii) ill-defined data governance arrangements across service providers, many of whom are not part of the publically funded health service and iii) systemic and temporal issues that affect data quality. Initiatives to improve data collections include introduction of i) patient unique identifiers, ii) health entity identifiers and iii) integration of the Eircode postcodes. Recently enacted general data protection and health research regulations will clarify legal and ethical requirements for data use. Conclusions: Ongoing reform initiatives and recent changes to data privacy laws combined with detailed knowledge of the datasets, appropriate permissions, and good study design will facilitate future use of administrative health and social care data for PEoLC research in Ireland.

Using administrative health data for palliative and end of life care research in Ireland: potential and challenges

Background: This study aims to examine the potential of currently available administrative health and social care data for palliative and end-of-life care (PEoLC) research in Ireland. Objectives include to i) identify data sources for PEoLC research ii) describe the challenges and opportunities of using these and iii) evaluate the impact of recent health system reforms and changes to data protection laws. Methods: The 2017 Health Information and Quality Authority catalogue of health and social care datasets was cross-referenced with a recognised list of diseases with associated palliative care needs. Criteria to assess the datasets included population coverage, data collected, data dictionary and data model availability, and mechanisms for data access. Results: Nine datasets with potential for PEoLC research were identified, including death certificate data, hospital episode data, pharmacy claims data, one national survey, four disease registries (cancer, cystic fibrosis, motor neurone and interstitial lung disease) and a national renal transplant registry. The ad hoc development of the health system in Ireland has resulted in i) a fragmented information infrastructure resulting in gaps in data collections particularly in the primary and community care sector where much palliative care is delivered, ii) ill-defined data governance arrangements across service providers, many of whom are not part of the publically funded health service and iii) systemic and temporal issues that affect data quality. Initiatives to improve data collections include introduction of i) patient unique identifiers, ii) health entity identifiers and iii) integration of the Eircode postcodes. Recently enacted general data protection and health research regulations will clarify legal and ethical requirements for data use. Conclusions: Ongoing reform initiatives and recent changes to data privacy laws combined with detailed knowledge of the datasets, appropriate permissions, and good study design will facilitate future use of administrative health and social care data for PEoLC research in Ireland.

Staffing crisis: Addressing the high turnover rate of personal support workers in Ontario’s long-term care sector

Personal support workers (PSWs) serve a valuable role within the health system, providing up to 80% of direct care to residents and clients in the home and community care (HCC) and long-term care (LTC) sectors. According to a report by the Ministry of Long-Term Care, as of 2018, 50 000 PSWs were employed within LTC facilities in Ontario, accounting for the majority of the workforce within this sector. The original purpose of the PSW role was to support residents with activities of daily living such as dressing, toileting, and bathing. However, in an effort to minimize healthcare costs and keep up with the rapidly aging population, there has been a recent shift towards implementing policies that support the idea of aging at home. The criteria for admission to LTC in Ontario was amended in 2010, with individuals now required to have “high or very high physical and cognitive challenges” to qualify for care. As a result, LTC home residents require a greater complexity of care, as reflected by the fact that an estimated 81% reportedly suffer from some form of cognitive impairment. To meet the increasing needs of residents in a sector that is severely understaffed, the role of PSWs has evolved to take on a greater responsibility in resident care and provide levels of support that are often beyond the scope of their training. As unregulated healthcare professionals, PSWs operate under the direct supervision of a nurse practitioner (NP) and face limited autonomy, strict reporting requirements, low wages, and minimal opportunities for further advancement. These factors contribute to the high staff turnover rates that exist for PSWs in LTC; 25% of PSWs leave the sector after just two years of work experience and 40% leave within the first year of graduation. This article will investigate the various factors that contribute to the high rate of PSW turnover, examine the COVID-19 pandemic and the staffing crisis, and highlight possible interventions that may improve staff retention within the LTC sector.

Using linked administrative health data for palliative and end of life care research in Ireland: potential and challenges.

Background: This study aims to examine the potential of currently available administrative health data for palliative and end-of-life care (PEoLC) research in Ireland. Objectives include to i) identify administrative health data sources for PEoLC research ii) describe the challenges and opportunities of using these and iii) estimate the impact of recent health system reforms and changes to data protection laws. Methods: The 2017 Health Information and Quality Authority catalogue of health and social care datasets was cross-referenced with a recognised list of diseases with associated palliative care needs. Criteria to assess the datasets included population coverage, data collected, data dictionary and data model availability and mechanisms for data access. Results: Eight datasets with potential for PEoLC research were identified, including four disease registries, (cancer, cystic fibrosis, motor neurone and interstitial lung disease), death certificate data, hospital episode data, community prescription data and one national survey. The ad hoc development of the health system in Ireland has resulted in i) a fragmented information infrastructure resulting in gaps in data collections particularly in the primary and community care sector where much palliative care is delivered, ii) ill-defined data governance arrangements across service providers, many of whom are not part of the publically funded health service and iii) systemic and temporal issues that affect data quality. Initiatives to improve data collections include introduction of i) patient unique identifiers, ii) health entity identifiers and iii) integration of the eircode postcodes. Recently enacted general data protection and health research regulations will clarify legal and ethical requirements for data use. Conclusions: With appropriate permissions, detailed knowledge of the datasets and good study design currently available administrative health data can be used for PEoLC research. Ongoing reform initiatives and recent changes to data privacy laws will facilitate future use of administrative health data for PEoLC research.

Lessons on COVID-19 from Home and Community: Perspectives of Nursing Leaders at All Levels.

The initial focus of the COVID-19 pandemic was on the surge capacity of hospitals. Moving forward, however, the attention needs to shift toward keeping people healthy at home. In this paper, we discuss critical insights from the home and community care sector, which shed light on pre-pandemic fault lines that have widened. The paper, however, takes a positive look at how a better future can be built, particularly for those most vulnerable in society. We offer three key insights and analyses as well as examples of how one national homecare organization in Canada, SE Health, is facing the pandemic. We discuss the following key insights: (1) pre-pandemic systemic biases and barriers were exasperated during the pandemic, which impacted the most vulnerable; (2) nurse leaders were faced with unprecedented fear and anxiety from both patients and their staff colleagues; and (3) the pandemic provided an opportunity for significant learning, innovation and capacity development. The pandemic is far from over - we are in a marathon, not a sprint. The paper concludes with how nurse leaders can lead the way in navigating through the pandemic and build a better "new normal."

Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia

ObjectivesThe capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and...

Healing Rates of Venous Leg Ulcers Managed With Compression Therapy: A Secondary Analysis of Data.

The purpose of this study was to explore average time to heal for patients with venous leg ulcers (VLUs) receiving standard of care that included compression and advanced wound dressings. Secondary analysis of an existing electronic database. A convenience sample consisting of 1323 patients with VLUs from various community care sectors (homecare and clinics) across Canada. The Wound Studies database used in the analysis consisted of data from 6 studies conducted prospectively between 1999 and 2009 in which the treatment and delivery of care for all lower leg ulcers (venous, arterial, and mixed) in Canada was examined. From these studies, only patients with VLUs, with an ankle-brachial pressure index of greater than 0.8, and surface area measurements of the ulcers at baseline, 3 months, and 6 months were included. Descriptive statistics were used to determine the proportion of patients who achieved closure at 3 and 6 months and explore the weekly and monthly healing rates for those who did and did not achieve closure. Logistic regression analysis was performed to identify predictive factors for healing. A total of 777 patients (mean age 69 years) met inclusion criteria. The proportion of patients who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively. Of the participants who achieved wound closure, monthly mean healing rate, measured by percentage of reduction in surface area, was 33.4% (0.56 cm, SD 1.4 [median 0.15 cm]) through month 3, and 31.0% (0.70 cm, SD 1.6 [median 0.08 cm]) through month 6. The overall monthly surface area reduction was 30%. Study findings suggest a monthly surface area reduction of 30% provides a baseline healing rate for VLUs managed with compression therapy and advanced dressings. Findings also suggest standard of care is not sufficient for healing in over 50% of the population, as the proportion of those who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively.

“Friend-ish”: Home Care Workers, ‘Social Labour’ and Managing the Boundaries of the Carer Relationship

A rise in services sector employment has led to increased attention on the myriad forms of labour workers must enact as part of their jobs. In this study, we extend prior studies to develop the concept of ‘social labour,’ whereby home care support workers—as an example of an increasingly large part of the services economy—need to actively manage the relationship boundary between the professional services they perform and the personal relationships that may develop. This is especially likely given repeated interactions between the workers and the clients, and the commodification of the ‘loving care’ that the aged care sector emphasises as a value-add of their services. Drawing on interviews with fifty older adult consumers, we find that home care support workers need to engage in social labour through 1) following the lead of clients who set out the terms of the relationship and the degree of sociality, 2) managing the potential dual role of a ‘support worker’ and a ‘friend’, and 3) meeting the social needs of clients vulnerable to isolation, as well as attending to clients at vulnerable times. Our findings highlight the complexity of the relationship between care workers and consumers, and the negotiation of the professional role that care workers must engage in as an additional aspect of their employment. As Australian Government programs and the community care sector increasingly acknowledge the value of social support and companionship, greater attention is needed to this aspect of employment of care work, with its attendant implications for both workers and clients.