Organizational Change and the Health and Well-Being of Home Care Workers
| Principal investigator(s): | Margaret Denton (McMaster University) |
| Co-investigator(s): | Isik Urla Zeytinoglu, Sharon Davies (McMaster University) |
| Sponsoring Institution: | McMaster University |
For more information about this study, please contact Margaret Denton mdenton@mcmaster.ca
Results
Project results show that home care workers have high levels of stress and burnout. On the positive side, workers in all occupational groups in this sector show high levels of self-esteem and mastery. In terms of physical health problems, a number of diagnosed health problems are common among this workforce, such as back pain, arthritis and rheumatism, migraine headaches, high blood pressure, stomach and intestinal disorders, and cancer. Physical health problems among this workforce are much higher than the comparable group in the Canadian population. Another occupational health problem for this workforce is workplace harassment and violence. Taking into consideration that these workers are primarily employed in elderly or sick clients’ homes, it is common for these workers to experience unacceptable racial/ethnic or sexual comments or harassment. Workers have high levels of job insecurity and are afraid of losing their jobs or workplaces closing because of their agency not getting the contract. Still, the workers are dedicated to their agencies and show low levels of propensity to leave. However, managers and supervisors are having problems managing the increasingly stressed, dissatisfied home care workforce. Many respondents are critical of the restructuring and managed competition process.
Our study shows that the restructuring and organizational change in the home care sector have contributed to the deteriorating health of workers. The business-like work environment, lack of resources in home care sector, government’s budget cuts, wage inequalities, work intensification, and perceived decline in the quality of care given to clients, are all taking their toll on these workers. Their stress levels are increasing and for some, burnout is a significant problem. The restructuring and organizational change factors are also associated with increased levels of diagnosed and self-reported musculoskeletal disorders (MSDs), job dissatisfaction, absenteeism, fear of job loss, and propensity to leave the workplace. In addition, the poor physical work environment, such as safety hazards in clients’ homes, repetitiveness of the job, and poor psychosocial work environment, such as lack of organizational (and supervisory) support, low co-worker support, lack of control over work, and lack of time to provide emotional support to clients, are all factors associated with increased levels of stress, burnout, MSDs, job dissatisfaction, absenteeism, feelings of job insecurity, and propensity to leave their agency.
Conclusion
Our results show that occupational health problems experienced by workers in this study are preventable. It is important to acknowledge occupational stress as resulting from incremental changes in the work and external work environment, and the resulting effects on physical health, job dissatisfaction, absenteeism, and propensity to leave the workplace. Sufficient government funding to provide services, avoiding continuous changes in the work environment, and making rational restructuring decisions based on input from all stakeholders can contribute to healthier workplaces and healthy workers.
Our results can assist employers, policy makers and workers in preventing work-related diseases and injuries. This research uncovered and provided new information to all stakeholders to improve the prevention of work-related injuries and illnesses. We hope our results can assist the WSIB to improve their policy and process by providing further evidence on how organizational change, restructuring, and management policy dictated by the government can affect workplaces, work practices and workers’ health.
As we conduct further statistical analysis of our data and as our research is published, we anticipate that our findings will make significant contributions to policy formation and professional practices in Canada and elsewhere. We also hope that the results of this project can be used to influence policy formation in home care sector at the local, provincial and international levels. Agencies and unions working with us are anxious to assess the impact of changes made in their organizations, and of health care restructuring on the health and well-being of their employees. We encourage them to use the outcomes of this research to make appropriate work changes that can minimize disabilities and work-related illnesses such as stress, burnout and MSDs. Our research contribution will be especially important as home care reform comes to the forefront of policy debates in Ontario and Canada.
Objectives
The purpose of this research program is to uncover and provide new information to improve the prevention of work-related injury and illnesses in home care work. This study focuses on home care workers, which include both visiting home care workers (personal support workers, nurses and therapists who work directly in the client/consumer’s home) and office home care workers (case managers, coordinators, office staff, supervisors and managers).
Home care has recently been restructured from a non-competitive system of home health care delivery by non-profit and for-profit organizations to a system of ‘managed competition’ [through requests for proposals (RFP)], where both non-profit and for-profit agencies have to compete for contracts to deliver home health care services. Further, the restructuring of health care has shifted much of the burden of health care to the community sector without a corresponding shift in the level of funding for community health care agencies.
The objective of this research is to study the impact of health care restructuring and other organizational changes on the mental and physical health of home care workers. By mental health we refer to stress and burnout. By physical health we refer to occupational illnesses such as musculoskeletal disorders (MSDs) and injuries. Job satisfaction, absenteeism, job insecurity and propensity to leave are examined as individual and organizational outcomes.
Method
This study covered 11 agencies and 7 union locals. We interviewed 59 key decision-makers, 171 workers in 29 focus groups, and surveyed 1,313 workers (70% response rate). Qualitative data were analyzed for themes and quantitative data analysis consisted of descriptive statistics and associations between variables.
The research design incorporated both qualitative and quantitative data gathering. We began with 59 interviews with agency executive directors, managers and union representatives to develop an understanding of health and safety issues in their agencies. Of interest was the relationship of organizational change associated with health care restructuring in general and long-term care restructuring in particular. This was followed with a series of 29 discussion groups with employees from the participating agencies to gather their input on these issues. Information gathered through the interviews and the discussion groups, a review of current literature and knowledge gained from our earlier study informed the development of a questionnaire that was administered to all 1,949 employees of the home care agencies. In total 1,311 home care workers responded to the survey, representing a close to 70% response rate.
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