Long-Term Care Facility Workers’ Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care: A Qualitative Study in British Columbia, Canada

Abstract

Subcontracting long-term care (LTC), whereby facilities contracted with third party agencies to provide care to residents, became widespread in British Columbia after 2002. This qualitative study aimed to understand the impact of subcontracting from the perspective of care workers. We interviewed 11 care workers employed in subcontracted facilities to explore their perceptions of caring and working under these conditions. Our overarching finding was one of loss. Care workers lost wages, benefits, security, and voice. Their working conditions worsened, with workload and turnover increasing, resulting in a loss of experienced staff and a loss of time to provide care. These findings call into question the promises of quality and flexibility that legitimated policies permitting subcontracting, while adding to the mounting evidence that subcontracting LTC harms both workers and residents.

Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review

“…One suggestion in previous reviews was that stakeholders must implement more clearly defined precautionary routines and regulations that address for-profit incentives and risk-related outcomes such as decreased staffing levels or job resources ( Comondore et al, 2009 ; Herrera et al, 2014 ; Ronald et al, 2016 ). As discussed by Banerjee et al (2021) , enforcing stricter staffing-level regulations to combat incentives to cut the workforce could be one option. Kruse et al (2021) discussed different approaches: disincentivizing for-profit ownership, favoring non-profit ownership, and demanding higher minimum staffing standards.…”

“…For-profit incentives have also been linked to reduced staffing levels in U.S. nursing homes ( Harrington et al, 2012 ) and fewer hours of care in Canada ( Hsu et al, 2016 ). Furthermore, subcontracting nursing homes to for-profit third-party agencies was described by interviewed Canadian direct-care staff as detrimental to their working environment ( Banerjee et al, 2021 ). Private for-profit ownership was, in an umbrella review, associated with poorer results concerning health-related outcomes, specifically care quality in nursing homes ( Herrera et al, 2014 ).…”

First-Line Managers’ Perceptions of Their Psychosocial Work Environment in Nursing Homes: A Qualitative Analysis of the Influence of Ownership Type

“…Subsequently, the type of ownership might play a role in infuencing the psychosocial work environment, afecting the demands and resources experienced by FLMs and care workers. For-proft incentives have been associated with reduced stafng levels [24] and worse working conditions [25,26], and Lindmark et al's [18] systematic review highlighted the potential benefts for staf of non-proft ownership.…”

Biopower under a state of exception: stories of dying and grieving alone during COVID-19 emergency measures

“…This model has direct effects on the adequacy of care received by residents as the labour force often is characterised by low qualifications, low unionisation, poor job security, unsafe working conditions and low pay (Banerjee et al . 2019; Banerjee et al . 2021).…”