Does Context Count? The Association Between Quality of Care and Job Characteristics in Residential Aged Care and Hospital Settings: A Systematic Review and Meta-Analysis

Abstract

Background and Objectives Within residential aged care settings, reduced quality of care (QOC), abuse, and neglect have been global phenomena which require urgent intervention. As the reported rate of these problems is much higher in aged care compared to hospital settings, we investigated whether differing job design characteristics between the two settings might explain the difference. Research Design and Methods We used a meta-analysis to compare differences in the relationships between high job demands, low job resources, and job strain with QOC and counter-productive work behaviors (CWBs) across aged care and hospital settings. Results Data was extracted from 42 studies (n=55 effects). QOC was negatively correlated with high job demands (ρ̅ =-.22, 95% CI: -.29:-.15, k=7), low job resources (ρ̅ = -.40, 95% CI:-.47:-.32, k=15), and job strain (ρ̅ =-.32, 95% CI: -.38:.-.25, k=22), CWBs had a positive relationship with job demands (ρ̅ =.35, 95%CI: .10:.59, k=3) and job strain (ρ̅ =.34, 95% CI: .13:.56, k=6). The association between poor QOC and low job resources was stronger in aged care (r=-.46, 95% CI:-.55:-36, k=8) than in hospital settings (r= -.30, 95% CI:-.41:-.18, k=7). Discussion and Implications Our findings suggest that relationships between low job resources and poor quality of care are exacerbated in residential aged care contexts. To improve care outcomes, stakeholders should improve job resources such as skill discretion, supervisory supports, and increased training and staffing levels in residential aged care.

“The Stigma is what you do”: Examining the Relationship Between Occupational Stigma and Worker Outcomes in the Aged Care Context

“…For example, policies could focus on enhancing client quality and safety care standards, through ensuring adequate remuneration, training, and opportunities for career advancement, as these factors are prototypical of poor occupational conditions (Manchha et al, 2022). We also note that, although moral taint is sometimes unjustified when applied to workers who do not engage in immoral or unethical practices (Hodroj et al, 2022), the attribution of moral taint to aged-care work may sometimes be a legitimate reflection of the existence of such practices. Thus, policies focusing on mitigating these practices (e.g., elder abuse) may help reframe negative societal perceptions about aged-care workers' ethics and hence, moral taint associated with aged-care work.…”

“…They also may perceive social taint, given that aged-care work involves working with people (e.g., residents and co-workers) who may belong to social groups that experience discrimination based on negative age and race-based stereotypes (Clarke & Ravenswood, 2019). Finally, the aged-care industry is frequently and publicly reported to engage in unethical practices (e.g., elder abuse, unregulated institutions that may infringe on the rights of older adults; Hodroj et al, 2022). The existing composition of aged care, with its poorly regulated governance, may systemically foster inadequate care and neglected residents (Hart et al, 2021).…”