Search results

This paper examines job satisfaction and participation in decision making in three home health aide facilities with different organizational structures (worker-owned for-profit, for-profit with no participation or ownership by workers, and nonprofit).

More than 600 surveys were completed by home health aides across the three facilities. The author also engaged in participant observation during training sessions and other meetings and conducted a small number of interviews with caregivers and agency management.

Home health aides at the worker-owned, participative decision making organization were significantly more satisfied with their jobs than those at the other agencies. Results for the other agencies were not significantly distinguishable from one another.

This study involved respondents from one of each type of business. A study across several of each type of organization would allow more focus on the effects of the structural characteristics of the organizations.

In the United States, the work that home health aides perform provides a valuable service to society. On behalf of caregivers and those for whom they provide care, conditions of the work need improvement. If participative democratic workplaces provide better outcomes, they should receive more attention from lawmakers, the business community, and researchers.

This research highlights the working conditions of the people (primarily women) who perform this work. The poor compensation received is a reminder of inequality in opportunity for some workers and of the value placed on this type of caring labor.

This research is unique in its focus on work environment and outcomes in home health care across nonprofit, for-profit, and worker-owned for-profit organizations. The findings of different job satisfaction outcomes from the others in the worker-owned organization and similar outcomes in the nonprofit and conventional for-profit organizations are also unique.

Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.

This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the gendered, raced, and citizenship-based expressions of their work roles.

This quantitative intersectional study draws on two nationwide datasets from the US National Center for Long-term Care Statistics, a division of the Centers for Disease Control and Prevention, the National Nursing Assistant Study (NNAS), and National Home Health Aide Survey (NHHAS).

Workplace context was the strongest predictor of workers’ health risks and working conditions. Physical injuries affected more than half of facility-based workers annually compared to less than 10% of home-based workers. Facility-based workers are more likely to report insufficient time for tasks, lower job satisfaction, and less respect and appreciation from patients. Home-based workers may be more likely to experience emotional distress, be offered fewer benefits, but experience fewer injuries, due to the better relative health of their patients and having more time for client care. Women reported more injuries and more time pressure than men across racial and citizenship groups within the same work setting.

There are limitations to the NHHAS and NNAS public-release data file data. We are unable to fully capture citizenship, some racial/ethnic categories, workers over age 65, supervisory workers, facilities with fewer than three residents, and facilities not certified with Medicare or Medicaid. The exclusion of these questions, workers, and contexts is a weakness of the present study.

Analyses draw on data from the first nationally representative sample surveys of home health aides and nursing assistants in the United States. Direct care workers are an important population to capture through intersectional research since care work is done predominantly by multiracial women and immigrants. This research also underscores the importance of workplace contexts in shaping the labor performed and the workers’ experiences.

This article describes actual UI prevalence and quality of care at Israeli LTC institutions for the elderly. The analysis is based on current regulatory data on 14,406 residents at 196 residential homes, and 8,278 patients at 159 hospitals for the chronically ill. It includes a calculation of summary indices of quality, the percentage of institutions with deficient items and of those showing change, and a description of functional status profiles. Multiple regression explains the deficiency rate variance through independent institutional variables. There is a higher prevalence of severe functional impairment and full incontinence at hospitals for the chronically ill than at residential homes. There were higher rates of deficiencies and lower rates of corrections for structural items than for process items at both. A major improvement occurred for process items (50‐100 per cent). Regarding outcomes, 34 percent of the residents with UI during the first assessment were continent two years later.

The purpose of this article is to highlight inequalities created and sustained through gendered, raced, and classed organizational processes and practices using Joan Acker's work as a lens for perceiving the mechanisms that support such practices. It aims to use home health aide work as an example of how US labor laws and court decisions create and support disadvantages for workers who are largely economically‐disadvantaged and often women of color.

The article considers processes of inequality based on demographic characteristics and the resulting stereotyping, discrimination, and gender, race, and class inequalities.

The article finds that multiple intersecting processes of inequality exist in organizations, manifested in practices of stereotyping and discrimination for some job applicants and workers and advantageous positioning for certain others.

Future research should more specifically consider the effects of multiple processes of inequality on individuals' organizational experiences and the intersections of gender, race, and class (as well as other markers such as ethnicity, sexual orientation, and disability) in organizational practices.

Managers and human resources practitioners should be aware of the effects of processes related to the intersectionality of gender, race, and class and work to eliminate resulting stereotyping and other discriminatory organizational practices linked to these processes in their organizations.

Identification of processes of inequality resulting in stereotyping and discrimination may help reduce them, thus increasing opportunities for work, wages, and benefits, and reducing poverty for members of the most devalued groups.

This research contributes to the literature on the intersecting nature of gender, race, and class‐based inequalities and on human resources decision making in organizations.

This purpose of this paper is to investigate the possibility of non-linear relationships between supervisor support for stress management and intervention process ratings from a workplace stress management intervention to highlight how context shapes intervention experience.

Data from 37 nurses and nurse aides assigned to the treatment group in an occupational stress management intervention were analyzed using polynomial regression in SPSS.

A quadratic function with a U-shape best explained variance in process variables for the relationship between supervisor support for stress management at baseline and ratings of intervention relation reactions and overall perceptions of session helpfulness in both sessions and for task reactions in session 1. Those with low and high supervisor support for stress management tended to perceive the intervention favorably, which is framed in terms of the intervention compensating for or complimenting their work environment, respectively.

Although exploratory and based on a small sample, this paper lays the groundwork for future theoretically-grounded investigations of relationship between intervention context and process.

Results provide a rationale for training supervisors in stress management support as a supplement to a workplace intervention.

This paper investigates a novel molar supervisor support construct and challenges previous research that assumes that the relationship between context and intervention process or outcomes always conform to a simple linear relationship.

This is the first part of a two‐part paper examining the problem of nursing shortages in the health profession in Canada. It draws on the problem from a historical and sociological perspective, with personal interviews, and historical data, to demonstrate the author’s theory that nursing shortages are nothing new. They are systemic in nature resulting from fundamental problems in the profession itself. Traditional solutions such as bringing in cheaper labour have exacerbated the problems, serving to perpetuate the commonly held view of nursing as an extension of women’s work in the home. Poor working conditions, ongoing power struggles with administrators and the medical establishment, and a handmaiden image have all served to create an ongoing cultural environment of powerlessness which the nursing profession has been unable to transcend, and serves as a deterrent to successful professional leadership and ongoing recruitment.

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

The purpose of this paper is to analyse the role of hospital leaders and high-performance work practices (HPWPs) in intensive care units (ICUs) in organizational agility and its impact on healthcare personnel satisfaction.

This study was carried out in three ICUs of an important Spanish public hospital, one for adults, one paediatric and one neonatal. The unit of analysis was ICUs personnel (324 individuals: 14.5%, 48.8% and 36.7% from the categories of doctors, nurses and nurses' aides, respectively) who were invited to participate in the study. The sample had 248 individuals, with a sampling distribution by categories that was quite similar to that of the population. To test the hypotheses proposed, structural equations modeling (SEM) were used as the maximum likelihood estimation method.

The results confirm the proposed model and reveal the importance of the human dimension in ICUs on hospital agility and performance in terms of satisfaction of the clinical staff working in this area.

This paper is original because it analyses units of high complexity, such as ICUs from a management and non-clinical perspective. In addition, it studies the role of hospital managers and HPWPs on employee outcomes, as well as in-hospital responsiveness in a very dynamic context that demands agility on the management approach.

Older women living in medically underserved areas (MUA) might have particular problems with access to health care. This is an in-depth report of the accessibility issues raised by six frail older women (age 82–93 years) during a longitudinal descriptive phenomenological study of the experience of home care. Three White women lived in the same rural MUA, and three Black women lived in the same urban MUA. The need for health service was understood subjectively and prospectively as the personal perception of a situation requiring relief or supply. Some women reported presenting needs for accessibility to providers, whereas others reported needs for their future accessibility to providers or services. Some intentions were likely linked to residence location, and residence in a rural MUA was relevant to the phenomenon of securing the help that I might need down the road. Feasibility was proposed as a new parameter of access. Research and practice implications were proposed.