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Costs and Benefits of Caregiving Caregiving and Health Care Reform Creating Better Conditions for Care
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Labour Process Change: Women’s Paid Home Care Work in Saskatoon Allison Williams, Research Faculty, Saskatchewan Population Health and Evaluation Research Unit, Assistant Professor, Department of Geography, Susan Wagner, Professor, College of Nursing, and Monic Buettner, University of Saskatchewan, prepared for the Prairie Women’s Health Centre of Excellence
Nona Glazer (1993) first concluded that health reform is changing labour processes and contributing to the deteriorating working conditions of home care practitioners in the United States.[1] Many Canadian scholars have discovered a similar phenomenon taking place north of the border.[2] As health care reform relocates care away from institutional services, there has been and continues to be an unprecedented growth in home care. Deinstitutionalization, as well as an aging Canadian population, are creating a demand for more complex home care. The home care sector itself is being restructured in the hope of making the delivery of care more cost-efficient. As a result, the female-dominated home care labour force is undergoing significant changes. Practitioners’ work lives, overall quality of life and health are being affected. Research indicates that practitioners are experiencing an intensification of work, evident in an increase in job responsibilities and a decrease in the time to carry them out. These changes contribute to a third job transformation—an increase in work stress. Poor working conditions are the major cause of practitioner "burnout" (generally understood as exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration) and high turnover rates, greatly impacting the quality and availability of this workforce.[3] In addition to the obvious impact on the home health care labour force, burnout and turnover threaten continuity and quality of care for patients and families. Saskatoon District Health (SDH) Home Care provides home support services (including personal care, meals, respite care and home management), nursing care, volunteer workers, and a "meals on wheels" service. After a number of restructuring strategies were implemented by SDH Home Care, our research team collected quantitative and qualitative data to explore how the work lives and health of paid home care practitioners were affected. These data included practitioners’ assessments of the quality of work life, overall quality of life, and personal health and well-being. We used a collaborative research partnership model and worked with SDH Home Care management and a research advisory committee of staff members. The home care practitioner groups that participated in our study were female Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Home Health Aides (HHAs). RNs assess client needs, plan and coordinate health care, deliver nursing services, evaluate care, and teach and counsel clients and caregivers (formal and informal). A trained HHA’s duties include helping with personal care, applying bandages to assist circulation, administering oxygen, dispensing medication and aiding with catheter and bowel care. At the time of the study, most LPNs’ duties were identical to HHAs’ duties, although they were trained to perform some nursing tasks such as changing dressings and dispensing medication if the client is stable. Until restructuring, HHAs and LPNs practiced under the supervision of an RN. A period of restructuring took place in SDH Home Care from April to September 1999, which were the six months that we selected for the study period. The main elements of change were: (1) the integration of all practitioner categories into geographic teams, (2) role changes for practitioners, (3) transfer of medication management from RNs to both HHAs and LPNs, and (4) changes in office personnel.
The quantitative data reveal that all practitioners, regardless of their position, rated work satisfaction and overall health and well-being as being poorer over the study period when compared to the previous six months. HHAs rated their overall health and well-being lower than the other practitioners and were found to be using comparatively more sick/stress days. The qualitative data suggest that, in terms of both emotional and physical health, HHAs are clearly most affected by restructuring changes. These findings support the hypothesis that restructuring affects the health and well-being of practitioners and particularly the health of those lower on the human health care hierarchy. Eighteen policy directions were suggested to the management of Saskatoon Home Care by the research team. These include the implementation of policies to enhance the control HHAs CREATING BETTER CONDITIONS FOR CARE feel over work, more time allowed for patient care visits and more opportunities for practitioners to have input into planning policies and procedures, particularly when these are slated for change. SDH Home Care management has implemented a number of recommendations from the study; the role of LPNs, for example, has been expanded and now excludes any HHA duties. This research has practical significance for human health care policy. Exploring the effects of restructuring strategies sheds light on women’s caring work, women’s health and the place of women in society. For a full copy of the report, The Impact of Women’s Formal
(Paid) Home Care Work in Transition, please contact: Prairie Women’s Health Centre of Excellence NOTES |
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