Jennifer Plenderleith

Casualized employment and turnover intention: Home care workers in Ontario, Canada

The purpose of this paper is to examine the associations between casualized employment and turnover intention in home care. Casualized employment refers to employment conditions of non-permanent contracts, part-time or casual hours, involuntary hours, on-call work, split shifts, pay per visit, and hourly pay with variable hours. Casualized employment also refers to perceived employment insecurity and labour market insecurity. Data are from a survey of 991 visiting nurses, therapists and home support workers in a medium-sized city in Ontario, Canada. Results show that, controlling for many other factors, casual hours and perceived employment insecurity and labour market insecurity are positively and on-call work is negatively associated with home care workers turnover intention. Non-permanent contract, part-time hours, involuntary hours, split shifts, and non-salaried pay are features of the market-modelled home care work environment and therefore may not be associated with turnover intention. Results provide evidence on the effects of casualized employment strategies on home care workers turnover intention.

Flexible employment and nurses' intention to leave the profession: The role of support at work.

OBJECTIVESnThe objectives of this paper are to examine (1) the association between flexible employment and nurses intention to leave the profession, and (2) whether or not support at work mediates the association between flexible employment and nurses intention to leave the profession. Flexible employment is analyzed objectively using non-permanent contract, part-time employment status, casual employment status, involuntary hours and on-call work, and subjectively using job insecurity. Support at work refers to organizational, supervisor and peer support.nnnMETHODSnData come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario. Descriptive statistics are provided. Bivariate correlations, hierarchical regression analysis and mediation tests are conducted.nnnRESULTSnCompared to those in full-time employment, nurses in part-time employment do not intend to leave the profession. None of the other objective flexible employment factors are associated with intention to leave the profession. Perceived job insecurity is associated with intention to leave the profession. Low support at work contributes to intention to leave the profession and mediates the association between job insecurity and intention to leave the profession.nnnCONCLUSIONSnThe study provides evidence to health sector managers and policy makers that part-time employment, perceived job security and support at work are important factors to consider in efforts to retain nurses in the profession.

Older Adults' Awareness of Community Health and Support Services for Dementia Care

The article examines where older adults seek help in caring for a parent with dementia and the factors associated with their identification of community health and support services as sources of assistance. The authors conducted telephone interviews, using random digit dialing, of 1,152 adults aged 50 and over in the city of Hamilton. Respondents received a vignette that raised issues related to parental dementia. In identifying support sources, over 37 per cent of respondents identified their physician, 33 per cent identified informal support such as family and neighbors, and 31 per cent identified home health services. Only 18 per cent identified community support services. Female participants having higher levels of education were more likely to identify their physician as a source of support. Knowing where to find information about community support services was associated with an increased likelihood of mentioning physicians and home health services as sources of assistance. L’article examine où les personne agées peuvent chercher l’aide pour prendre soin d’un parent avec démence et les facteurs associés à leur identification des services de santé et de soutien communautaires comme des sources d’aide. Les auteurs menées des entrevues téléphoniques, à l’aide de numérotation de chiffres aléatoires, de 1,152 adultes âgés de 50 et plus dans la ville de Hamilton. À déterminer les sources de soutien, plus 37 pour cent des répondants a identifié leur médecin, 33 pour cent a identifié un soutien informel comme la famille et voisins et 31 pour cent a identifié des services de santé maison. Seulement 18 pour cent a identifié des services de soutien communautaires. Participants femmes ayant des niveaux plus élevés de scolarité étaient plus susceptibles d’identifier leur médecin comme une source de soutien. Savoir où trouver renseignements sur services de soutien communautaires était associée à une probabilité accrue de mentionnant des médecins et des services de santé maison comme sources d’aide.

Spreading and sustaining best practices for home care of older adults: a grounded theory study

BackgroundImproving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations.MethodsFour home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n =44) and 1 yearar later (n =40). Open, axial, and selective coding and constant comparison analysis were used.ResultsA model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints.ConclusionsSpread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

Task shifting policy in Ontario, Canada: Does it help personal support workers’ intention to stay?

The objective of this paper is to analyze the impact of task shifting policy on personal support workers (PSWs) intention to stay in home care. Data were collected through interviews with 46 home care staff of a large home care organization in Ontario, Canada. Interviews were transcribed, coded, and a thematic analysis was conducted using a qualitative software package. Half of the study participants mentioned that task shifting increases PSWs intention to stay in home care, while less than a quarter commented that task shifting increases PSWs intention to leave. Results show that the implementation of task shifting policy in Ontario, Canada may contribute to personal support workers intention to stay; however, inadequate compensation may negatively affect intention to stay and should be addressed. We recommend policy-makers consider appropriate compensation to assist PSWs in effectively executing shifted tasks.

Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care

Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the clients home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed.

Would Older Adults Turn to Community Support Services for Help to Maintain Their Independence

The purpose of this article is to determine whether middle-aged and older adults would identify community support services (CSSs) as a source of assistance for difficulties with the instrumental activities of daily living (IADLs). Furthermore, we determine factors related to the identification of home health and CSSs.Telephone interviews were conducted with 768 adults aged 50 and older. Respondents were presented with a vignette describing a situation where loss of independence is threatened. They were asked what they would do in that situation. Although less than 20% mentioned CSSs, nearly 50% mentioned either a home health or CSS. Findings suggest those less likely to mention a home health or CSS include men, older adults, and the foreign born. In addition, those with less education, functional health limitations, no social support, and a lack of knowledge of where to find information about CSSs mentioned home health or CSSs less often.

Home Care Workers' Skills in the Context of Task Shifting: Complexities in Care Work.

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs role in care provision, problematize the belief that low skilled care workers have little control over their work. HCWs skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work.

Social determinants of older adults’ awareness of community support services in Hamilton, Ontario

Community support services (CSSs) have been developed in Canada and other Western nations to enable persons coping with health or social issues to continue to live in the community. This study addresses the extent to which awareness of CSSs is structured by the social determinants of health. In a telephone interview conducted in February-March 2006, 1152 community-dwelling older adults (response rate 12.4%) from Hamilton, Ontario, Canada were made to read a series of four vignettes and were asked whether they were able to identify a CSS they may turn to in that situation. Across the four vignettes, 40% of participants did name a CSS as a possible source of assistance. Logistic regression was used to determine factors related to awareness of CSSs. Respondents most likely to have awareness of CSS include the middle-aged and higher-income groups. Being knowledgeable about where to look for information about CSSs, having social support and being a member of a club or voluntary organisations are also significant predictors of awareness of CSSs. Study results suggest that efforts be made to improve the level of awareness and access to CSSs among older adults by targeting their social networks as well as their health and social care providers.

Associations between workers' health, and non-standard hours and insecurity: the case of home care workers in Ontario, Canada

This article examines associations between home care workers health, and non-standard hours and insecurity. Health refers to symptoms of stress and musculoskeletal disorders (MSDs), non-standard hours refer to part-time and casual hours, and insecurity refers to job and employability insecurity. Data come from our 2002 survey of 532 home care workers (nurses, therapists and personal support workers) in a medium-sized city in Ontario, Canada. Path analysis regression results for the conceptual model show that (1) part-time and casual hours and job insecurity are positively and significantly associated with symptoms of stress, (2) the associations between part-time and casual hours and MSDs are mediated by symptoms of stress, and (3) job and employability insecurity are directly associated with MSDs. Results provide evidence that non-standard hours and insecurity must be addressed in order to improve home care workers health. We show the detrimental effects of non-standard hours and insecurity on workers health, and the results have implications for employers, human resource managers, trade unionists and government policy-makers.