What’s Past is Prologue:
Comparing Long-term Care Workers and Working Conditions Between Canada and Nordic Countries 10 Years Later
In 2006, our team was funded by CIHR to conduct the Long-term Care Workers’ Survey (LTC-WS) to better understand the work of Canada’s highly gendered LTC labour force and to compare conditions here with the Nordic countries. This groundbreaking survey was conducted in three Canadian provinces (Ontario, Manitoba, Nova Scotia) as well as Sweden, Norway, Denmark and Finland, and later in Germany and Japan. It advanced knowledge about work in LTC facilities in Canada and internationally, highlighting issues surrounding gender, work and care. The results underlined challenges related to staffing, models of care and workers’ exposure to violence in LTC facilities in Canada.
Today, Canada’s long-term care (LTC) workforce is undergoing major shifts in demographics, working conditions and work organization, involving new challenges and opportunities. Our team has been funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) to provide fresh comparative insight into the nature of contemporary work in LTC. Led by Dr. Tamara Daly, a CIHR Research Chair in Gender, Work and Health, this four year mixed-method project brings together a multi-disciplinary team of experts and partners representing LTC workers across the country. It focuses on exploring the current nature of work in LTC five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia.
A new, expanded survey for LTC workers is currently underway, as are complementary surveys for informal caregivers, paid companions, and managers in LTC facilities to build on the work started with the Invisible Women Study. Survey results, together with findings from ethnographic observation, focus groups and interviews, will improve understanding of work, working conditions, and work organization. In collaboration with our Nordic colleagues, who are also conducting a revised survey for LTC workers, we will extend and expand current understandings of different forms of work in different jurisdictions. In examining a wide spectrum of formal and informal work in LTC settings, this project will provide urgently needed insights into recent changes as well as key challenges and opportunities for the future in this important sector.
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Re-imagining Long-term Residential Care
Long-term residential care is where many of our most vulnerable members live and, in spite of moves towards aging in place, where many will continue to live in the future. It is also a workplace for thousands of paid and unpaid providers, most of whom are women and many of whom are from racialized communities. It is a barometer of values and practices; a signal of economic, cultural and social perspectives. It raises issues well beyond specific services and practices; issues such as human and social rights, the role of the state, responsibilities of individuals and families, work organization and skills; and notions of care. Yet too often it is characterized as failure; failure of the family to care, failure of the health care system to cure and failure of the individual to live independently, perhaps explaining why it has received so little research and policy attention. Instead of focusing mainly on failures, this project identifies promising practices for conceptualizing and organizing long-term care, learning from and with other countries. What approaches to care, to work organization, to accountability, to financing and ownership offer the most promising practices when the goal is to treat both providers and residents with dignity and respect, to understand care as a relationship and to take differences and equity into account? What contexts and conditions support these practices, allowing residents and providers to flourish? These are questions for the social sciences and humanities, as well as for those who deliver, those who organize and those who need care.
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Invisible Women: Gender and the Shifting Division of Labour in Long-term Residential Care
How does growth in the number of private duty carers coupled with the care work performed by unpaid students, volunteers and family members in long-term residential care facilities impact the organization of care? The study is specifically interested in how occupational health and safety and the division of labour are affected by the informal care provided by people other than those employed at the facility. It is mostly women who are employed in long-term residential care. Recent health human resources research does recognize that women are the overwhelming majority of paid providers but consideration of gender in relation to paid health care work is not common, as is evident when reviewing the 2010 health systems trends report from the Ontario Ministry of Health and Long-Term Care. While we have little information on the gendered dimensions of paid work in long term residential care, we have next to no information about the other paid and unpaid carers in facilities, nor is this informal care acknowledged in research or in policy. Addressing this gap is of vital importance because of the implications for our understanding of facility care, of the safety of the space and of the people who live and work there. We will survey all nursing homes and retirement homes in Ontario, and conduct interviews and detailed observations of units in 5 facilities in Toronto and with selected residents and their carers in each of the 5 facilities to elicit answers to several important overarching questions: 1. How has the division of labour shifted for facility employees due to the work performed by informal carers (i.e. paid private duty carers, students, volunteers and family members)? 2. In what ways are workloads and occupational health and safety in the facilities affected by the care performed by these other carers? 3. Finally, how do we understand the amount of time available for care (e.g. staff intensity) when we account for work performed by other carers?
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Validating a response format to facilitate responding in older adults
This study evaluates if a response tree maintains the psychometric properties in, and improves older hospitalized adults’ responding to, several standardized surveys measuring symptoms of orthostatic hypotension, fatigue, and sleep quality. The results will: 1) provide data validating the use of the revised scales; and, 2) have implications for how other self-report scales are designed for use with older hospitalized adults. These are important considerations since the data generated from such surveys are used all the time for evaluation, accountability and quality improvement purposes (e.g. Hospital Report Card and Patient Satisfaction Surveys).
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Systematic review of acute hospital geriatric intervention units
Specialized geriatric services have been designed to prevent the complications of hospitalization for acutely ill older adults with complex chronic disease. In this review we are examining all of the information that has been written about these services. We are describing the activities that are delivered in each service, and we are evaluating which services are best at preventing complications for older adults.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Nurse and organizational readiness to deliver best elder care: The key to Ontario’s ability to design and implement Senior Friendly Hospital plans
Many provincial health authorities committed to developing Senior Friendly Hospitals after improved outcomes were identified when older adults received services based on the Acute Care for Elders (ACE) model of service delivery. The ACE model speaks to the unique and central role of nurses, yet little is known about nurses’ capacity to provide best elder care. The goal of this project is to better understand nurses’ needs to provide best elder care. The project will examine the relationships between organizational (team collaboration, geriatric resources, and leadership support) and nurse (skill and knowledge in geriatric nursing and patient & family centred-care, and ACE role agreement) characteristics, nurse outcomes (role clarity, job satisfaction and turnover intentions), and nurses’ perspectives on best elder care. We will ask up to 3615 nurses to complete relevant surveys, and up to 80 nurses participate in focus groups to further our understanding of their needs and to identify strategies to help nurses provide best elder care. This project is critical to the success of Senior Friendly Hospital initiatives. It will provide information that decision-makers in provincial health authorities can use to enhance nurses’ ability to ensure that older adults have good health and discharge outcomes during hospitalization.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).