Finding dignity in dirty work: the constraints and rewards of low‐wage home care labour

Abstract

The ageing of the population in the US and elsewhere raises important questions about who will provide long-term care for elderly and disabled people. Current projections indicate that home care workers -most of whom are unskilled, untrained and underpaid -will increasingly absorb responsibility for care. While research to date confirms the demanding aspects of the work and the need for improved working conditions, little is known about how home care workers themselves experience and negotiate their labour on a daily basis. This paper attempts to address this gap by examining how home care workers assign meaning to their 'dirty work'. Qualitative interviews suggest that home care workers have a conflicted, often contradictory, relationship to their labour. Workers identify constraints that compromise their ability to do a good job or to experience their work as meaningful, but they also report several rewards that come from caring for dependent adults. I suggest workers draw dignity from these rewards, especially workers who enter home care after fleeing an alienating service job, within or outside the healthcare industry.

Personal service assistance: Musculoskeletal disorders and injuries in consumer‐directed home care

“…Moderate to high social support from the recipient dropped the risk of being in the most chronic group by approximately onethird. Positive emotional ties connecting providers with recipients may mitigate job strain and impart dignity to an otherwise difficult, demanding, and often demeaning, service job (Chichin, 1992;Denton et al, 2002;Stacey, 2005). Furthermore, Lindahl and others have described the relationship between the home care professional and care recipient as one of 'being there for each other' (Lindahl et al, 2011).…”

The problems of a ‘dirty workplace’ in domiciliary care

“…Many of these activities are classified as 'dirty work', and can be challenging for domiciliaries. It is widely argued that because of stigma attached to the dirty work in domiciliary care, it is undervalued (Twigg, 2000;Stacey, 2005Stacey, , 2011McGregor, 2007;England and Dyck, 2011). Although surprisingly these studies have not examined how this dirt can also create a dirty workplace.…”

“…Twigg (2000) mentions the smell of bodily fluids and incontinent clients, but her focus is on the dirty work rather than the workplaces. Quotations from domiciliaries in Stacey's (2005) study do reveal how dirt from the clients can infiltrate the workplace, such as the leakage of bodily fluids onto sofas. Later Stacey (2011) does briefly describe the potential for a client's home to be "unsanitary and even threatening" (p,49), but in neither of these publications is this discussed further.…”

“…McGregor's (2007) study of dirty work focused on migrants, who describe their role as 'British Bottom Cleaners', and who also found such work challenging. Stacey's (2005Stacey's ( , 2011 American research acknowledges that such work is hard; nevertheless she also argues that domiciliaries derive 'dignity' from being able to do such dirty work through their skill and ability to perform these tasks, and the benefits this has for their clients. However, England and Dyck's (2011) account suggests that there is little dignity in performing 'dirty work', as it has been delegated down the care hierarchy to domiciliaries.…”

“…The term 'dirty work' refers to Hughes' (1958) and later Ashforth and Kreiner's (1999,p, 414) definition of work that has 'physical, social or moral taint'. In domiciliary care the work is 'physically tainted' from its association with bodies and bodily fluids, human and household waste, death and disease (Stacey 2005(Stacey , 2011. It is also 'socially tainted' through its association with a stigmatised group -older and disabled people -who are also discriminated against in terms of care; and because of the potentially 'servile relationship', to use Ashforth and Kreiner's term (1999, p,415), between domiciliaries and their clients.…”