Home care workers’ experiences of work conditions related to their occupational health: a qualitative study

Abstract

Background The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. Methods A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. Results HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. Conclusions This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

The Hidden Script of Work-Related Burdens in Home Care – A Cross Over Mixed Analysis of Audio Diaries

“…Home care workers are exposed to strains in all four areas (Quinn et al, 2021; Treviranus et al, 2021). Examples of this include strains related to relationships with colleagues, patients, and relatives (social relationships; Mojtahedzadeh, Wirth, et al, 2021), challenging client needs (work content; Karlsson et al, 2020), staffing challenges, high workloads and time pressure (work organization; Fjørtoft et al, 2020; Grasmo et al, 2021; Otto et al, 2019; Sjöberg et al, 2020), and dangerous traffic situations (work environment; Grasmo et al, 2021). In addition, the working conditions in home care are associated with a variety of physical strains such as working in awkward posture when assisting with toileting and bathing in private bathrooms or holding heavy loads when lifting patients (King et al, 2018; Otto et al, 2019).…”

“…Much of the research on work-related burden and its consequences has been cross-sectional in design; thus, the findings are limited by snapshots of pre-selected variables and fail in determining whether a strain associated with an outcome is causal or not (Karlsson et al, 2020; Ruotsalainen et al, 2020). Existing qualitative studies in this field provide a more comprehensive picture of work-related burdens in home care, but are dominated by interviews and focus groups (e.g., Fjørtoft et al, 2020; Grasmo et al, 2021), which provide only one-time retrospective narratives. This methodological approach limits the insights into situated events, illustrating how and to what extent home care workers experience different types of work-related burdens, and how they link them in one storyline within a specific contextual framework (Williamson et al, 2015).…”

Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial

“…The workers need to adapt to the patients' health, functional abilities and living circumstances, such as crowded and small residences that are frequently insufficiently equipped for the required care tasks [1]. As a result, home care workers may spend considerable periods of time in awkward postures, often involving pulling and pushing while caring for patients [1,2], and home care workers often find their work physically strenuous [3][4][5]. As a likely consequence, home care workers often report musculoskeletal pain and sick leave; as illustrated by their 11% sick leave rate, almost double the national average [6][7][8].…”

“I found myself alone” – A phenomenological study of the home care workers' experience during the COVID‐19 pandemic

“…Because of the fear of getting infected (de Leo & Trabucchi, 2020 ), many home‐dwelling older people who needed care hired HCWs, a type of informal caregiver paid for their services by the patient. HCWs provide personal caregiving services, including assisting their clients in activities of daily living, carrying out medically oriented tasks such as helping their older clients take their medications, and in some cases providing companionship to their clients (Grasmo et al, 2021 ). In Italy, where this study was conducted, HCWs are generally Eastern European women who do not have the qualifications for or formal training to be HCWs.…”