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Maintaining the ‘caring self’ and working relationships: a critically informed analysis of meaning-construction among paid companions in long-term residential care

Published online by Cambridge University Press:  18 February 2019

Laura M. Funk  and
Linda Outcalt
Laura M. Funk*
Affiliation:
Department of Sociology, University of Manitoba, Winnipeg, Manitoba, Canada
Linda Outcalt
Affiliation:
Department of Sociology, University of Victoria, Victoria, BC, Canada
*
*Corresponding author. Email: Laura.Funk@umanitoba.ca
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Abstract

In Canadian residential long-term care, paid companion services are increasingly viewed as helping to meet older adults’ psycho-social needs. Complementing the critique of these services from a political economy perspective, analyses of companions’ talk about their work can illuminate not only why companions stay in devalued and often invisible work, but also how social assumptions and circulating narratives about nursing homes and older adults are implicated in this process. In this article, we draw on in-depth analyses of interviews with both companions and organisational representatives. We interpret companions’ accounts in relation to their need to justify the necessity for their work to their employers (families), to nurture good relationships with the facilities in which they work, and to maintain a sense of identity as a responsible, conscientious and ‘caring self’. In this way, these precarious workers inadvertently reproduce dominant narratives, including those that stigmatise dementia and residential care, and facilitate the privatisation of person-centred, relational care. Organisational representatives generally reproduce similar assumptions about care responsibilities, in a context in which facilities are increasingly challenged to meet a range of resident needs. Discussion highlights tensions around responsibility for psycho-social care in nursing homes, highlighting organisational vested interests in avoiding risk and downloading responsibilities to families and to private, independent and temporary workers.

Keywords

private companionsnursing homesinterpretive analysislong-term care
Type
Article
Information
Ageing & Society , Volume 40 , Issue 7 , July 2020 , pp. 1511 - 1528
Copyright
Copyright © Cambridge University Press 2019

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References

Alzheimer Society of Canada (2014) PC P.E.A.R.L.S.™: 7 Key Elements of Person-centred Care of People with Dementia in Long-term Care Homes. Available at http://www.alzheimer.ca/sites/default/files/Files/national/Culture-change/PCPEARLS_full_e.pdf.Google Scholar
Armstrong, H, Daly, TJ and Choiniere, JA (2016) Policies and practices: the case of RAI-MDS in Canadian long-term care homes. Journal of Canadian Studies 50, 348–367.CrossRefGoogle Scholar
Banerjee, A, Daly, T, Armstrong, P, Szebehely, M, Armstrong, H and Lafrance, S (2012) Structural violence in long-term, residential care for older people: comparing Canada and Scandinavia. Social Science and Medicine 74, 390–398.CrossRefGoogle ScholarPubMed
Barken, R, Daly, TJ and Armstrong, P (2016) Family matters: the work and skills of family/friend carers in long-term residential care. Journal of Canadian Studies 50, 321–347.CrossRefGoogle Scholar
Brassolotto, J, Daly, T, Armstrong, P and Naidoo, V (2017) Experiences of moral distress by privately hired companions in Ontario's long-term care facilities. Quality in Ageing and Older Adults 18, 58–68.CrossRefGoogle ScholarPubMed
Brown, K and Korczynski, M (2017) The caring self within a context of increasing rationalization: the enduring importance of clients for home care aides. Sociology 51, 833–849.CrossRefGoogle Scholar
Bruce, E (2004) Social exclusion (and inclusion) in care homes. In Innes, A, Archibald, C and Murphy, C (eds), Dementia and Social Inclusion. London: Jessica Kingsley, pp. 123–135.Google Scholar
Canadian Institute for Health Information (2013) When a Nursing Home is Home: How Do Canadian Nursing Homes Measure Up on Quality? Ottawa: Canadian Institute for Health Information.Google Scholar
Centre on Aging (2014) Health Status and Health Care Use (Quickfacts). Winnipeg, Canada: University of Manitoba. Available at http://umanitoba.ca/centres/aging/media/CoA_Profile_Quickfacts_2014_health_status_FINAL_web.pdf.Google Scholar
Cooke, H, Puurveen, G and Baumbusch, J (2017) ‘It's the nature of the person’: critically exploring family members’ perceptions of residential care aides in long-term care. Paper presented at the 46th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, 21 October, Winnipeg, Canada.Google Scholar
Cossever, F (2006) Private companions in long term care. Long Term Care 16, 18–20.Google Scholar
Coughlan, R and Ward, L (2007) Experiences of recently relocated residents of a long-term care facility on Ontario: assessing quality qualitatively. International Journal of Nursing Studies 44, 47–57.CrossRefGoogle ScholarPubMed
Daly, T and Armstrong, P (2016) Liminal and invisible long-term care: precarity in the face of austerity. Journal of Industrial Relations 58, 473–490.CrossRefGoogle ScholarPubMed
Daly, T, Armstrong, P and Lowndes, R (2015) Liminality in Ontario's long-term care facilities: private companions’ care work in the space ‘betwixt and between’. Competition and Change 19, 246–263.CrossRefGoogle Scholar
Daly, T, Struthers, J, Muller, B, Taylor, D, Goldmann, M, Doupe, M and Jacobsen, FF (2016) Prescriptive or interpretive regulation at the frontlines of care work in the ‘three worlds’ of Canada, Germany and Norway. Labour/Le Travail 77, 37–71.CrossRefGoogle ScholarPubMed
Daly, T and Szebehely, M (2011) Unheard voices, unmapped terrain: care work in long-term residential care of older people in Canada and Sweden. International Journal of Social Welfare 21, 139–148.CrossRefGoogle Scholar
Degiuli, F (2010) The burden of long-term care: how Italian family care-givers become employers. Ageing & Society 30, 755–777.CrossRefGoogle Scholar
Degiuli, F (2016) Caring for a Living: Migrant Women, Aging Citizens, and Italian Families. New York: Oxford University Press.CrossRefGoogle Scholar
Dergal, J (2011) Family Members’ Use of Private Companions in Nursing Homes: A Mixed Methods Study (Doctoral dissertation). University of Toronto, Toronto. Available at http://hdl.handle.net/1807/31734.Google Scholar
Dobbs, D, Eckert, JK, Rubinstein, B, Keimig, L, Clark, L, Frankowski, AC and Zimmerman, S (2008) An ethnographic study of stigma and ageism in residential care or assisted living. Gerontologist 48, 517–526.CrossRefGoogle ScholarPubMed
Dodson, L and Zincavage, RM (2007) ‘It's like a family’: caring labor, exploitation, and race in nursing homes. Gender and Society 21, 905–928.CrossRefGoogle Scholar
Doupe, M, Brownell, M, Kozyrskyj, A, Dik, N, Burchill, C, Dahl, M, Chateau, D, De Coster, C, Hinds, A and Bodnarchuck, J (2006) Using Administrative Data to Develop Indicators of Quality Care in Personal Care Homes. Winnipeg, Canada: Manitoba Centre for Health Policy. Available at http://mchp-appserv.cpe.umanitoba.ca/reference/pch.qi.pdf.Google Scholar
Duffy, M, Armenia, A and Stacey, CL (2015) On the clock, off the radar: paid care work in the United States. In Duffy, M, Armenia, A and Stacey, CL (eds), Caring on the Clock: The Complexities and Contradictions of Paid Care Work. New Brunswick, NJ: Rutgers, pp. 3–13CrossRefGoogle Scholar
Folbre, N and Nelson, JA (2000) For love or money – or both? Journal of Economic Perspectives 14, 123–140.CrossRefGoogle Scholar
Funk, LM and Roger, KS (2017) Implications of the shifting landscape of residential care for volunteers’ lived experiences and role involvement. Ageing International 42, 44–61.CrossRefGoogle Scholar
Gilleard, C and Higgs, P (2010) Aging without agency: theorizing the fourth age. Aging and Mental Health 14, 121–128.CrossRefGoogle ScholarPubMed
Gubrium, JF and Holstein, JA (2000) Analyzing interpretive practice. In Denzin, NK and Lincoln, YS (eds), The Sage Handbook of Qualitative Research. Thousand Oaks, CA: Sage, pp. 487–508.Google Scholar
Harper Ice, G (2002) Daily life in a nursing home: has it changed in 25 years? Journal of Aging Studies 16, 345–359.CrossRefGoogle Scholar
Hasson, H and Arnetz, JE (2011) Care recipients’ and family members’ perceptions of quality of older people care: a comparison of home-based care and nursing homes. Journal of Clinical Nursing 20, 1423–1435.CrossRefGoogle ScholarPubMed
Hochshild, A (1983) The Managed Heart: Commercialization of Human Feeling. Berkeley, CA: University of California Press.Google Scholar
Johnson, EK (2015) The business of care: the moral labour of care workers. Sociology of Health and Illness 37, 112–126.CrossRefGoogle ScholarPubMed
Keefe, J, Légaré, J, Charbonneau, P and Décarie, Y (2012) Intergenerational support to older Canadians by their adult children: implications for the future. In De Santis, G (ed.), The Family, the Market or the State? (International Studies in Population Vol. 10). Dordrecht, The Netherlands: Springer, pp. 141–158.Google Scholar
Lloyd, L, Banerjee, A, Harrington, C, Jacobsen, FF and Szebehely, M (2014) It is a scandal! Comparing the causes and consequences of nursing home media scandals in five countries. International Journal of Sociology and Social Policy 34, 2–18.CrossRefGoogle Scholar
Manitoba Nurses Union (2018) The Future of Long-term Care is Now: Addressing Nursing Care Needs in Manitoba's Personal Care Homes. Winnipeg, Canada: MNU.Google Scholar
McGregor, MJ, Tate, RB, Ronald, LA, McGrail, KM, Cox, MB, Berta, W and Broemeling, AM (2010) Trends in long-term care staffing by facility ownership in British Columbia, 1996 to 2006. Health Reports, Statistics Canada 21, 27–33.Google ScholarPubMed
McParland, P, Kelly, F and Innes, A (2017) Dichotomising dementia: is there another way? Sociology of Health and Illness 39, 258–269.CrossRefGoogle ScholarPubMed
Mead, GH (1934) Mind, Self and Society. Chicago, IL: University of Chicago Press.Google Scholar
Miller, EA, Tyler, DA, Rozanova, J and Mor, V (2012) National newspaper portrayal of U.S. nursing homes: periodic treatment of topic and tone. Milbank Quarterly 90, 725–761.CrossRefGoogle ScholarPubMed
Novek, S (2013) Filipino health care aides and the nursing home labour market in Winnipeg. Canadian Journal on Aging 32, 405–416.CrossRefGoogle ScholarPubMed
Outcalt, L (2013) Paid companions: a private care option for older adults. Canadian Journal on Aging 32, 87–102.CrossRefGoogle ScholarPubMed
Shenk, D (2009) Moral agency of direct care workers and the people for whom they care. Journal of Aging, Humanities and the Arts 2, 285–299.CrossRefGoogle Scholar
Stacey, CL (2011) The Caring Self: The Work Experiences of Home Care Aides. Ithaca, NY: ILR Press.CrossRefGoogle Scholar
Stacey, CL (2005) Finding dignity in dirty work: the constraints and rewards of low-wage home care labour. Sociology of Health and Illness 27, 831–854.CrossRefGoogle ScholarPubMed
Vourlekis, BS, Gelfand, DE and Greene, RR (1992) Psychosocial needs and care in nursing homes: comparison of views of social workers and home administrators. Gerontologist 32, 113–119.CrossRefGoogle ScholarPubMed