Joanna Burke-Bajaj on workplace equity in long-term care
Health with Humanity
By Joanna Burke-Bajaj
Workplace Equity in Long-Term Care: Devaluing care and the feminisation of labour
When discussing the widespread implications of health inequities it is important to not negate the fact that the need for improvements in health equity apply not only to patients and communities seeking care, but also to healthcare providers and all those who work to deliver care. Within the healthcare workforce, as with most other professions, workers come from diverse personal backgrounds and represent multiple intersections of race, gender, class, and other identities. In some areas of healthcare these complex identities affect the compensation, and working conditions, and professional environment of wide groups of healthcare providers. Recently, these working inequalities have come to light particularly within the workforce of long-term care and the care of older adults.
Long-term care (LTC) facilities are a unique branch of healthcare because they act not only as congregate living communities but also as spaces for administering sometimes significant levels of care from healthcare professionals, allied health workers, and personal support workers (PSWs). Within the LTC sector there is great importance placed on the understanding that staff should always treat the space as respectfully as anyone would treat someone else’s home, holding emphasis on the fact that LTC sites are communities where people both live and work. This mindset is essential in order to provide respectful and dignified care to those for whom LTC is their home, but it also highlights how some have begun to view LTC as more akin to home-based care than to hospitalized care, and this distinction has become key to furthering workplace inequities between hospital-based healthcare providers and LTC workers.
Across OECD countries, workforce demographics show that the overwhelming majority of long-term care staff are women and that they tend to experience worse working conditions and lower pay than hospital staff (OECD 2019). Historically, the LTC sector has been marked by inequitable economic working policies including lower wages and a higher prevalence of part-time and temporary contract work, which resulted in high staff turnover rates in the field (OECD 2020). Scholars have noted that many countries of the Global North have increasingly had migrant and racialized women take on the majority of caregiving roles in LTC, which has created unique impacts on this sector in the COVID-19 pandemic, most notably by the way that LTC work is viewed and devalued through the feminization of labour, systemic racism, and xenophobia. Due to the fact that women perform enormous amounts of unpaid care work for families and communities around the globe, when women represent the majority of workers in a paid care sector, their labour is often devalued as being feminized labour that is simply traditionally expected and which women should be inclined to do (Gahwi & Walton-Roberts 2020).
The irony of this treatment of women care workers, particularly for the migrant women who represent a significant number of care roles, is that they exist in a ‘care paradox’. As defined by the WHO, the ‘care paradox’ exists where migrant women work to fill essential gaps in the ageing healthcare systems of affluent nations, but yet their roles are undervalued to the point that many do not have access to equal healthcare services for themselves and their families (WHO 2017). Existing literature has also pointed to the fact that employers view migrant care workers as more willing to work in poor conditions with longer hours of shift work, and more likely to be hired in non-professional positions with lower pay (Gahwi & Walton-Roberts 2020).
“Migrant women care workers act as a cushion for states that lack adequate public provision for long-term care, child care and care for the sick.” – WHO 2017
As many high-income nations are beginning to face large increases in ageing populations, the availability of care is often far outpaced by demand, yet still many nations have not hired enough caregiving roles and have made existing roles into part-time and temporary contract work. Insufficient opportunities for care come as a result of a lack of sufficient resources for workers and facilities, and the disregard for the resources needed to care for ageing individuals is directly related to the devaluing of care work.
Part of building a future of health equity for all involves building fair and sustainable job opportunities and working conditions for healthcare workers. We must ensure that workplace equity is at the forefront of human resources decisions regarding compensation, wages, benefits, contracts, and more. After all, how can we expect to facilitate equitable approaches to health for patients and clients without having equitable practices start at the healthcare workforce level?
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Gahwi L & Walton-Roberts M. (2020). Migrant Care Labour and the COVID-19 Long-term Care Crisis: How Did We Get Here? Balsillie Papers, Issue 1. Accessed at https://www.balsillieschool.ca/wp-content/uploads/2020/06/Balsillie-Paper-Gahwi-and-Walton-Roberts-3.pdf
OECD. (2019). Gender Equality: Women are well-represented in health and long-term care professions, but often in jobs with poor working conditions. OECD Gender Equality Data. Accessed at https://www.oecd.org/gender/data/women-are-well-represented-in-health-and-long-term-care-professions-but-often-in-jobs-with-poor-working-conditions.htm.
OECD. (2020). Who Cares? Attracting and Retaining Care Workers for the Elderly. OECD Health Policy Studies, OECD Publishing, Paris. Accessed at https://doi.org/10.1787/92c0ef68-en.
WHO. (2017). Women on the Move: Migration, care work and health. Accessed at https://apps.who.int/iris/bitstream/handle/10665/259463/9789241513142-eng.pdf;jsessionid=4F386088EC8EE7180EF589577BEB7012?sequence=1