Because of the gradual aging of the population, hospital facilities for socio-sanitary care of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hire home-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations (...) about their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires from home-care workers’ point of view. We reconstructed how home-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile of home-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of. (shrink)

Community care for frail elderly people rests heavily on the work of low-status, paraprofessional home care workers. Home care workers describe their work as highly personalized caring labor that often seeps out of its formal boundaries into informal, unpaid activities. Although these activities are valued by workers, their supervisors, elderly clients, and family members, they represent uncompensated and exploited labor. Cost-cutting trends in home care management that seek to depersonalize home care (...) labor are likely to increase its exploitative potential for paid care workers and, simultaneously, to disadvantage and jeopardize elderly home care clients and their unpaid family caregivers. (shrink)

Unionization of home care has depended on the state location of the occupation. Government social policies and funding created home care, shaping the structure of the industry and the conditions of work. The welfare nexus, linking old age, disability, health, and welfare policies, however, also transformed care hidden in the home into a public service. Through case studies of California and Oregon, leaders in deinstitutionalizing care of the elderly and disabled, we explore the (...) social struggles that forced the state to recognize its invisible workforce. The home location of personal attendants and other health aides has entailed not only organizing challenges but policy innovation as well. Using the welfare state location of the labor, workers allied with consumers to develop the public authority as a newstructure of representation. The history of home care shows that social welfare and health policy have long been entangled with labor policy. (shrink)

Home care is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good (...) care involves attending to the needs of another out of a concern for their well‐being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care.. (shrink)

Care workers frequently withdraw from elderly people in their care; this has resulted in a number of scandals in the media. Here I analyze an empirical scene observed at an old people’s home in Denmark, which contains behavioral patterns among the care workers which could be seen as withdrawal. At the same time it illustrates the care workers' commitment to the elderly. A paradoxical "empathy at a distance" is characteristic of the scene. When analyzing my (...) written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a "hermeneutical key" which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own care relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important theme. The article illustrates how working consciously with the researcher's subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers’ need for emotional supervision. (shrink)

Bien que Caring for America ait fait l’objet de nombreuses recensions au moment de sa publication en 2012, ce n’est que maintenant, sept ans plus tard, que l’on peut saisir l’importance de son apport à la littérature sur le travail de care. Depuis une dizaine d’années, cette littérature s’étoffe, surtout dans les sciences sociales mais Caring for America s’en distingue par sa dimension historique. Eileen Boris et Jennifer Klein montrent que les caractéristiques associées par les chercheurs au...

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. (...) First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch. (shrink)

Background Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. Research aim Our aim was to describe the care workers’ lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being (...) and nursing education. Research design Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. Participants and research context We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. Ethical considerations This was a sensitive study, which was connected to the participants’ individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. Findings Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. Conclusions Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society. (shrink)

The ethical dimension of care work is less explored in Chinese long-term care (LTC) settings. This paper accentuates care ethics embodied by direct care workers (DCWs) from an ethnographic study of care at Sunlight Nursing Home in central China. I include the notion of xiao (filial piety) to construe care ethics by engaging both feminist and intersectional approaches. Empirical findings highlight the narrative of mei banfa (‘there is nothing you can do about it’) (...) in revealing the complexity of caregiving in a commercialised environment where both physical and emotional care intertwine. Mei banfa compels DCWs to invoke their agency in care practice despite inadequate support from the nursing home and negative social portrayals of care work. It is a cognitive coping strategy of DCWs to harness their energy in upholding care ethics for both the elderly residents and their own family members. Such commitment is unlikely to be sustained if structural barriers continue to impede the recognition of care labour as part of social production. Arguably, an ethically informed approach to both policymaking and care practice gives voice to human interdependency in care work and affords ways to reimagine a caring future. (shrink)

The American system of long‐term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved ones often (...) at considerable cost to themselves.As the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties. The supply of unpaid family caregivers will become limited, as the ratio of people in the category of ages forty‐five to sixty‐four compared to those who are eighty and older shrinks from just above seven to one in 2010 to just above four to one in 2030. Paid caregivers will be needed to take up the slack, yet they are poorly paid, work under very difficult conditions, and receive little respect from the health care system. In this essay, I discuss the circumstances facing these paid home‐care workers and a possible path forward, illustrating the current problems by drawing on interviews I conducted for a book‐length study published in 2017. (shrink)

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A (...) constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the health care workers’ conflict between their professional role and their moral role, which they perceived as unclear. (shrink)

The glaring lack of formal and informal caregivers in Germany has not only become apparent in hospitals and nursing homes but also in home care arrangements. One tension is particularly pertinent in such arrangements: a ‘family-oriented’ logic of the long-term care insurance and the individual wishes of those in need of care meet the actual possibilities of family carers. This care gap has been compensated for by 24-hour care workers, so-called ‘live-ins’, from Eastern Europe (...) for some years. This contribution maps the ‘live-ins’ situation comprehensively from an ethical perspective. Based on different constellations regarding the ‘live-ins’ status as a professional nurse or non-professional caregiver, which ethical principles and moral norms are affected by whom and potentially conflict with each other in such home care arrangements at a micro and meso level of care are outlined. Special attention is paid to the tension between self-care and care for others, and to questions of the shared responsibility in and social responsibility of those external services that are involved in home care in addition to the ‘live-in’. In order to uncover, understand and influence the current ethical problems, an ethical framework that considers both the divergent interests of all individuals involved in the home care arrangement and their mutual dependency and vulnerability is needed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 373-378 [Access article in PDF] The Forgotten Self:Training Mental Health and Social Care Workers to Work With Service Users Kim Woodbridge Keywords self, workers perspective, them and us, win-win situation The three main papers and the case studies presented in this issue of Philosophy, Psychiatry, & Psychology all focus on the service user perspective in relation to the self as illustrated by (...) different aspects of philosophy. This is also in the context of the service user looking for help during a time when they are experiencing levels of distress and difficulty.Important as this is, evident by the substantial clinical and philosophical literature in this area, what has been overlooked is the perspective of the mental health and social care worker responsible for the care of individuals whose sense of self is disturbed. The significance of this omission has been brought home to me through my experiences in running training workshops for workers working with service users with a diagnosis of personality disorder. (From here on, in this paper, the terms worker and trainee are used interchangeably to refer to the mental health and social care worker).During these workshops challenges to the worker's sense of self have been revealed emotionally ("this doesn't feel like me"), ideologically ("I am not a bad person"), and/or practically ("I don't usually behave like this") when discussing their work with service users. This paper draws from the workshop experiences to explore and consider the workers perspective in relation to the self in more detail.There follows a descriptive account of three workshop sessions which include the trainees responses. With each activity the responses are considered within the context of the self, particularly from the worker's perspective. In the conclusion the argument is made, as evidenced by these illustrations, for the importance of including the workers' perspective when attempting to understand the self. The Trainees and Service Users Workers from various professional and nonprofessional backgrounds attend the workshops. They include psychiatrists, nurses, social workers, support workers, and occupational therapists who work in both in-patient and community settings. They usually have several years of clinical experience working with people with a [End Page 373] diagnosis of personality disorder, but rarely have they had any formal education or training in the area. Discussing their experiences of working with this service user group generates strong and highly emotionally charged personal responses during training.It is their experiences of the relationships with service users whose sense of self is absent, inconsistent, or unstable, that make a substantial contribution to the content of the workshops.Often service users are struggling with fragmented, distorted, or threatening perceptions of the world, themselves, and others. The worker, while embedded within their own sense of self, is engaged in a relationship with the service user. The issues that arise as a part of this relationship can be challenging and distressing for the workers. There are two main areas:The impact the service user's chaotic, fragmented, and unstable sense of self has on the worker's own sense of self.The response of the workers when their sense of self is challenged, and the impact that response has on the service user. These can be seen in more detail in the examples taken from the training sessions presented later in this paper. The Training Sessions The training sessions are either run alone or form part of a 1- or 2-day workshop. As mentioned, the groups are composed of a variety of professionally and nonprofessionally qualified staff. The experiences they share mainly relate to people with a diagnosis of Borderline Personality Disorder, although other subcategories are mentioned occasionally. Information regarding these and other related sessions can be found in two recent publications: Making positive connections (Duff, Meredith, & Woodbridge,2003) and "Whose good practice?" (Woodbridge & Fulford, 2003). The First Activity: Revealing Internal Models Given the lack of available evidence, even the best-informed trainees are likely to have to fill in the knowledge gaps with their own interpretations of... (shrink)

“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

The high-tech health service work done by amateur family caregivers in U.S. homes challenges the conventional division of the social world into public and private. Under new federal reimbursement systems, the diagnosis-related groups, patients are being discharged sicker than before from hospitals and nursing homes, or after treatments in outpatient clinics. Health care facilities depend on a work transfer, shifting their earlier responsibilities for the sick to the family. There, women family members do for free the work once done (...) by paid health service workers in health care facilities, caring for family members who need their nursing and housekeeping services. Women's unpaid work knits together “public” and “private,” demonstrating how capitalism reorganizes the labor process to make use of free service labor. (shrink)

p166 In February 1965, the United States escalated the war against South Vietnam radically, and also, on the side, began regular bombing of the North at a much lower level. That was a big public issue in the United States: Should we bomb North Vietnam? The bombing of the South was ignored. The same shows up in the internal planning, for which we now have an extremely rich record, not only from the Pentagon Papers, but from tons of declassified documents (...) that have been released in the last couple of years. It turns out again, one of the very few interesting revelations of the Pentagon Papers that there was no planning for the escalated bombing of the South. There was very meticulous planning about the bombing of the North carefully calibrated, when should we do it, and a lot of agonizing about it. The bombing of the South at triple the scale of the North is barely discussed. There are a few casual decisions here and there. The same shows up in McNamara's recent memoirs. He discusses at great length the bombing of the North. The bombing of the South he literally doesn't mention. He mentions what he did on January 21, 1965, a really important day: there was a big discussion about whether to bomb North Vietnam. He doesn't mention what we know from other documents, that on that same day, he authorized for the first time the use of jet planes to escalate the bombing of South Vietnam over and above the massive bombing that had been going on for years that's not even mentioned. (shrink)

Home-based service jobs have developed considerably across Western societies. In fact, chances are high that a working-class woman in France today will, at some point in her life, be a house cleaner, home-based child care provider, or home aide for the elderly. Going against political, scholarly, and everyday discourses that, saturated with the double prejudices of gender and class, treat all these home service occupations, which require little prior training, the same, this article illuminates the (...) variability of the forms of subordination experienced by women practicing these occupations in France. Comparing these jobs with the ensemble of low-skill jobs and with each other exposes what is specific to the particular form of subordination each job type entails, in terms of the extent of job supervision and the nature of the home where it is practiced, the presence or absence of relations with coworkers and/or a “public,” and the nature of this “public.” It mobilizes nationwide statistical data in a new way to shift attention to these numerous ordinary work situations, which are much less studied than those of the domestic workers of the wealthiest cities of the Western world. (shrink)

Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data (...) were analysed with a thematic analysis approach. Participants and research context The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. Ethical considerations The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. Findings A main challenge was that staff found it difficult to respect the patient’s autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff’s threshold for considering the use of coercion appeared to be high. Conclusions Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems. (shrink)

Mysticism is condemned as often as it is praised. Much of the condemnation comes from mysticism’s apparent disregard of morality and ethics. For mystics, the experience of “union” transcends all moral concern. In this careful examination of the works of such practitioners or examiners of mysticism as Paul Tillich, Thomas Merton, Evelyn Underhill, and Martin Buber, the author posits a spectrum of uneasy relationships between mysticism and morality. Horne explores the polarities of apophatic (imageless) and imaginative mysticism, the contemplative and (...) the active life, and morality and amorality. He stresses the importance of the distinction between “proper-name” (entirely personal) morality and “social” morality, for the history of Christian mysticism is a mix of minimal moral concern, proper-name morality, and social morality. The volume will be of interest to students of religious experience, ethics, and the recent history of mysticism. Carefully reasoned and documented, the argument is couched in clear prose, easily accessible to lay readers as well as to scholars. (shrink)

Background:Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress.Objectives:The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs’ experiences of (...) ethical issues.Methods:Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home.Findings:The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work.Conclusions:The review highlighted a need for improved ethics education for care-providers. (shrink)

PurposeThe purpose of this paper is to explore how surveillance facilitates new power relationships.Design/methodology/approachThis longitudinal qualitative study is predicated on observations of the home care workers interacting with their managers and clients. The emerging picture was complemented with interviews of the participants. The home care workers were chosen as being crucial in the construction of new everyday relationships, and their interpretations were given most value in presenting how surveillance and monitoring relationships are constructed as embedded mundane (...) practices and as emerging from practical needs.FindingsThe paper discusses an implementation and use case of surveillance capable technology in a social home care setting. The findings suggest discrepancy of how surveillance is being interpreted by different participants depending on their positioning in the context of use.Originality/valueThe study presents a case study where surveillance issues emerge not only at the workplace but also in the domestic sphere. The paper explores the workers' role in defining surveillance at the workplace, and questions the limits of legitimate surveillance in the social care context concerning vulnerable citizens as clients. (shrink)

The aim of this article is to reveal how care workers in the home-help services handle the process when older people’s relocation to a residential home is under consideration. Since the care workers are engaged daily in defining care receivers’ needs and yet have no formal influence on care decisions in Sweden, the focus is on how they solve this dilemma. In this inductive study, the theoretical framework is based on occupational alliances, relationship-based practice, (...) and discretion. Thirty-three care workers in home-help services are included in open semi-structured interviews. Prominent features in the findings are that the care workers take their stand at the borderland of care management, when they know or try to find out what is right. The conclusions drawn are that care workers find ways to informally influence the decision-making process, quite contrary to the idea of approaches referred to as purchaser/provider models. The implications for social work policy and practice are that a distinction between assessment and intervention may not benefit the field of eldercare and should therefore be regarded as an area in need of thorough reconsideration. (shrink)

IntroductionFew studies have examined psychological distress in healthcare workers across the care continuum. This study describes distress levels reported by HCWs across care settings and factors associated with distress.MethodsA cross-sectional survey of HCWs from Windsor, Ontario, was conducted between May 30th, 2020, and June 30th, 2020. The survey included the Kessler Psychological Distress Scale, sociodemographic, frontline status, perceptions of training, protection, support, respect among teams, and professional and personal stressors. Univariate analyses were used to compare across settings and (...) multivariate logistic regression assessed factors associated with distress.ResultsFour hundred and three HCWs from the hospital, community health and social service, first responder, primary care, home, and long-term care participated in the survey. Common concerns included fear of transmitting COVID-19 to family, safety on the job, and balancing personal care with work demands. LTC and home-care HCWs reported greater concern about workload and staffing levels, whereas community health workers were more anxious about their financial security. Overall, 228 HCWs who completed the K10 reported high distress, with greater rates among hospital and LTC HCWs. Distress was more likely in HCWs who identified as female, younger than 55, perceived lower respect among team, and experienced greater worry about physical and mental health and managing high workloads.ConclusionResults showed a high degree of distress experienced by HCWs across care settings and the impact of the COVID-19 pandemic on personal and work-related stress. Promoting self-care and supportive and collaborative healthcare teams are promising avenues for mitigating symptoms of distress. (shrink)

Background: During the COVID-19 pandemic, frontline workers faced a series of challenges balancing family and work responsibilities. These challenges included making decisions about how to reduce COVID-19 exposure to their families while still carrying out their employment duties and caring for their children. We sought to understand how frontline workers made these decisions and how these decisions impacted their experiences.Methods: Between October 2020 and May 2021, we conducted 61 semi-structured interviews in English or Spanish, with individuals who continued to work (...) outside of the home during the pandemic and had children living at home. Interviews were recorded, transcribed verbatim, and analyzed using abductive methods.Results: Frontline workers experienced moral distress, the inability to act in accordance with their values and obligations because of internal or external constraints. Their moral distress was a result of the tensions they felt as workers and parents, which sometimes led them to feel like they had to compromise on either or both responsibilities. Individuals felt morally conflicted because 1) their COVID-19 work exposures presented risk that often jeopardized their family’s health; 2) their work hours often conflicted with their increased childcare responsibilities; and 3) they felt a duty to their colleagues, patients/customers, and communities to continue to show-up to work.Conclusions: Our findings point to a need to expand the concept of moral distress to include the perspectives of frontline workers outside of the healthcare professions and the fraught decisions that workers make outside of work that may impact their moral distress. Expanding the concept of moral distress also allows for a justice-based framing that can focus attention on the disparities inherent in much frontline work and can justify programmatic recommendations, like increasing paid childcare opportunities, to alleviate moral distress. (shrink)

Canada’s population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as (...) healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs’ experiences of ethically challenging situations is warranted.We conducted a phenomenological study to access the lived experience of HCAs (N=12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care. (shrink)

In recent years, much attention has been paid to how older people living at home can remain independent and manage their illness themselves, while less attention has been given to those who have become frail and need assistance with challenges of everyday life. In this article, I drew on Latimer's formulation of care for frail older people as relational and world‐making and on Foucault's work related to the care of the self in developing an understanding of how (...) frail older persons manage to live well at home in the final years of their lives. I use data from an ethnographic study of home care nursing in the homes of 15 frail older people to develop an understanding of how their care at home can be developed. The participants were holding on to life, which reflected their vitality and vulnerability as well as agency in continuing to explore ways to preserve and build their world at home. With declining ability and stamina relations with material things, relatives and official care workers become of central importance in holding on to life. Home care services can be thought of as part of life, as world‐forming, where workers contribute to daily activities that support living well at home. (shrink)

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social‐based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives (...) from critical social theory to explore the phenomenon of social‐based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social‐based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower‐class workers and subsequently improving resident care delivery. (shrink)

Palliative care is a recent branch of health care. The doctors, nurses, and other professionals involved in it took their inspiration from the medieval idea of the hospice, but have now extended their expertise to every area of health care: surgeries, nursing homes, acute wards, and the community. This has happened during a period when patients wish to take more control over their own lives and deaths, resources have become scarce, and technology has created controversial life-prolonging treatments. (...) Palliative care is therefore faced with more ethical problems that other areas of health care. This book, by a clinician, teacher, and writer on health care ethics, has been written to provide all those who care for the terminally ill--doctors, nurses, social workers, clergymen, physiotherapists--with the concepts and principles which will assist them with difficult decisions. It challenges many received doctrines of palliative care, but its well-illustrated central theme is that technical expertise must be controlled by humane, non-technical judgments. (shrink)

Hiring international migrant eldercare workers to work hard for little pay simply because this traveling workforce needs wages higher than those they would receive back home seems somehow “wrong.” The standard justification for hiring migrants seems more like an excuse than a justification. My purpose in this article, however, is not to condemn people who hire international migrant eldercare workers, but to suggest that these employers as well as their employees are caught in the same moral bind. Depending on (...) how uncaring a state is about meeting its people’s fundamental needs including adequate long-term care, it will create a hostile environment for the development of caring people. But a society without a sufficient number of caring people risks unraveling. People who avoid care work and who shun the practice of care are, in my estimation, “marginal” to society in that they are not contributing to the foundation that makes society possible. (shrink)

This essay examines a special program developed by the international Canadian mining firm, Placer Dome, to help recently laid-off workers find remunerative work in southern Africa. Shortly after it bought a 50% interest in the Deep South gold mine in South Africa, the mine laid off nearly 2600 workers. The firm gave redundant miners token serverance pay and offered them opportunity to participate in training and counseling services at the mine site. Overwhelmingly, the miners came from homes all over southern (...) Africa at great distance from the mine to which homes they chose to return. In addition, many had become ill from the HIV virus. Placer Dome soon realized that something more was required, given the very high rates of unemployment in the region. After securing grants from USAID and CIDA, and working with NGOs representing both the unions and mining companies in South Africa, the firm developed Project CARE. The project contacted workers where they lived and offered them or another proxy member of their households a variety of training, coaching, and consultative services. Within 2 years 65% of those contacted had either found new employment or started their own business. The project helped those households with HIV-affected ex-miners care for their affected family members. While describing the case, the essay raises more general ethical questions about the responsibilities of mining firms in particular for their redundant workers. (shrink)

This paper examines nurses’ international migration within the broader context of female migration, particularly against more studied groups of women who have migrated for employment in care‐giving roles. We analyze the similarities and differences between skilled professional female migrants (nurses) and domestic workers (nannies and in‐home caretakers) and how societal expectations, meanings, and values of care and ‘women's work’, together with myriad social, cultural, economic and political processes, construct the female migrant care‐giver experience. We argue that, (...) as the recruitment of foreign workers gains visibility, strategies are introduced to better prepare female migrant care‐givers for the marketplace. Language, specifically command of English and accent modification, is highlighted as one means to assimilate migrant care‐givers to host communities. (shrink)

This paper examines the environment in which waged caregiving takes place. Because the activities of care have been predominantly performed by women in the home, a caring attitude is taken to be inherent to the persons who perform this labor. My analysis endeavors to clarify this misconception. Drawing on studies of paid caregivers who assist elderly individuals accomplish the tasks of self-care, I discuss how these workers face at least three layers of uncertainty. Paid caregiving takes place (...) on a fragile moral terrain, and I argue that the prevalent structure of paid care labor cannot acknowledge this, nor can it support caring within care labor. I use Claudia Card’s concept of gray areas to highlight the manner in which the structure of care labor inhibits the care worker from easily negotiating the moral terrain of caregiving. (shrink)

In Japan, most residents with Hansen’s disease live in dedicated sanatoria because of an established quarantine policy, even after being cured of the primary disease. They suffer from secondary diseases and are advancing in age, and advance care planning is increasingly crucial for them to live their lives with dignity in a sanatorium. In this study, we have three aims: to understand how to promote communication about their wishes for medical treatment, care, and recuperation; to identify required assistance; (...) and to explore how to promote ACP in a sanatorium. This study is a qualitative research conducted through semi-structured interviews. The study included 57 ex-Hansen’s disease patients and 66 staff from 10 facilities. Ex-Hansen’s disease patients were expected to consider ACP, but this was in the context of uncertainty about whether a sanatorium would close and whether there would be doctors to manage their needs. They reported being confused when staff rushed to confirm their advance directives, feeling that they were not provided with enough information before being approached. Barriers to promoting ACP were found to be insufficient of team-based care and information sharing, ex-Hansen’s disease patients’ weak interest in their end of life, and their conservative thoughts. We believe that ACP can be achieved by listening to the wishes of recovered patients through regular home care visits by nurses and everyday support by care workers. Furthermore, multidisciplinary coordination is urgently needed for promoting ACP. (shrink)

Studies of the challenges faced by women in policing have paid little attention to the specific experiences of policewomen who are mothers. Guided by critical theorizing on the gendered nature of the police culture and domestic labor, 16 police officer mothers in Ontario, Canada, were interviewed. Our qualitative analyses explore their experiences of the “lion’s share” of domestic labor; the organizational, cultural, and operational features of policing; and the challenges of child care, and examine how these combine to foster (...) particular stresses. In contrast to intensive mothering approaches that rely on the advice of external experts, our participants work to protect children by carefully constructing stories and asking questions that are based on their own on-the-job experiences with dangerous and/or abhorrent situations. As such, they engage in danger-protection parenting practices to prevent their children from becoming victims or offenders. Our research extends the theorizing on intensive/extensive mothering practices, builds on the scholarship on policing, and adds to the literature on women in nonstandard occupations. This sociological analysis of police mothers’ experiences and practices underscores the importance of understanding and working to change the social contexts, at work and at home, that compromise the well-being of police mothers and other emergency-response workers. (shrink)

In the early twentieth century, scientific innovations permanently changed international warfare. As chemicals traveled out of laboratories into factories and military locations, war became waged at home as well as overseas. Large numbers of women were employed in munitions factories during the First World War, but their public memories have been overshadowed by men who died on battlefields abroad; they have also been ignored in traditional histories of chemistry that focus on laboratory-based research. Mostly young and poorly educated, but (...) crucial for Britain’s military success, these female workers were subjected to procedures of social regulation and consigned to carrying out dangerous chemical procedures causing chronic illness or death; in particular, when TNT died their skin yellow, they were colloquially known as 'canaries.'. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through (...) participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

Despite the fact that there is unmet demand for nurses in health services around the world, some nurses migrate to destination countries to work as domestic workers. According to the literature, these nurses experience contradictions in class mobility and are at increased risk of exploitation and abuse. This article presents a critical discussion of the migration of nurses as domestic workers using the concept of ‘global care chain’. Although several scholars have used the concept of global care chains (...) to illustrate south to north migration of domestic workers and nurses, there is a paucity of literature on the migration of nurses to destination countries as domestic workers. The migration of nurses to destination countries as domestic workers involves the extraction of reproductive and skilled care labor without adequate compensatory mechanisms to such skilled nurses. Using the case of the Canadian Live‐in Caregiver Program, the study illustrates how the global movement of internationally educated nurses as migrant domestic workers reinforces inequities that are structured along the power gradient of gender, class, race, nationality, and ethnicity, especially within an era of global nursing shortage. (shrink)

This essay examines a special program developed by the international Canadian mining firm, Placer Dome, to help recently laid-off workers find remunerative work in southern Africa. Shortly after it bought a 50% interest in the Deep South gold mine in South Africa, the mine laid off nearly 2600 workers. The firm gave redundant miners token serverance pay and offered them opportunity to participate in training and counseling services at the mine site. Overwhelmingly, the miners came from homes all over southern (...) Africa at great distance from the mine to which homes they chose to return. In addition, many had become ill from the HIV virus. Placer Dome soon realized that something more was required, given the very high rates of unemployment in the region. After securing grants from USAID and CIDA, and working with NGOs representing both the unions and mining companies in South Africa, the firm developed Project CARE. The project contacted workers where they lived and offered them or another proxy member of their households a variety of training, coaching, and consultative services. Within 2 years 65% of those contacted had either found new employment or started their own business. The project helped those households with HIV-affected ex-miners care for their affected family members. While describing the case, the essay raises more general ethical questions about the responsibilities of mining firms in particular for their redundant workers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Driven from Home: Protecting the Rights of Forced Migrants Edited by David Hollenbach, SJ, and: Kinship across Borders: A Christian Ethic of Immigration by Kristen HeyerRené M. Micallef SJDriven from Home: Protecting the Rights of Forced Migrants EDITED BY DAVID HOLLENBACH, SJ Washington DC: Georgetown University Press, 2010. 296 pp. $20.46Kinship across Borders: A Christian Ethic of Immigration KRISTEN HEYER Washington DC: Georgetown University Press, 2012. (...) 210 pp. $29.23Although based on a conference held at Boston College in November 2008, Driven from Home is no less timely today, given the context of current debates on immigration in the United States, the European Union, Australia, and the Middle East. David Hollenbach’s introduction explains how the book brings together Christian (mostly Catholic) theologians, human rights activists, humanitarian practitioners, and legal scholars to help us focus on a class of persons referred to as “forced migrants” or “persons needing protection.” These individuals are neither classical “convention refugees” (according to international law definitions) nor are they simply “migrant workers” (in the classical sense) since their basic human rights to security and subsistence cannot [End Page 230] be adequately guaranteed in their home country or region. They do not emigrate merely in search of a higher standard of living; rather, forced migrants enter and settle in foreign lands seeking some sort of “protection” similar to that afforded to “conventional” refugees. More concretely, the book focuses on persons on the move—individuals fleeing violence and the extreme poverty rampant in regions devastated by ecological degradation and natural disasters.Extending the logic of the 1952 Refugee Convention and adapting it to the realities of today, one can argue convincingly that the international community has a duty to protect such persons when their states of origin are structurally unable or unwilling to afford protection (as argued in Susan Martin’s essay). However, paternalistic approaches that diminish rather than augment the agency of local governments and migrants are to be avoided (as maintained in M. Brinton Lykes’ essay). The book helps us reflect on what can be done to guarantee the basic rights of forced migrants not only at the level of international law and institutions but also through domestic and regional policymaking spurred and inspired by both Christian and secular global-humanitarian values. Such values are eminently compatible when applied to this particular issue (see Silvano Tomasi’s contribution). Agbonkhianmeghe Orobator’s essay—which offers insightful reflections (albeit rather general ones) from Christian ethics, ecclesiology, and biblical theology—likewise points to the need for a truly interdisciplinary approach to the issue. The other authors help the book achieve precisely this. Theological ethics finds its own distinctive place and voice in dialogue with a range of perspectives: legal and political sciences and case studies (Frank Brennan, Daniel Kanstroom); philosophical approaches (Arash Abizadeh); and sociological research on particular migrant populations (M. Brinton Lykes, Maryanne Loughry). The book includes essays that integrate case studies, technical reflections, useful summaries of theological principles and doctrines (J. Bryan Hehir, Mary M. DeLorey, and Tomasi), and philosophical stances (Abizadeh, Thomas G. Weiss), and present practical and legal proposals (see Martin’s essay). A stimulating read for scholars and for the general public, the volume provides good training material for faith-based activists and practitioners.The argumentation strategy in many of the essays in Driven from Home is to appeal to the reader’s sense of solidarity with the needy or suffering neighbor. It promotes the virtues of hospitable citizenship and hospitable disciple-ship while carefully trying to convince national and international policymakers to reinforce and expand the international protection regime. Emboldened by the 2005 “Responsibility to Protect” breakthrough at the United Nations, the authors seek to remain acceptable to a wide audience in an atmosphere of resurgent nationalism, nativism, and protectionism. The authors generally avoid harsh critiques of Westphalian models of sovereignty and do not dwell [End Page 231] on the Catholic doctrines of the universal destination of created goods and the (circumscribed) right to immigrate (and not only to emigrate). Rather, they seek to introduce a new protection niche without fundamentally challenging the prevailing ideology of sovereignty, gently proposing new legal instruments as though they... (shrink)

Undocumented and undomiciled, Gustavo Jiménez had been in the United States for several years. He knew his leg wasn’t right when it began to swell and redden. After the cellulitis spread to his bloodstream, he was found unconscious on the street and admitted to the intensive care unit. He improved quickly and was soon able to tell a social worker his name and that he had family in Quito. Then his health took a turn for the worse, and (...) he developed multisystem organ failure. His doctors believed his prognosis grave and further care futile. They wanted to invoke a provision under their state’s law that allows, at the discretion of at least two physicians, for the withdrawal of life‐sustaining therapy for isolated and decisionally incapacitated patients, but the social worker had ethical concerns about the doctors’ desire to make such a momentous decision without family input. She asked for a “time‐out to locate his family,” but one of the doctors asserted, “His family isn’t here, and you’ll never find them. Besides we need the bed. The ER is full of patients we can help.” What is owed a patient and family in such a situation? (shrink)

Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived (...) experience of troubled conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

Social workers form part of many healthcare teams. This role can involve in-depth conversations with clients and home visits. These encounters can reveal sensitive information, not all of which may be accessible to other members of the healthcare team. Most modern healthcare systems employ shared care records, which are populated by, and accessible to, multiple members of the healthcare team. Shared care records are valued for their capacity to enhance inter-professional communication and improve patient care. But (...) this very capacity may increase an underlying tension between privacy and efficient, effective care. Ethical tensions can arise for health social workers between comprehensive documentation and protecting client privacy by limiting access to privileged information obtained in the context of a social work encounter. This qualitative empirical ethics study investigated health social workers' experiences of tensions between client privacy and maintaining complete records, and how they thought the tension should be resolved. Participant testimony informed a pragmatist approach to identify principles governing recording of sensitive information in shared care records. Three principles were identified: necessity, accuracy, and neutrality. Participants' reports of moral concerns about recording indicate that ethical tensions can occur. The identified principles offer a starting point for managing such tensions. (shrink)

The aim of this paper is to propose a research agenda for future studies of local forms of caregiving. It does this by exploring practices of care giving and receipt through the prism of childcare. Focusing on Nairobi, it investigates one critical form of care work in the city: the labour of women who work as ‘nannies’ in private homes, a form of labour that has received little systematic study or scholarly attention. Every day, women in Nairobi construct (...) complex and far-ranging care chains that ensure that the socially necessary labour of childcare takes place. The phenomenon of ‘diverted mothering’ that has been associated with the globalisation of care can also be understood as a local phenomenon. Whereas global care chains involving migrant domestic workers have been the focus of detailed investigation, hitherto the workings of more widespread and highly fragile local care chains in the cities of the third world have been neglected. We argue that it is critical to understand practices of intimate and emotional labour in the context not just of global migration but in situations of severe intersecting inequalities within the global south. (shrink)

Women from post-socialist countries started migrating to Turkey in the second half of the 1990s to work in the domestic work sector. Migrant domestics have formed their niche as live-in caregivers, due to the disinclination of the existing local labour power to work in the care sector. Yet, the employer mothers, besides asking their live-in workers to tend their children, often demand that they also do the daily chores in the home, purposely leaving the heavy cleaning to their (...) Turkish domestics. This way, live-in migrant domestics are promoted from the status of foreign employees to fictitious family members, to eventually embody `the ideal housewife'. (shrink)

The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing how therapists (...) should handle unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of (...) contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)