Home Care Workers Research Articles

The effects of job characteristics and organizational climate on evidence-based practice implementation among child care workers in child group homes

The effects of job characteristics and organizational climate on evidence-based practice implementation among child care workers in child group homes

Care and Control: Are the National Minimum Wage Entitlements of Homecare Workers at Risk under the Care Act 2014?

Abstract Homecare is a major source of women’s low-wage employment in the UK. Practices of unpaid working time are widespread and many workers are not paid in accordance with their existing national minimum wage entitlements. On 1 April 2015, a new duty of well-being in social care came into force and local authorities are required to promote the control of care by service-users. As a consequence, homecare workers will increasingly be engaged in complex multi-lateral work relations and subject to multi-party control. This article examines how the national minimum wage entitlements of homecare workers have been legally interpreted and questions if their entitlements might be adversely affected under provisions of the Care Act 2014. There is a legacy of judicial decision-making in which care-giving is not recognised as ‘work’ for the purposes of the national minimum wage. Yet recent decisions have produced a more satisfactory entitlement framework by establishing that employer control over working time determines ‘work’. However, it seems this framework is put at risk by the statutory promotion of service-user control. As work relations are re-cast, contractual relationships in which care-giving falls outside the protection of national minimum wage law will appear increasingly attractive because they may both enhance service-user control and facilitate very low cost labour. Without innovation in legal treatments of multi-party control and sustained attention to the worth of care-giving as employment, the rights of homecare workers are at risk under the Care Act 2014.

Navigating the field of temporally framed care in the Danish home care sector

The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care.

The Caring Self within a Context of Increasing Rationalisation: The Enduring Importance of Clients for Home Care Aides

The current political economy imposes cost-saving rationalisation within home care work. In this context, a key question is whether home care aides act with indifference to clients or whether home care aides continue to espouse and act out of the caring self, which centres on the desire to give meaningful care to clients. This article assesses the thesis of the caring self within a context of rationalisation in relation to home care aides in three organisations. The article brings qualitative and quantitative research to bear on this question. It finds that despite the processes of rationalisation occurring in home care work, home care aides’ overall satisfaction with client relations, and their ability to satisfy clients continue to have significant links to their job satisfaction, and discretionary effort. This offers support for the thesis of the caring self within the context of rationalisation.

If I am not for myself, who is for me? The experiences of older migrant home care recipients during their hospitalization

Objective: Hospitalization is a major risk for older adults; therefore, it is crucial to provide the appropriate treatment during hospitalization. This study examined hospitalized older adults’ perceptions regarding three groups of treatment providers: nursing staff, family members, migrant home care workers.Method: Qualitative interviews were conducted with 17 hospitalized older adults. Data were gathered by in-depth interviews. Content analysis included open coding, axial coding and integration of the main findings using constant comparisons.Results: Three themes emerged: (1) ‘What is my worth?’ This theme was focused on the participants’ perceptions of themselves as helpless and dependent on others. (2) ‘What would I do without them?’ This theme referred to the perception of the migrant home care workers and nursing staff as essential. It meant immense gratitude, but also a sense of dependency on paid caregivers. (3) ‘They have their own busy life.’ This theme concerned participants’ low treatment expectations from their family members due to their perception of their family members as having multiple obligations.Conclusion: Hospitalized older adults prefer to turn to paid caregivers rather than to their families. Findings are discussed in light of the tension between formal and informal care in countries that are transitioning from traditional family values to modern values, placing the care of older adults by paid caregivers.

Harris v. Quinn and the Contradictions of Compelled Speech

In Harris v. Quinn, the Supreme Court held that unionized home care workers have a First Amendment right to refuse to pay their fair share of the cost of services that the union is statutorily required to provide. The Court thus transformed what had been a legislative debate about so-called right-to-work laws, which about half of states have adopted, into a constitutional requirement for one narrow category of public sector employees. The problem with transforming this policy argument into a First Amendment requirement is that treating fair share payments to a union as compelled speech raises First Amendment rights of both supporters and opponents of the union. If expenditures on union representation are speech–as the majority in Harris thinks they are–then the union’s obligation to provide free representation compels speech by the union and its members. While, in our view, the requirement to pay for legal services is not compelled speech, the Court’s entire agency fee jurisprudence, including Harris, insists that it is. On the Court’s analysis, then, laws and contracts that require unionized employees to pay for union representational services compel speech of dissenters exactly to the same extent that their prohibition compels speech of unions and their members. Moreover, to the extent that a union must rely on member dues that it would otherwise spend on political activities to cover the costs of services for free riders, the duty of fair representation owed to nonpayers would violate the First Amendment rights of the union by siphoning off money that would otherwise be used to support these activities. Accordingly, the Court must alter its usual analysis of the constitutionality of agency fee agreements and recognize that union representation requires balancing competing freedom of speech and association interests. Once the First Amendment rights of unions and union members are recognized, agency fee or fair share provisions emerge as a constitutionally sound accommodation of the interests of dissenters, unions, and union members. 1 The authors are, respectively, Chancellor’s Professor of Law and a JD candidate at the University of California, Irvine School of Law. They gratefully acknowledge comments from Nick Hartmann and research assistance from Christina Tsou. 1 Fisk and Poueymirou: Harris v. Quinn and the Contradictions of Compelled Speech Published by The Keep, 2015

Assessing the skills of home care workers in helping older people take their prescribed medications.

The Southern Health and Social Care Trust in Northern Ireland applied a modified version of the Objective Structured Clinical Examination (OSCE) to assess the skills of home care workers in assisting older people taking prescribed medications. In Northern Ireland, home care workers are care workers employed by health and social care trusts or private agencies. The application of the model has developed the skills of this staff group, improved the relationship between the commissioner and provider, significantly reduced the time spent by community nurses in individual training and assessment, and enhanced the patient experience for those taking medication. Overall, the application of this model has provided assurances to the Trust board, the executive director of nursing, and operational directors that home care workers are competent in assisting older people in this high-risk activity.

Home Care Workers' Skills in the Context of Task Shifting: Complexities in Care Work.

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that "low skilled" care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work.

Discrepancies in assessing home care workers' working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels.

BackgroundThe present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers’ working conditions.MethodsThe study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders’ appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels).ResultsEmployees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular.ConclusionsIt is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.

Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care.

To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years. Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients' medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training. Practical nurses spent 10-45 minutes reviewing one client's medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers'/client's lack of interest to client's pharmacotherapy and short client contacts were the most common barriers to use the tool. The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool.

The Implementation of the Right to Live in the Families for the Children from the Child Care Home: Approach of the Workers of Child Care Home

The Implementation of the Right to Live in the Families for the Children from the Child Care Home: Approach of the Workers of Child Care Home

Work demands and health consequences of organizational and technological measures introduced to enhance the quality of home care services – A subgroup analysis

This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into ‘high’, ‘moderate’ and ‘low’ strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects.

Pain Assessment Strategies in Home Care and Nursing Homes in Mid-Norway: A Cross-sectional Survey

The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes.

Mental and behavioral health conditions among older adults: implications for the home care workforce

Objectives: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities.Methods: Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts.Results: Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work.Conclusion: This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides.

Agitation in dementia and the role of spatial and sensory interventions: experiences of professional and family caregivers.

There is a growing interest in environmental interventions to complement the psychosocial approaches to cope with agitation in dementia. The aim of this study was to present this evidence from literature and research to care practitioners and family carers in order to gather their reflections. In this way, we can identify experienced gaps in care practice and define needs for further research. A framework with seven types of environmental interventions for agitation in dementia was developed through literature review, referring to the impact of light, smell, noise, temperature, nature, colour and spatial configuration. This framework guided three expert panels, respectively, with family caregivers of persons with dementia (N=5), professional home care workers (N=12) and professional caregivers working in nursing homes (N=10). All caregivers stressed the impact of agitation on their quality of life and on the quality of life of the person with dementia. Most caregivers were familiar with the impact of daylight, natural elements and domestic smells. Caregivers were unfamiliar with the specific effects of bright light therapy and were interested in more research on the effectiveness of light, temperature and spatial configuration. They stressed the individuality of agitation in dementia. Caregivers already use sensory and spatial interventions to manage agitation, and they are interested in knowing more about feasible effective interventions. Caregivers need to be informed on the possible benefits of sensory environmental factors on coping with agitation. To this end, it is very useful to take the experiences of caregivers into account.

Information Needs of Family Caregivers of People With Dementia.

Understanding caregiver needs is essential when caring for people with dementia. The aim of this study was to identify family caregivers' information needs as perceived by home care workers and the caregivers themselves. This study used a descriptive survey design and convenience sampling. The two groups of care providers were given a list of 48 items and asked to choose caregivers' top 10 information needs. Group 1 (n=33 unpaid family caregivers) identified dealing with behavior changes and group 2 (n=59 paid home care workers) identified providing personal care as most important. While differences between these groups emerged, both care providers chose more items related to needing help for the care recipient, than items related to needing help for the caregivers themselves, e.g., support group. These information needs can be used by rehabilitation nurses and other healthcare professionals to develop educational materials and supportive interventions.

Work Postures When Assisting People at the Toilet

The aim of our study was to analyze home care workers’ movement patterns and back postures, relating them to risks while helping an ambulatory care recipient to and from the toilet in a homelike environment. We found that severe risks of unpredictable movements with exposed postures could explain many injuries. Because of high-risk injuries, we suggest decreasing the time when the care recipient stands and the home care worker helps with clothing and personal hygiene. We also suggest the development of support in front of the recipient to prevent her or him from falling forward.

Work–Life Integration and Workplace Rights for Domestic Workers in Support to Elderly Persons

Our article shows that there is a real challenge in balancing work and family for employees working in support services in domestic work for elderly persons; their workplace rights on this issue are quite limited, and they depend largely on managers’ understanding and support. Given their difficult working conditions, these workers actually find quite a challenge in trying to reconcile work and family. Our article is based on a qualitative research mobilizing 33 semi-structured interviews with employees of the home care sector in the field of the social economy mainly but also in the private sector. We first present the concept of work–family and personal life, then the area of home care and domestic work for the elderly. Then, we present the particular challenges observed in reconciling work and family life, where possible by comparing men and women. The results highlight two major sources of differentiation: age and single parenthood. Those who are older highlight the fact that children have grown up, and they have (finally) some time for themselves, even if their working conditions are difficult (broken schedules, etc.). In contrast, single women live a much more difficult situation concerning work–family, partly because of the lack of workplace rights on this issue and because of the poor working conditions for many (broken hours of work, low wages, difficult working conditions). We conclude with some recommendations, including the Right to request, which appears to be the best option, although it would need some further analysis.

Personal home care workers' role in hospital: a qualitative study.

Unlike in most high-income countries, in Israel personal (social) care of elderly patients in hospitals is provided either by relatives or friends, or, for those patients with live-in assistance at home, by their home care workers. Our aim was to understand the explicit and implicit roles of live-in carers and whether any difficulties occurred. Interviews in the internal medicine unit of Hadassah Hospital with 17 patients, 16 relatives, 20 home care workers and 20 nurses. Data were subjected to categorical content analysis. Three major themes emerged: the development of teamwork with relatives and nurses; the varied roles of home care workers including nursing care, emotional care, and monitoring and supervision of the patient; and the conflicts and challenges associated with having a care worker related to their physical presence and the care worker's own social needs. Israel partially addresses its nursing shortage by allowing paid home care workers to take an active role in the care of hospitalized older adults. This can have both a positive and a negative impact on the role and perception of nursing.

Labors of love: nursing homes and the structures of care work

Contents Acknowledgments ix Introduction: Locating Nursing Home Care Work 1 1 Making the Most of Medicaid 21 2 Staging the Inspections 37 3 Documenting Conflict 57 4 The Costs of Doing Business 77 5 Feeding Residents on a Starving Budget 101 6 The Uses of Emotions 115 7 Making Sense of Death and Abuse at Work 139 8 Connecting Quality of Life and Quality of Work 155 Appendix: From the Poorhouse to the Skilled Nursing Facility 169 Notes 175 References 185 Index 197 About the Author 207