Risks to home care workers: Professional perspectives

Abstract

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and 'risks.' Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.

The problems of a ‘dirty workplace’ in domiciliary care

“…Various reasons were proposed by the respondents for this dirt: including physical or mental illness of clients which prevents them from cleaning; social deprivation; the inability to contain or correctly dispose of bodily fluids and household waste; or the client's or household members' choice to live in this manner. McKeever et al (2006) and Gershon et al's (2008) suggest that clients are potentially unable to reduce workplace hazards, whereas Taylor and Donnelly (2006) and Milligan (2009) argue that clients and relatives can be reluctant to change their home to make it more suitable as a care workplace if this contradicts their expectations of a living space. All of these factors applied in this study.…”

“…In general, it is argued that there is insufficient knowledge about domiciliaries' workplaces (Twigg, 1999;McKeever et al, 2006;Gershon et al, 2008;Henriksen et al, 2009;Milligan, 2009), and that improved understanding of domiciliaries' perspective is essential (Taylor & Donnelly, 2006).…”

“…Yet, although the client's home impacts upon domiciliary care, there has been limited research on this topic, and there have been calls internationally for more studies into domiciliaries' workplaces. Although this is a UK study, the place of domiciliary care is a subject of international interest (Dyck et al, 2005;Taylor and Donnelly, 2006;Henriksen et al, 2009) Interestingly, despite the recognition of dirty work in domiciliary care studies, the notion of a dirty workplace is largely absent. Whilst the limited literature (even internationally) that focuses on domiciliary care workplaces typically emphasises the hazards it entails, even these studies appear reluctant to describe client's homes as 'dirty workplaces'.…”

Other People's Homes as Sites of Uncertainty: Ways of Knowing and Being Safe

“…This raises challenges for how working in homes is both understood conceptually, and regulated in practice (Smith 2011). Taylor and Donnelly (2006) examined the safety of care workers, and the complex nature of simultaneously meeting the needs of their clients, and their own safety concerns. They highlight the tensions between the emphasis on risk management within health and social services, and the concurrent push for home-based care.…”

The Undervalued Work of the Home Care Aide

“…But despite the increasing demand, home care aides in the U.S. face difficult job conditions including physically difficult work; few opportunities for job advancement; low wages; irregular hours; and few, if any, employee benefits. Home care aides face similar difficult conditions in Canada (8), the Netherlands (9), and Northern Ireland (10,11). Turnover rates in the U.S. range from 44 to 65% annually (12), which can result in compromised care for elders and increased costs for home care agencies.…”