Working environment in elderly care

Recent research suggests that working conditions in the Danish elderly care sector are under pressure from new demands, which change the potential to create meaning and identity at work. While one study concludes that the quality of the working environment fell overall between 2005 and 2008, a new book on elderly care in Scandinavia investigates how employees can still produce meaning and identity at work, and suggests which dilemmas must be addressed by management.

Transformation of care of the elderly

A new book, Elderly care in transition: Management, meaning and identity at work. A Scandinavian perspective, published by Copenhagen Business School Press, discusses how care of the elderly in Scandinavia has been transformed by the modernisation of the public sector. This reflects the reduction in the amount of time being spent with each individual because of the increasing pressure placed on the system by the growing number of elderly people who need care.

The book offers many interesting perspectives on the dilemmas and possibilities of what is often termed New Public Management (NPM). The term describes the adjustments that many countries, particularly in western Europe, have been making to their welfare models in recent decades, such as the introduction of explicit measures of performance, decentralisation, private-sector styles of management, contracting out and privatisation.

The conclusions of two Danish studies presented as separate chapters in the book are summarised below.

Creating a positive work identify

The chapter entitled ‘Meaning of work in elderly care in Denmark – fragile reconstructions’ by Betina Dybbroe is based on an in-depth case study of domiciliary care workers in organisations undergoing reform based on NPM over a long period of time. The study, which was conducted by researchers from the Department of Environmental, Social and Spatial Change at Roskilde University, found that the creation of meaning in elderly care depends on the possibility of constructing a positive work identity that is recognised both collectively and socially.

The author notes that constructing a positive work identity in care work can be achieved by focusing on:

  • the nursing elements of work;
  • the social elements of work;
  • the ability of domiciliary care workers to assess the state of the elderly and to solve their problems.

Much debate on developments in Danish elderly care has focused on neo-Taylorian and neo-liberal management tendencies, and how meaning, professionalism and autonomy is under pressure. The author concludes that new constructions of meaning are indeed possible in the work setting of modern public management if local management and politicians are able to develop care work to implement these ways of constructing a positive work identity.

Emotional aspects of the job

A different approach to the construction of meaning is presented in the chapter entitled ‘The meaning of work from subjective and intersubjective perspectives: A daily conflict of creating and losing meaning in elderly care’ by Annette Kamp. This study, which was carried out by researchers from the Department of Psychology and Educational Studies at Roskilde University in 2011, is based on a case study involving a dying patient, the central carer and the patient’s relatives.

The author argues that meaning is not only ruled by knowledge and experience but also by emotions, reciprocity and subjectivity. It is an ongoing process centred on the relationship between staff and care-receivers. The worker is here seen as a creative actor seeking individual meaning and a sense of belonging to the world of work. Dilemmas arise when the work ethic in providing care for the patient is opposed by conflicting interests and a lack of clarity in job demands. This leads to guilt, shame and frustrations, which, according to the author, are emotional aspects of elderly care to which managers and researchers should pay more attention.

Working environment in elderly care

Also in January, two reports based on a large study by Denmark’s National Research Centre for the Working Environment (NFA) was published which examined the development of the working environment among domiciliary elderly care workers between 2005 and 2008. The research consisted of a large survey among a number of municipalities across Denmark, comparing the working environment between municipalities and over time.

The survey was carried out three times with 36 municipalities participating in the first round (n = 9,949), 39 in the second round (n = 10,065) and 10 municipalities in the third round (n = 8,431). Nine municipalities participated in all three rounds and their results were compared.

The first report (in Danish, 1.38Mb PDF) examines how the municipalities compare with each other when looking at the following 10 work environmental areas:

  • physical working environment;
  • incidence of musculoskeletal problems;
  • demands at work;
  • resources at work;
  • positive conditions at work;
  • health and well-being;
  • quality of care;
  • experiences of offensive behaviour;
  • sickness absence;
  • expectations of employment termination/retirement.

The report concluded that, while still visible, the differences between the municipalities in relation to employee assessment of work environment, health and well-being decreased between 2005 and 2008 (Clausen et al, 2012). There was a correlation between many of the work environmental factors, and health and well-being, suggesting that these areas affect each other. Especially strong relationships were seen between factors such as psycho-social demands, psycho-social resources, positive conditions at work, quality of care, and health and well-being. This suggests that, by improving one condition at work, one should expect to see an improvement in these connecting conditions, which in the end could improve recruitment in the sector.

The second report (in Danish, 1.12Mb PDF) compares the development of the work environment of different professions in the care industry. With the exception of the physical working environment, which has improved, the report concludes that, while the results are ambiguous, they do show that the working environment among care workers worsened overall between 2005 and 2008 in the nine municipalities that participated in all three rounds of the survey. In particular, employee health and well-being had declined (Bern et al, 2012). Prognoses suggest that there will be more elderly in the future with fewer people available to recruit to the industry. A good work environment is seen as a crucial contributor to the recruitment of new employees and the retention of existing ones.

References

Bern, S.H., Clausen, T., Caneiro I.G., Borg, V. and Aust, B. (2012), Ændringer i arbejdsmiljø, helbred og trivsel for otte stillingsgrupper i ældreplejen fra 2005 til 2008 (1.12Mb PDF), SOSU Report no. 22, NFA, Copenhagen.

Clausen, T., Bern, S.H, Carneiro, I.G, Sejbæk, C.S, Borg, V. and Aust. B. (2012), Arbejdsmiljø, helbred og trivsel i ældreplejen i ni danske kommuner fra 2005 til 2008 (1.38Mb PDF), SOSU Report no. 21, NFA, Copenhagen.

Dybbroe, B. (2012), ‘The meaning of work from subjective and intersubjective perspectives: A daily conflict of creating and losing meaning in elderly care’, in Kamp, A. and Hvid, H. (eds), Elderly care in transition: Management, meaning and identity at work. A Scandinavian perspective, Copenhagen Business School Press, Frederiksberg, pp. 133–164.

Kamp, A. (2012), ‘Meaning of work in elderly care in Denmark – fragile reconstructions’, in Kamp, A. and Hvid, H. (eds), Elderly care in transition: Management, meaning and identity at work. A Scandinavian perspective, Copenhagen Business School Press, Frederiksberg, pp. 107–132.

Helle Ourø Nielsen, Jeppe Møller and Simone Visbjerg Møller, Oxford Research

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