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Health Promotion Theme, Canadian Public Health Association May 28, 2014 Toronto, Ontario, Canada

How Do Care Work Hierarchies & Task Orientation Impact Care Workers’ Experiences of Occupational Health and Safety? Case Studies of LTC in Toronto. Health Promotion Theme, Canadian Public Health Association May 28, 2014 Toronto, Ontario, Canada Iffath U.B. Syed , HBSc , MPH, PhD Student

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Health Promotion Theme, Canadian Public Health Association May 28, 2014 Toronto, Ontario, Canada

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  1. How Do Care Work Hierarchies & Task Orientation Impact Care Workers’ Experiences of Occupational Health and Safety? Case Studies of LTC in Toronto Health Promotion Theme, Canadian Public Health Association May 28, 2014 Toronto, Ontario, Canada Iffath U.B. Syed, HBSc, MPH, PhD Student Authors: IffathSyed, Dr. Tamara Daly, Dr. Ruth Lowndes, Dr. Pat Armstrong, Martin Chadoin, M.A., VishayaNaidoo, M.A. and C. Rowell

  2. Research Funding Institute of Gender & Health Contact Information: Dr. Tamara Daly, Ph.D. CIHR Research Chair in Gender, Work & Health Associate Professor, School of Health Policy & Management, York University Email: dalyt@yorku.ca

  3. Introduction • 2,577 Long Term Care Facilities Across Canada • 33.4% located in Ontario • Canadian Health Care Association 2007 Image Credit: Ministry of Health and Long Term Care, 2014

  4. Overview – Preliminary Analysis • How do front-line long term care staff experience task orientation and work hierarchies? • How are a task-oriented division of labour and stringent work hierarchies affected by staffing shortages? • In what ways are employee’s health and safety impacted? Image Credit: Ministry of Health and Long Term Care, 2014

  5. Theoretical Background • Task oriented division of labour • refers to work that is boundary laden, highly regulated, with the task divisions being very formalized • This is in contrast to relational work, where the task division is less strict and more fluid and contingent upon needs in the moment • Daly and Szebehely, 2012 • Work hierarchies • result in unequal social relations embedded in the workplace • Razack 2002 and Zaman 2012

  6. Methods • Rapid ethnographies of 5 non-profit long-term care facilities in Toronto, Ontario • 143 interviews conducted • Workers • Families • Directors of Care/Management • Observations recorded in Field Notes (N=110)

  7. Observed front-line care staff tasks

  8. Task-oriented Division of Labour - PSWs • PSW / Care Aides • “We don’t lift up the heavy stuff. We don’t empty the linen, you know, like the dirty linen. They [other staff] do that for us.” – PSW1, Site 4. • “I would love to be able to take someone downstairs and take them [the residents] out for a walk and all that. Like we can’t do that. We can’t take them off the unit. That’s something that would be kind of fun if you had the right resident where they have a good personality.” – PSW 2, Site 4

  9. Task-oriented Division of Labour – Rec Therapists “I’m responsible for central recreation so I coordinate all the programs. A lot of my programs will revolve around music and concerts. Games based. They could be board games, card games, bingo, that sort of thing. They could be arts based.” – Rec Therapist, Site 4 “I don’t have to toilet people, I don’t give medications... I just have fun. That’s all we get to do. We have fun. You know, at the end of the day you have... I think we’re given 30 minutes to document, 15 to 30 minutes…I will help [PSWs] bring them to the toilet... I’m not trained on the lift so I can’t help you if it’s a lift. To wipe them I’m not qualified technically. I haven’t been trained for that.” – Rec Therapist, Site 3 “They don’t tell us in the job description [about dining]. I would say ‘Oh, you didn’t tell us we would have to do meal partnering.’ Well it’s under ‘All other duties’, right?” – Rec Therapist, Site 5

  10. Task-oriented division of labour - nurses “I still do my rounds, take blood sugars and I’ll check on everybody but, you know, I cannot also take like some residents in the dining room, and they have to wait their medication because it takes time to give.” – RN1, Site 4 “Every unit has one assigned nurse whose role is to make sure that whatever information is put in is accurate for the client…it’s so task-oriented workplace, right? It’s [a] very clinical model” – Director of Care, Site 4

  11. Task oriented division of labour – housekeepers “I’m a housekeeper so I come in and I clean the second floor. I also clean first floor, the main floor. Then once I’m done I come up to second floor and start cleaning the nursing station, doing the sitting areas, then start my rooms. We have three rooms a day [for] general cleaning. And then after we’re done those three rooms we go along and we clean every bathroom of the residents, floors and bathrooms…and then work yourself around doing the activity rooms. Plus two kitchenettes. From time to time [my supervisor will] ask me if I’ll do the lunchroom. There’s a lunchroom for staff. I do the vacuuming. I do the vacuuming and I bring up the linen. I take the cart down before I go for break and then bring it up…if she [the supervisor] comes up and she sees me [helping a resident] ‘Well that doesn’t belong to your job. Just do what’s part of your job.’ It’s always about what’s part of my job. She doesn’t want us to do anything that’s part of their [the PSWs] job. ” – Housekeeper, Site 1

  12. Work hierarchies between different jobs “Even if you’re the manager and I need help with a resident, because that’s what we’re here for, you shouldn’t be too high to come and transfer me with somebody.” – PSW 1, Site 3 “There’s lots of hierarchy, right?, and then you get into okay, well I’m Filipino and I’m an RN, you know. That puts me higher than a Filipino PSW” – RN Manager, Site 4 “I find there is hierarchy here. You know, if for example a cleaner and a health care aide get into a dispute on linens, um, you know, we may say to the cleaner ‘Go and put the linens away’ even if it’s a health care aide responsibility, you know, just so that we make sure things continue.” – Manager, Site 1 “There is a hierarchy. I’m treated as one of the team, and the director of our department, I think, values my input. I value her input…but we also, um, you know, because we do work in an environment that is siloed and sometimes it is us against nursing. It sounds awful to say but it happens and so sometimes we do need to kind of retreat into our department” – Manager, Site 1

  13. Staffing shortages “we’re often short staffed here and this is a heavy floor because a lot of residents are in wheelchairs. A lot of times I’m really in there helping them and helping them with transfers.” – RPN 2, Site 3 “Trying to get food distributed, trying to get the health care aides to take the time to feed someone who needs to be fed their snack. Sometimes it feels like an afterthought. They’re busy. Like I mean it’s a function of too little staff to go around. Everybody knows that…Like it’s positively barbaric. I mean basically you’re bringing people into the dining room to sit and watch while someone is eating in front of you until it’s your turn. That’s not dignified. Like there’s all sorts of... it’s just purely wrong if you ask me.” Manager, Site 1

  14. How do task orientation and work hierarchies interact with staff shortages? “We have priorities. We have to always tell them ‘We have 28 residents and every resident has needs. Some more than others, so as a staff I have to make my priorities. Which is more priority? I have to prioritize my priority. Who needs me more? Time is the problem. We don’t have the time anymore. And even with the feeding you see…you have to put them in the table like, you know…Like assembly line. But you have to improvise. As I said, you know, it’s not right…. It’s inhuman” -- PSW1, Site 4 “Sometimes I sacrifice myself. I sacrifice my break. I don’t go for my break and I said for so many years [Site 4] must owe me a lot of money for not having a break. But I don’t want to tell the right hand what my left hand is doing, you know. I’m not exaggerating. I have to sacrifice myself. It’s me. People are not going to do that. They’re going to go for their break and so what happens? The care is even going to be...lower.” - PSW 1, Site 4 “I’m rushing through my residents to help them so we can get to dinner and all this and, you know, time constraints and all that kind of stuff it can be quite frustrating. You know, this is not a factory. This is not a factory job. It’s not an assembly line. Like some nursing homes it’s an assembly line. I can’t be running around like a monkey. It’s just too much for me and I was just running around and getting too stressed” – PSW 2, Site4

  15. Concluding Remarks • Structural challenges such as staffing shortages create challenging working conditions • A task-oriented division of labour and strict work hierarchies can lead to: • Workers’ experiences of stress and strain • Even more rigid boundaries around the work

  16. References Agnew, V. (2009). Racialized Migrant Women in Canada. Toronto: University of Toronto Press. CCOHS (2014). Musculoskeletal disorders – psychosocial factors. Available from: www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html Daly, T. and Szebehely, M. (2012). Unheard voices, unmapped terrain: Care work in long-term residential care for older people in Canada and Sweden. International Journal of Social Welfare. 21: 139-148 DOI: 10.1111/j.1468-2397.2011.00806.x. King, D.S. (2007). Rethinking the care-market relationship in care provider organisations. Australian Journal of Social Issues, 42(2) pp. 199-212. Levi, L. (2011). Psychosocial factors, stress and health. In Hurrell, J.J., Levi, L., Murphy, L.R., Sauter, S.L., (Eds.). Theories of Job Stress:Encyclopedia of Occupational Health and Safety. International Labor Organization, Geneva. Available from: http://www.ilo.org/oshenc/part-v/psychosocial-and-organizational-factors/theories-of-job-stress/item/10-psychosocial-factors-stress-and-health Ministry of Health and Long Term Care (2014). Home, Community and Residential Care Services. Available from: http://www.health.gov.on.ca/en/public/programs/ltc/default.aspx Razack, S.H. (2002). “When place becomes race”. In Razack, S.H. (Ed.). Race, Space and the Law: Unmapping a White Settler Society. Toronto: Between the Lines. Zaman, H. (2012). Asian Immigrants in “Two Canadas”: Racialization, Marginalization, and Deregulated Work. Halifax: Fernwood Publishing.

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