Home Care: Workplace Challenges: Addressing Task Shifting & The Impact of Workplace Violence

Every time I think about home care I get worried.  I worry about the frail elder and how well a home care worker is prepared to care for someone.  I worry about the home care worker and his or her ability to manage the needs and demands.  I worry about how isolating the experience is and ask, why couldn’t this elder be in a good nursing home environment with activities, socialization and on-site health care?  And then I am reminded that home care is the wave of the future and that most elders do want to remain in their own homes and that with good training and compassionate people home care can and does work well.

The Round Table addressed the issue of home care from the perspective of the home care worker.  More frequently home care is described and researched from the client’s perspective:    Is providing assistance with household chores (which is often the only expressed need) adequate?   Does home care relieve familial burden?  Is “selling” companionship the key to just letting someone in the door.  We used 3 different journal articles as our center point to discuss issues of task shifting, workplace violence and aggression and the more general topic of the relationship between home care worker, elder and family.   What I appreciated most was that these 3 articles put the home care worker at the center.  Bringing the home care worker out of the shadows is an apt metaphor when we recognize that the home care workforce is primarily made up of immigrant women of color – an already marginalized and shadowed group.

Nurse delegation was the first topic we addressed and generally received a positive response.  But I walked away from the entire morning discussion thinking that no matter what the tasks are, whether it be mundane tasks of housekeeping or the skills needed for changing wound dressings or catheters, the most salient factors were the importance of observation and monitoring (because frail elders are continually changing), having a team approach and understanding the emotional and human relationship aspect of developing trust as the core of the work.  I do not mean to imply here that the mundane tasks of housekeeping are not complex.  In fact, the mere fact of walking into someone’s home, who may not even want you there, and providing intimate care requires insightful skills and describes the ambiguous nature of the relationship, lying somewhere between formal and informal caregiving.

The discussion about workplace aggression and violence touched on the issue of working with complicated individuals with a history of mental illness.  Once again it was voiced that home care workers need the support of a skilled treatment team and validation that they are not at fault for occurrences of threats or actual acts of violence.  It was highlighted for me that the under-reporting or reluctance to report aggressive behaviors may be culturally determined.  Having to admit to such an act may mean “I’ve done something wrong,” turning it on themselves with feelings of guilt, shame or embarrassment.

A sustaining theme through the morning’s discussion was the need to bring greater professionalism and career building opportunities for home care workers.  Professionalism acknowledges that home care workers are an integral part of an entire care team.  As one person commented, it is important to view home care as a career and not a convenience.   This is an important policy issue that must be addressed at a political level. Those of us who recognize the worth and value of the work and can advocate on behalf of the workers also ultimately advocates for our older adult clients because they in turn will receive the best quality care .

The Round Table Discussion Group meets monthly for an interdisciplinary conversation with experienced professionals in the field of aging.  Each conversation uses one or two journal articles as reference points.  The articles read for this discussion were:

• Task Shifting in the Provision of Home & Social Care in Ontario, Canad:  Implications for Quality of Care, Margaret Dent, et al, Health and Social Care in the community (2015) 23(5), 485-492

• Workplace Violence Against Homecare Workers and its Relationship with Workers Health Outcomes:  A Cross-Sectional Study, Ginger C. Hanson,BMC Public Health 2015 15:11  Article URL  http://dx.doi.org/10.1186/s12889-014-1340-7

• Satisfaction With the Relationship From the Perspectives of Family Caregivers, Older Adults and Their Home Care Workers, Liat Ayalon & Ilan Roziner, Aging & Mental Health, 20:1, 56-64