Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia

Abstract

Canadian frontline careworkers are six times more likely to experience daily physical violence than their Scandinavian counterparts. This paper draws on a comparative survey of residential careworkers serving older people across three Canadian provinces (Manitoba, Nova Scotia, Ontario) and four countries that follow a Scandinavian model of social care (Denmark, Finland, Norway, Sweden) conducted between 2005 and 2006. Ninety percent of Canadian frontline careworkers experienced physical violence from residents or their relatives and 43 percent reported physical violence on a daily basis. Canadian focus groups conducted in 2007 reveal violence was often normalized as an inevitable part of elder-care. We use the concept of "structural violence" (Galtung, 1969) to raise questions about the role that systemic and organizational factors play in setting the context for violence. Structural violence refers to indirect forms of violence that are built into social structures and that prevent people from meeting their basic needs or fulfilling their potential. We applied the concept to long-term residential care and found that the poor quality of the working conditions and inadequate levels of support experienced by Canadian careworkers constitute a form of structural violence. Working conditions are detrimental to careworker's physical and mental health, and prevent careworkers from providing the quality of care they are capable of providing and understand to be part of their job. These conditions may also contribute to the physical violence workers experience, and further investigation is warranted.

Finnish healthcare professionals' attitudes towards robots: Reflections on a population sample

“…Robots as mobile virtual assistants could help with translating or sign language. Thirdly, we associate the approval of robot assistance in threatening situations to the home or residential care workers’ worries regarding aggressive behaviour among residents and their relatives (Banerjee et al., ).…”

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“…Furthermore, the competing definitions must include overt and subtle oppressions. While difficult and uncomfortable for us to acknowledge, the oppressions of care include the coercion of gendered, racialised and globalised bodies into caring servitude (Glenn 2010) and potential harm to care workers (Banerjee et al 2012). Disability scholars and activists highlight that care can be patronising, used to justify institutionalisation and other inhumane practices, and deny agency.…”

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“…In the context of AHC, the value of Galtung's model can also be seen in its analysis of the complexity of violence, uncoupling direct violence from the isolated act of an individual and contextualizing it as a result of cultural and structural conditions. In medicine and health care, Galtung's concept has been applied, for example, by Farmer, to set the causation of certain diseases in the context of the perpetuation of social conditions and distributions of power (28), but also by Banerjee et al, who explored structural violence in long-term residential care for older people in Canada and Scandinavia (29). In the latter example, the authors show how care workers were exposed to structural violence through high workloads, rigid work routines, low autonomy, and low status, which made it difficult, if not impossible, to fulfill the residents' needs, who in turn behaved violently towards the care workers (29).…”

“…In medicine and health care, Galtung's concept has been applied, for example, by Farmer, to set the causation of certain diseases in the context of the perpetuation of social conditions and distributions of power (28), but also by Banerjee et al, who explored structural violence in long-term residential care for older people in Canada and Scandinavia (29). In the latter example, the authors show how care workers were exposed to structural violence through high workloads, rigid work routines, low autonomy, and low status, which made it difficult, if not impossible, to fulfill the residents' needs, who in turn behaved violently towards the care workers (29). The authors of the latter study suggest that, in care facilities, the experiences of those who care and who are cared for are strongly informed by structural conditions.…”