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

Abstract

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.

The evolving role of the personal support worker in home care in O ntario, C anada

“…In Ontario, there are four main routes to become a formally educated PSW, including (1) the public college system, (2) the private career college system, (3) adult or continuing education programmes offered through public or separate school boards, and (4) non‐profit training organisations (Barken et al., ; HPRAC, , Personal Support Network of Ontario, ). In 2014, in an effort to standardise the education of PSWs in Ontario, the Ministry of Training, Colleges and Universities released the Personal Support Worker Program Standard and required all programmes to update and submit a curriculum for approval (Kelly & Bourgeault, ).…”

“…In response to growing demand for home and community‐based services and to address shortages of professional staff and rising healthcare system costs, the PSW role has expanded to include care activities previously performed by RHPs (Barken et al., ; Berta et al., ; De Vliegher, Declercq, Aertgeerts, & Moons, ). This transfer of more advanced care activities to PSWs has been labelled “task‐shifting” in the literature (Barken et al., ; Denton et al., ; Zeytinoglu et al., ).…”

“…In response to growing demand for home and community‐based services and to address shortages of professional staff and rising healthcare system costs, the PSW role has expanded to include care activities previously performed by RHPs (Barken et al., ; Berta et al., ; De Vliegher, Declercq, Aertgeerts, & Moons, ). This transfer of more advanced care activities to PSWs has been labelled “task‐shifting” in the literature (Barken et al., ; Denton et al., ; Zeytinoglu et al., ). Care activities identified in the literature as being shifted to PSWs in home care include assistance with medications including eye drops and injections (Axelsson & Elmstahl, ; Craftman, Hammar, von Strauss, Hilleras, & Westerbotn, ; De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ), wound and stoma care (De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ), complex lifts and transfers (De Vliegher et al., ; Denton et al., ; Zeytinoglu et al., ), home exercise routines (Denton et al., ; Zeytinoglu et al., ), enteral feeding (De Vliegher et al., ; Denton et al., ; Zeytinoglu et al., ), catheterisation (Denton et al., ; Zeytinoglu et al., ), and assistance with complex home‐care technology such as feeding pumps, glucose monitors and home ventilators (Craftman et al., ; De Vliegher et al., ; Denton et al., ; Moorman & Macdonald, ; Sharman et al., ; Swedberg et al., ; Zeytinoglu et al., ).…”

A systematic review of observational studies of adult home care

“…This is the first review to explore how observational research can inform our understanding of the experiences and quality of care delivered by home‐care workers. While qualitative interviews and focus group methods have been used frequently to study home care (Barken, Denton, Plenderleith, Zeytinoglu, & Brookman, ; Lovelock & Martin, ; Yeh, Samsi, Vandrevala, & Manthorpe, ), methods of observation have to date been used less widely. From the studies we reviewed, the researchers observed various home‐care practices that were in line with good‐quality care, defined as care that was consistent, and enabled the development of trusting relationships between the home‐care providers and recipients (Cabana & Jee, ; Denton et al, ; Olsson & Ingvad, ; Saultz & Lochner, ).…”

The role of unregulated care providers in home care: A scoping review

“…As the demand for home care increases, due to cost and health human resource constraints more patient care is being transferred to UCPs resulting in a shift in UCP roles from traditional supportive care to more complex care activities (Tourangeau, Saari, & Patterson, ). This trend in the provision of home care has been referred to as task shifting (Barken, Denton, Plenderleith, & Zeytinoglu, ; Denton, Brookman, Zeytinoglu, Plenderleith, & Barken, ).…”