Abstract
Assistive personnel are the primary caregivers in long-term residential care (LTRC) in industrialized countries. Our goal is to describe and compare the work-related characteristics of assistive personnel in LTRC in five countries (Canada, Germany, Norway, U.K., and U.S), which may reflect how various societies view their responsibility to aging populations and the workers who care for them. OECD and national statistical databases are used to assess and compare the work context for assistive personnel. Analysis of the statistical data is informed by on-site observations in nursing homes with reputations for high quality, close readings of these organizations’ documents and records, and interviews with LTRC staff. Pay is generally low and the work required of assistive personnel is often demanding in all countries studied. While most assistive personnel have completed high school, formal certification requirements vary considerably. Professionalization is increasing in Norway with its high school major in eldercare, and in Germany, which has a 2-year certificate program. Financial compensation for assistive personnel in Norway and Canada is greater than in the other countries. Union membership for assistive personnel ranges from very high in Canada to negligible in the U.S. Some countries studied have training programs of only a few months duration to prepare assistive personnel for highly demanding jobs. However, in Germany and Norway, training aims to professionalize the work of assistive personnel for the benefit of workers, employers, and residents. There are high rates of part-time and/or casual work among assistive personnel, associated with reduced employment-related benefits, except in Germany and Norway, where these benefits are statutory for all. Data suggest that unionization is protective for assistive personnel, however union coverage data were not available for all countries. The need to improve the qualifications and training of assistive personnel was observed to be a national priority everywhere except in the U.S. Compensation is relatively low in the U.K., the U.S. and Germany, despite the important jobs performed by assistive personnel. Finally, to improve future research, statistical mapping of this critical component of the labour force in LTRC should be a greater priority across high-income countries.
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Notes
The Long-Term Care Homes Act allows four exceptions to the educational requirements. A person may be hired as a personal support worker without having completed the educational requirements if they are:
(a) a registered nurse or registered practical nurse;
(b) a person who was working or employed at a long-term care home at any time in the year preceding the first anniversary of the legislated educational requirements as a personal support worker and who has at least three years of full-time experience, or the equivalent considering part-time experience, as a personal support worker;
(c) a student who is enrolled in an educational program for registered nurses or registered practical nurses (with the approval of the facility’s director of care); and
(d) a person currently enrolled in a personal support worker program who is at the stage of completing the practical experience requirements of the program (under the supervision of a registered nurse or program instructor).
Converted to USD using http://www.oanda.com/currency/converter. Adjusted to 2014 USD using U.S. inflation calculator, available at http://www.usinflationcalculator.com/, May 5, 2015.
Converted to USD using http://www.oanda.com/currency/converter, May 5, 2015.
U.K. employers reported in our interviews that they prefer these contracts because it gives them more flexibility in case their patient/resident population increases or decreases unexpectedly.
References
Altenpflegegesetz in der Fassung der Bekanntmachung vom 25. August 2003 (BGBl. I S. 1690), geändert zuletzt durch Artikel 1 des Gesetzes vom 13. März 2013 (BGBl. I S. 446), cf. http://www.gesetze-im-internet.de/bundesrecht/altpflg/gesamt.pdf. Accessed 26 June 2014.
Armstrong, P., Armstrong, H., & Scott-Dixon, K. (2008). Critical to care: the invisible women health services. Toronto: University of Toronto Press.
BMAS. (2014). Mindestlöhne im Sinne des Arbeitnehmerentsendegesetzes. from: https://www.bmas.de/SharedDocs/Downloads/DE/pr-mindestloehne-aentg-uebersicht.pdf?__blob=publicationFile
Bureau of Labor Statistics, U.S. Department of Labor (2010–2011). Occupational Outlook Handbook. http://www.bls.gov/ooh/. Accessed May 2015.
Bureau of Labor Statistics, U.S. Department of Labor (2014–2015). Occupational Outlook Handbook. http://www.bls.gov/ooh/. Accessed May 2015.
Cavendish, C. (2013). The Cavendish Review: an independent review into healthcare assistants and support workers in the NHS and social care settings.
Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens F. (2011). Help wanted? Providing and paying for long-term care. OECD Publishing.
Comparative Perspectives on Precarious Employment Database. (2014a). Education by detailed HSC occupation, Canada, United States, and EU countries, 1983–2011 (HSC DE-1). Retrieved from from http://www.genderwork.ca/cpd
Comparative Perspectives on Precarious Employment Database. (2014b). Annual income for basic HSC occupation, EU countries 2004–2011 (HSC IB-5). Retrieved from from http://www.genderwork.ca/cpd
Daly, T., & Szebehely, M. (2012). Unheard voices, unmapped terrain: care work in long-term residential care for older people in Canada and Sweden. International Journal of Social Welfare, 21, 139–148.
Die Johanniter. (2014). Ausbildung Schwesternhelferin/Pflegediensthelfer: from: http://www.johanniter.de/aus-und-weiterbildung/ambulante-und-stationaere-pflege/schwesternhelferin-pflegediensthelfer/schwesternhelferin-pflegediensthelfer-region-aachen-dueren-heinsberg/accessed. Dec 27 2014.
Gender and Work Database. (2014). Table HC SLID E1. Retrieved from http://www.genderwork.ca/gwd/
GKV. (2008). Spitzenverband der Pflegekassen. Richtlinien nach §78b Social Code Book XI (SGB XI) zur Qualifikation und zu den Aufgaben von zusätzlichen Betreuungskräften in Pflegeheimen.
Gospel, H., Nishikawa, M., & Goldmann, M. (2011). Varieties of training, qualifications and skills in long-term care: A German, Japanese and U.K. comparison. SKOPE Research Paper No. 104.
Harrington, C., Choiniere, J., Goldmann, M., Jacobsen, F. F., Lloyd, L., McGregor, M., & Szebehely, M. (2012). Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship, 44(1), 88–98. doi:10.1111/j.1547-5069.2011.01430.x.
Hermansen, Å. (2011). Personell og yrkesfordeling innen pleie- og omsorgssektoren. Oslo: Fafo.
Høst, H. (2010). Helsefagarbeiderutdanning for voksne. Oslo: NIFU.
Hussein, S. (2011). Estimating probabilities and numbers of direct care workers paid under the national minimum wage in the U.K.: A Bayesian Approach. Social Care Workforce Periodical, 16. Retrieved from http://www.kcl.ac.uk/sspp/policy-institute/scwru/pubs/periodical/2011/issue16.aspx
Jacobsen, F. F., & Mekki, T. E. (2012). Health and the changing welfare state in Norway: a focus on municipal health care for elderly sick. Ageing International, 37, 125–142.
Khatutsky, G., Wiener, J., Anderson, W., Akhmerova, V., Jessup, E. A., & Squillace, M. R. (2011). Understanding direct care workers: a snapshot of two of America’s most important jobs. Washington: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.
Kühnlein, G., Stefaniak, A., & Wohlfahrt, N. (2011). Wettbewerb in der Sozialwirtschaft – Auswirkungen auf tarifliche Entwicklungen. In B. Stolz-Willig, J. Christoreridis (Ed.): Hauptsache billig? Prekarisierung der Arbeit in den sozialen Berufen (pp. 144–162). Münster.
Kuemmerling A. (2009) Der lange Weg zur Professionalisierung der Altenpflege und seine (nicht?)-intendierten Folgen. In: S. Lehndorff (Ed.): Abriss, Umbau, Renovierung? Studien zum Wandel des deutschen Kapitalismusmodells. Hamburg: VSA, 136–165
Landesregierung Nordrhein-Westfalen (2006). Gesetz zur Durchführung des Altenpflege-gesetzes und zur Ausbildung in der Altenpflegehilfe.
Laxer, K. (2013). Counting carers in long-term residential care in Canada. In P. Armstrong & S. Braedley (Eds.), Troubling care: critical perspectives on research and practices. Toronto: Canadian Scholars’ Press.
Meyn, C. (2012). Occupational health and safety in elderly care in Germany: (Un)healthy work organization and workplace health promotion. unpublished paper for ReLTC.
National Health Service. (n.d.). NHS careers in detail: Healthcare assistants/auxiliary nurses. Retrieved from http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/healthcare-assistant/
Norwegian Ministry of Health and Care Services. (2013). Future Care: Meld. St. 29 (2012–2013). Report to the Storting (White Paper) from the Stoltenberg II Government. Retrieved from http://www.regjeringen.no/pages/38452288/PDFS/STM201220130029000EN_PDFS.pdf
Norwegian Ministry of Labor and Social Affairs. (2014). Lov om arbeidsmiljø, arbeidstid og stillingsvern mv. (arbeidsmiljøloven). LOV-2005-06-17-62 (revised 01.01.2014).
NUMGE. (2011). Kjappe løsninger på deltidsfella? Retrieved from http://oss.fagforbundet.no/tags/deltid/?article_id=64033.
OECD. (2011). Health at a glance 2011: OECD indicators. OECD Publishing. doi:10.1787/health_glance-2011-en
OECD. (2014). Average annual wages. OECD employment and labour market statistics (database). Retrieved from doi: 10.1787/data-00571-en
Ontario Ministry of Health and Long-term Care. (2007). Long-term care homes act. S. O. (2007) (Vol. c. 8). : http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_07l08_e.htm.
Ontario Ministry of Health and Long-term Care. The regulation of personal support workers the minister’s question on February 7, 2005 the Honourable George Smitherman, Minister of Health and Long-Term Care. http://www.health.gov.on.ca/en/common/ministry/publications/reports/personal_support_workers/personal_support_workers.pdf
Pennington, K., Scott, J., & Magilvy, K. (2003). The role of certified nursing assistants in nursing homes. Journal of Nursing Administration, 33(11), 578–84.
Personal Support Network of Ontario. (2011). PSW training organizations comparisons for Ontario. Retrieved from http://www.psno.ca/uploads/1/0/1/9/10197937/psno_summary_of_psw_training_in_ontario_july_2011.pdf
Robbins, I., Gordon, A., Dyas, J., Logan P., & Gladman, J. (2013). Explaining the barriers to and tensions in delivering effective healthcare in U.K. care homes: a qualitative study. BMJ Open, 3(7). doi: 10.1136/bmjopen-2013-003178 PMCID: PMC3717448.
Simonazzi, A. (2009). New skills for new jobs? Status quo and perspectives for the elderly care sectors in. Europe: European Employment Observatory (EEO) Thematic Paper. Retrieved from http://www.eu-employment-observatory.net/resources/reports/NewSkillsForNewJobs-ElderlyCareSector-SIMONAZZI.pdf.
Skills for Care. (2014). Guide to qualifications and standards in adult social care, 2014–2015 Leeds, Skills for Care. Retrieved from www.skillsforcare.org.uk.
Squillace, M., Remsburg, R. E., Harris-Kojetin, D., Bercovitz, A., Rosenoff, E., & Han, B. (2009). The National Nursing Assistant Survey: improving the evidence base for policy initiatives to strengthen the certified nursing assistant workforce. Gerontologist, 49(2), 185–197.
Statistics Norway (2012). Nursing and Care Services. Retrieved from http://ssb.no/en/helse/statistikker/pleie
Ströver, M. (2010). Die Neukonstruierung der Pflegeausbildung in Deutschland. In Eine vergleichende Studie typischer Reformmodelle zu Gemeinsamkeiten und Differenzen sowie deren Nachhaltigkeit. Lippe Verlag: Hellweg.
World Health Organization. (2010). Classifying health workers: mapping occupations to the international standard classification. Geneva: World Health Organization.
Acknowledgments
This article is based, in part, on data obtained from the MCRI project, “Re-Imaging Long-Term Residential Care: An International Study of Promising Practices,” funded by the Social Sciences and Research Council of Canada – Major Collaborative Research Initiative.
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Laxer, K., Jacobsen, F.F., Lloyd, L. et al. Comparing Nursing Home Assistive Personnel in Five Countries. Ageing Int 41, 62–78 (2016). https://doi.org/10.1007/s12126-015-9226-2
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DOI: https://doi.org/10.1007/s12126-015-9226-2