Long-term Care Workers Research Articles

The shared experience of caring: a study of care-workers' motivations and identifications at work

ABSTRACTThis article presents an analysis of long-term care-workers' work motivation that examines the way this is shaped by the social contexts in which they operate. We conducted a thematic analysis of 19 in-depth interviews with care-workers. Three core themes were identified as underpinning their motivation: those of ‘fulfilment’, ‘belonging’ and ‘valuing’, and together these contributed to a central theme of ‘pride’. We also found an overarching theme of ‘shared experience’ to be integral to the way in which care-workers made sense of their motivation and work experience. We draw on the social identity approach to provide a conceptual framework through which to understand how this shared experience shapes care-workers' motivation and the quality of care they deliver. In particular, we note the importance that care-workers' attach to their relationships with clients/patients and highlight the way in which this relational identification shapes their collective identification with their occupation and organisation and, through this, their motivation.

요양보호사의 업무 스트레스와 대처전략이 생활만족도에 미치는 영향 -경기도를 중심으로-

The purpose of the study was to explore job stress, coping strategies and life satisfaction, and to identify related factors in long-term care workers. A cross-sectional study was used to study 111 long-term care workers in Gyeonggi-do. Questionnaires were given to the workers, and data were collected between 1 February and 30 March 2015. The data were analyzed using a stress scale, and a life-satisfaction index. The major findings were: 1) The type of facility was a significant factor in life satisfaction of long-term care workers (F=4.11, p=.020). 2) A statistically significant relationship existed between job stress(r=-.46, p<.001), coping strategies(r=.21, p=.040) and life satisfaction. 3) The results of the regression analyses showed that job stress, coping strategies, and type of facility were statistically significant in predicting the life satisfaction level of long-term care workers. The result of this study provides a better understanding of job stress, coping strategies, and life satisfaction in long-term care workers.

노인요양시설에서 요양보호사의 직업적 정체성이 서비스 질에 미치는 영향에 대한 실증적 연구 - 직무만족의 매개효과 -

노인요양시설에서 요양보호사의 직업적 정체성이 서비스 질에 미치는 영향에 대한 실증적 연구 - 직무만족의 매개효과 -

Contributing influences of work environment on sleep quantity and quality of nursing assistants in long-term care facilities: A cross-sectional study

The effect of shift work on nurses' sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants' sleep health.

The social organization of a sedentary life for residents in long-term care.

Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.

Future Demand For Long-Term Care Workers Will Be Influenced By Demographic And Utilization Changes

A looming question for policy makers is how growing diversity of the US elderly population and greater use of home and community-based services will affect demand for long-term care workers. We used national surveys to analyze current use and staffing of long-term care, project demand for long-term care services and workers through 2030, and assess how projections varied if we changed assumptions about utilization patterns. If current trends continue, the occupations anticipated to grow the most over the period are counselors and social workers (94 percent), community and social services workers (93 percent), and home health and personal care aides (88 percent). Alternative projections were computed for scenarios that assumed changing racial and ethnic patterns of long-term care use or shifts toward noninstitutional care. For instance, if Hispanics used services at the same rate as non-Hispanic blacks, the projected demand for long-term care workers would be 5 percent higher than if current trends continued. If 20 percent of nursing home care were shifted to home health services, total employment growth would be about 12 percent lower. Demographic and utilization changes would have little effect on projections of robust long-term care employment growth between now and 2030. Policy makers and educators should redouble efforts to create and sustainably fund programs to recruit, train, and retain long-term care workers.

Action Program Better Together in Amsterdam North: results process evaluation and impact assessment

Purpose: The purpose of this action program is to realize an improvement in the quality of health care and welfare services resulting in a healthier and a more self-sufficient population and cost reduction (Triple Aim). The program is developed for people with complex and/or multiple problems and limited self-sufficiency in the northern district of Amsterdam. ' Objectives:The objective is to develop and evaluate the implementation of integrated services from the sectors cure, care and community within the action program on Triple Aim outcome and to develop strategies to sustain improvements. Background: The Dutch healthcare and welfare system is being transformed and decentralized. From 2015, Dutch municipalities will be primarily responsible for long-term care services, youth care and work integration services. From 2012 onwards to prepare this complex system transition, an alliance of care, cure and welfare providers in Amsterdam North in close cooperation with the municipality of Amsterdam, health insurance company Achmea and TNO have developed and evaluated an action program for implementation of integrated services form the sectors cure, care and community. TNO supports the implementation of the action program by designing tools and processes for assessing and action planning (based on the multidisciplinary consultation guidelines of Frieslab), outcome based patient stratification (based on an evidence-based selfsufficiency matrix), progress monitoring and by training and coaching of professionals. The program is evaluated by a mixed method research design (process evaluation, impact assessment and shared savings model). Impact & outcomes:In our last ICIC-presentation (2014) we paid attention to the tools and processes for assessing, action planning and outcome based patient stratification. This time we 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117018 – http://www.ijic.org/ will give an update by focusing on the results of the process evaluation and impact assessment of the action program implementation from January 2013 to November 2014. The action program implementation shows promising results on the triple aim dimensions. Self-sufficiency of clients has increased in the first six months of the program, especially in the field of mental health and income (debt restructuring). There are strong indications that improved self-sufficiency has positive effects on clients’ experienced health and social participation. We will further discuss the criteria for efficient implementation of the action program, based on our process evaluation by continuous quality improvement loops. The process evaluation has given occasion to transform the action program’s processes repeatedly in order to fine tune and adjust those to regular processes of care and welfare services. Conclusions: This action program explores the opportunities for implementation of a regional, population-based approach to integrate health care and social services in the Netherlands. The preliminary results of the process evaluation and impact assessment are promising, including valuable strategies to sustain changes.

Examining workplace hazard perceptions & employee outcomes in the long-term care industry

The purpose of this study is to examine how workplace hazard perceptions are related to psychological strain and other employee outcomes for direct care workers in long-term care settings. Data were collected from 3068 direct care workers in long-term care. The study used 2 analytical techniques: confirmatory factor analysis (CFA) and structural equation modeling (SEM). CFA tested whether the observed variables measured the latent constructs of psychological strain, workplace hazards, and supervisor support. SEM was used to test direct and indirect relationships among the variables. Perceptions of workplace hazards were significantly and positively associated with psychological strain (β=.50, p<.001), which in turn was related to direct care workers’ higher turnover intentions and lower job satisfaction. Support from workplace supervisors did not moderate the workplace hazard risk perceptions–psychological strain relationship.These findings suggest that direct care workers’ perceptions of workplace hazards are related to reduced job satisfaction and higher intentions to quit. Our findings identify the need for organizations to reduce physical hazards in the workplace and acknowledge how perceptions of workplace hazards may reduce workers’ psychological health.

Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care

The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides. Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry. A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review. Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies). MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities.

Resisting Regulatory Rigidities: Lessons From Front-Line Care Work

In order to advance an argument addressing whether or not ethical and empowering care work is possible within the context of neoliberalism and managerialism, this article draws on international comparative, qualitative case-study data to ask whether processes and practices of radical care and emancipation already exist in nonprofit long-term care and social service work. If so, what do they look like, and what factors hinder or nurture social justice-based care practices? Given that paid and unpaid care continues to be a highly gendered and increasingly racialized realm of feminized struggle, it warrants further theorization and greater centrality within emancipatory projects and strategies.

Support Care Coordinators: A Unique Approach to Managing Personal Support Workers in Long-term Care

Support Care Coordinators: A Unique Approach to Managing Personal Support Workers in Long-term Care

The Relationship of Long-term Care Workers’ Health Awareness on Life Satisfaction

Background: Considering the importance of human resource management of the long-term care workers, this study is to propose a political and practical intervention approach. The approach is based on the analysis of research on the influe nce of long-term care workers’ health awareness on their life satisfaction. Methods: The participants of this study include 600 long-term care workers working at Nursing homes and Nursing facilities located in Seoul. The data collected from the participants are analyzed with Multi Regression Analysis. Results: As a result of T-test and analysis of variance, statistically significant parameters to the subjective awareness of health are as follows: marriage, education, religion and work places. And as the minor parameters that influence the rate of life satisfaction the positive relationships between the emotional health (β=0.178, p<0.01) and the intellectual health (β=0.281, p<0.001) is statistically significant. Conclusion: The results of analysis indicate as follows: there is a positively significant relationship between social demographic characteristics, health awareness and life satisfaction; the higher participation in social activities, more women than men, and the higher income, the higher health awareness. The findings point out the importance of emotional and intellectual health and efforts to promote better health and demand for a societal change in health awareness. This study provides the baseline data for a practical intervention measure and political suggestion by examining how the individual characteristics and health awareness influence life satisfaction of long-term care workers, and by analyzing the effect of the interactions between them.

Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan

Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: −2.93, p = .0389; −3.32, p = .0299; −1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: −1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.

노인 장기요양인력 양성체계에 관한 인식 연구

본 연구는 Q방법을 활용하여 현행 우리나라 노인 장기요양인력 양성체계에 관하여 다양한 이해관계집단의 구성원들이 갖는 주관적인 인식을 찾고, 인식 유형별 특성 등 논의과정을 통해 현행 노인 장기요양인력 양성체계와 관련한 사회복지적 함의를 찾고자 하는데 있다. 노인 장기요양인력 양성체계에 관한 인식 연구 결과, 기존 인력의 재교육을 강조하는 유형(유형1: 재교육 강조형), 공공서비스 제공자로서 윤리의식을 강조하는 유형(유형2: 전문직 윤리지향형), 실기 실습 중심의 교육을 강조하는 유형(유형3: 실기 실습 중심 교육지향형), 정부의 정책 판단의 중요성 등 공공부문의 역할을 강조하는 유형(유형4: 정부의 정책 판단 강조형), 그리고 장기요양 수급자의 증가에 따른 인력 수요를 강조하는 유형(유형5: 장기요양 수요 강조형) 등 다섯 가지 유형으로 나타났다. 또한 본 연구에서는 Q연구가 갖는 일반화의 한계를 보완하기 위한 양적 접근방법이자, 도출된 Q유형의 신뢰도와 타당도를 높이기 위한 Q사정도구로서 Q블록을 개발하였고, Q유형과 Q사정도구를 활용한 조사 결과에서는 높은 일치도를 나타내 보였다. The purpose of this study is to find out subjective perception types and needs of interested group on manpower training system with long-term care service by Q methodology, then to search for political measures to improve long-term care system in the implication of the sorted subjective perception types. The result of the study showed that there are five major sorts of subjectivities on manpower training system with long-term care service: emphasizes retraining of existing care worker(Type1), emphasizes ethics of public service provider(Type2), emphasizes practice-oriented education(Type3), emphasizes policy judgement of government(Type4), emphasizes training of long-term care worker in demand(Type5). And to try quantity approach methods, this study was developed Q-Block as a assessment tool to enhance validity and reliability of Q-types. The results of the survey showed high conformity.

Psycho-educational Approaches in Long-term Care Homes: Direct Care Workers and Managers’ Perspectives

The majority of the Direct Care Workers (DCWs) in long-term care (LTC) facilities have no formal qualifications or training on dementia and experience high levels of stress and burnout as a result of dementia-related symptoms and behaviours. Psycho- educational (PE) approaches can be effective in supporting DCWs, yet, they are underdeveloped within the context of formal care. Therefore, this study aimed to explore the expectations and concerns of care home managers (service managers and top- level managers) and DCWs about PE interventions. A qualitative, cross-sectional study was conducted. Individual interviews with 8 managers (75% female; mean age 45.5 ± 10.26) and 8 focus-group interviews with a total of 58 DCWs (female; mean age of 44.72 ± 9.06) of 4 LTC facilities were performed. All interviews were recorded, transcribed and analysed through thematic analysis by 2 independent judges. Managers’ main expectations were related to the opportunity to improve DCWs’: understanding and attitudes towards dementia; ability to interact with residents; motivation and job satisfaction. DCWs expected to: acquire knowledge and practical skills to deal with dementia; develop their knowledge about resident's biography; enhance their ability to deal with job strain; share experiences and improve group cohesion. Lack of time and support to translate learning into practice and sustain potential benefits over time were anticipated as the main barriers by both elements. There were coincident expectations and concerns among both managers and DCWs. Findings underscore the importance of targeting both DCWs-level and manager-levels perspectives to the planning of a sustainable PE intervention for DCWs.

The characteristics of in-home long-term care workers and the caring relationship in the perspective of citizenship

The characteristics of in-home long-term care workers and the caring relationship in the perspective of citizenship

Social rights and employment rights related to family care: Family care regimes in Europe

In early welfare states, social rights predominantly derived from formal employment relations. Within the past two decades, however, some European countries have opened these social institutions to care work also. Cash-for-care and social entitlements for periods of at-home family caregiving have changed the characteristics of informal care work that family members traditionally provide to older relatives. Formerly based on unpaid kinship relations, it has changed towards new paid and more formalized forms of care work by family members. But it can be assumed that long-term care work by family members is constructed differently across welfare states.The paper is guided by the following research question: How do welfare-state policies differ in the degree to which their policies towards family care for senior citizens create social risks for the caring family members? We use the conceptual framework of “family care regimes” as our analytical framework for the comparative research.To do this, we compare care policies towards older care-needy people in the welfare states of the Netherlands, Germany and Denmark. The findings show that a common feature in all three countries is that the situation of family carers is to some degree being formalized: in all three countries a frail senior citizen can chose a family member as the care provider, and the welfare states support the family care providers. Still, the legal situation as well as the quality and level of social rights for family caregivers differ considerably among the three countries. It is shown that the institutional framework for senior care by family members in Germany and the Netherlands represents a family care regime that supports semi-formal family care, and that in Denmark it can be classified as a family care regime that supports formal family care. We show that these different types of family care regimes differ considerably in the social risks they pose to family carers.

Ethnicity at work: the case of British minority workers in the long-term care sector

Purpose – The aim of this paper is to explore the effect of ethnicity and separate this from the other dynamics associated with migration among members of the long-term care workforce in England focusing on the nature and structure of their jobs. The analysis examines interactions between ethnicity, gender, and age, and their relations with “meso” factors related to job and organizational characteristics and “macro” level factors related to local area characteristics. Design/methodology/approach – The paper analyses new national workforce data, the National Minimum Data Set for Social Care (NMDS-SC), n=357,869. The paper employs descriptive statistical analysis and a set of logistic regression models. Findings – The results indicate that labour participation of British black and minority ethnic (BME) groups in long-term care work is much lower than previously believed. There are variations in nature of work and possibly job security by ethnicity. Research limitations/implications – While the national sample is large, the data were not purposively collected to examine differentials in reasons to work in the care sector by different ethnicity. Practical implications – The analysis highlights the potential to actively promote social care work among British BME groups to meet workforce shortages, especially at a time where immigration policies are restricting the recruitment of non-European Economic Area nationals. Originality/value – The analysis provides a unique insight into the participation of British BME workers in the long-term care sector, separate from that of migrant workers.

Care workers in long-term care for older people: challenges of quantity and quality

This article, drawing on a qualitative study in England, the Netherlands and Taiwan, explores how countries with very different care systems address the challenge of securing sufficient numbers of care workers with appropriate skills in ageing care. The analysis exposes the salient features of care systems, ageing-care markets and the ageing-care workforce in the three countries. To support the analysis, examples of how the countries attempt to recruit and retain ageing-care workers are provided. Key findings are that to secure an adequate number of skilled ageing-care workers, job satisfaction, coherence between care and labour policies and equal working conditions across sectors are vital. A quality ageing-care worker requires regular professional supervision and support, resources for ongoing training and career development opportunities. Most importantly, securing a sufficient number of ageing-care workers and ensuring they have appropriate skills are not isolated challenges but are interlinked and require collaboration between a range of care actors.

Personal care workers in Australian aged care: retention and turnover intentions

This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation.