Personalised risk: new risk encounters facing migrant care workers

Abstract

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people's choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011-2013, we note the potential for expanding the sociologically inspired concept 'personalised risk'. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of 'informality' of employment conditions experienced by directly employed care workers, the 'emotional' content of care worker-employer relationships, and 'intimacy' of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world. IntroductionIn this article, we explore the interconnections between social care, migration, and personalisation policies to highlight the concrete dimensions of the concepts of public and private risk. We present findings from a study of migrant care workers to develop a multilevel analysis of risks, including structural employment-related risks, challenges regarding relationships with care users, and finally micro-level (intimated) features of these relationships.With the growing demand for long-term care in the developed world new delivery mechanisms are emerging. Among these is the direct employment of care workers within domestic settings by individuals or their families. This may enable people in need of care and support to stay at home, sustain informal care provision by family and friends, and delay or avoid more expensive and generally unwelcome moves to long-term care facilities. England presents a case study of such a policy shift since it has adopted such

Under the radar: General practitioners' experiences of directly employed care workers for older people

“…Some GPs raised concerns (for both parties) about vulnerability or risk, and older people's reliance upon unknown people (as noted many erroneously thought that such care workers had to be checked for any criminal record). Care workers were potentially ‘tied’ to accommodation, working without employment protection and at risk of labour exploitation (see Christensen & Manthorpe, ). GPs described working around the need to gain consent to share information, and used case experience to overcome potential problems with implied consent and safeguarding risks.…”

Specialist support for persons with disabilities living in the community: Review of international practice

“…Unregulated markets for social care workers are found to be heavily gendered and reliant on migrant labour, and are characterised by poor working conditions (Carr and Robbins, 2009). Indeed, a combination of increased user empowerment and the distancing of support work from public view could in turn increase potentially gendered risks for the exploitation of migrant support workers (Christensen and Manthorpe, 2016). In addition, individualised funding schemes are found to increase short-notice requests for support workers employed through support organisations, giving rise to an 'on-call workforce' (Cortis et al, 2013).…”

“…Several studies analyse the implications for the relationship between users and their personal assistants of different direct payment, or cash-for-care, schemes (Shakespeare, Stöckl, and Porter, 2018;Christensen and Manthorpe, 2016;Christensen, 2012). Direct payment schemes have implications for the independence of persons with disabilities, but also for assistant roles in work that can be oppressive and that is historically gendered (Christensen and Manthorpe, 2016;Christensen, 2012). Indeed, there is evidence of conflict arising in relationships between these two parties in arrangements based on direct payments (Shakespeare, Stöckl and Porter, 2018).…”

Life Trajectories of Migrant Care Workers in the Long-Term Care Sectors in Norway and the UK

“…The case shows the almost unlimited options for designing care work in private households (cf. also Williams, 2010) and the risks related to intimate live-in arrangements (Christensen and Manthorpe, 2016). Experiences of discrimination also emerged as gendered; male care workers felt discriminated against in gaining entry into feminised social care work No dominant settlement tradition was found in the life trajectory typology of the UK participants.…”

“…These policies have increased the variety of arrangements of care work in private households, including live-in arrangements in the UK, the care worker living in the user's home. Related to these circumstances, in particular in the UK, attention has been paid to, for example, risks related to intimate relationships and an insecure labour market (Christensen and Manthorpe, 2016), the weakening of care workers' employee role when users are empowered , including problems with getting qualifications from the home country recognised (Datta et al, 2007) and gendered ways of perceiving female-dominated care work (Lupton, 2000;Hussein and Christensen, 2016). In contrast, the allocation of social care in Norway is needs-tested and mainly undertaken on a non-profit basis; and care workers do not live with their employers.…”