Negotiating user preferences, discrimination, and demand for migrant labour in long-term care

Who would rescue the dilemma of Chinese elderly care? An evolutionary game analysis and simulation research on the formalization of the domestic service industry with subsidy policy

Since China entered the aging society, the surging demand for elderly care and the industrial upgrading of "silver economy" has forced the domestic service industry to face endogenous challenges. Among them, the formalization of the domestic service industry can effectively reduce the transaction costs and risks of actors, innovate the endogenous vitality of the industry, and promote the improvement of elderly care quality through a triangular employment relationship. By constructing a tripartite asymmetric evolutionary game model of clients, domestic enterprises and governmental departments, this study uses the stability theorem of differential equations to explore the influencing factors and action paths of the system's evolutionary stable strategies (ESS), and uses the research data collected from China to assign values to models for simulation analysis. This study finds that the ratio of the initial ideal strategy, the difference between profits and costs, subsidies to clients, and subsidies or punishments for breach of contract to domestic enterprises are the key factors affecting the formalization of the domestic service industry. Subsidy policy programs can be divided into long-term and periodic programs, and there are differences in the influence paths and effects of the key factors in different situations. Increasing domestic enterprises' market share with employee management systems, formulating subsidy programs for clients, and setting up evaluation and supervision mechanisms are efficient ways through which to promote the formalization of the domestic service industry in China. Subsidy policy of governmental departments should focus on improving the professional skills and quality of elderly care domestic workers, and also encourage domestic enterprises with employee management systems at the same time, to expand the scope of service beneficiaries by running nutrition restaurants in communities, cooperating with elderly care institutions, etc.

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

AIM

To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.

DESIGN

An integrated review was conducted.

METHODS

Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.

RESULTS

Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.

PUBLIC CONTRIBUTION

Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.

Delivering person-centred palliative care in long-term care settings: is humanism a quality of health-care employees or their organisations?

Reflecting on sustained calls for patient-centredness and culture change in long-term care, we evaluated the relative importance of personal and organisational predictors of palliative care, hypothesising the former as weaker predictors than the latter. Health-care employees (N = 184) from four Canadian long-term care homes completed a survey of person-centred care, self-efficacy, employee wellbeing and occupational characteristics. Using backward stepwise regression models, we examined the relative contributions of these variables to person-centred palliative care. Specifically, blocks of variables representing personal, organisational and occupational characteristics; palliative care self-efficacy; and employee wellbeing were simultaneously regressed on variables representing aspects of person-centred care. The change in R2 associated with the removal of each block was examined to determine each block's overall contribution to the model. We found that occupational characteristics (involvement in care planning), employee wellbeing (compassion satisfaction) and self-efficacy were reliably associated with person-centred palliative care (p < 0.05). Facility size was not associated, and facility profit status was less consistently associated. Demographic characteristics (gender, work experience, education level) and some aspects of employee wellbeing (burnout, secondary trauma) were also not reliably associated. Overall, these results raise the possibility that humanistic care is less related to intrinsic characteristics of employees, and more related to workplace factors, or to personal qualities that can be cultivated in the workplace, including meaningful role engagement, compassion and self-efficacy.

Migrant Home Care Workers in the UK: a Scoping Review of Outcomes and Sustainability and Implications in the Context of Brexit

Migrant care workers play a significant role in meeting the escalating demand for social care in the UK. Workforce shortages create opportunities for new migrants to enter the social care workforce. This scoping review aims to identify and synthesise available evidence on the contribution of migrant workers to the provision of home care in the UK focusing on care worker and service outcomes as well as sustainability, and identify challenges and gaps in the context of Brexit and changing immigration policies. Twenty-two articles were identified for inclusion in the review and extracted using a structured format. The analysis presents a narrative description and synthesis of the research. Findings from the reviewed articles were grouped into five main themes: migrant, user and employer outcomes, effect on workforce, and sustainability-and 15 sub-themes that were described in detail. Much of the existing research on migrant care work is qualitative and focuses on migrant outcomes. The review identified some important gaps in research, namely, the impact of immigration status on migrant care worker outcomes, the cultural and psychological adaptation of migrant care workers to care practices, and the emerging UK live-in care market. Implications of findings are discussed in the context of post-Brexit immigration system.

Aging, Dependence, and Long-Term Care: A Systematic Review of Employment Creation

Population aging is an economic and social challenge in most countries in the world as it generates higher dependency rates and increased demand for long-term care. Undertaking the care of older dependent adults can result in new opportunities for job creation. There is limited knowledge of the impact of dependent care and long-term care on employment. We examined this impact through a systematic review. Countries with conditional cash benefits show job creation, and countries with unconditional economic benefits reveal the development of a grey care market with high participation of migrant labor. Migrant employment in developed countries affects the development of the labor market in the countries of origin. The employment created to care for dependent persons is generally precarious. In conclusion, global aging will increase long-term care worker demand, but the variations in policies can determine what kind of employment is created.

Challenges and opportunities for the multicultural aged care workforce: A systematic review and meta-synthesis

AIMS

To identify (a) the challenges for multicultural aged care teams; (b) the opportunities to facilitate teamwork; and (c) the strategies to assist team members in a multicultural work environment.

BACKGROUND

High-income countries have an increasingly culturally diverse aged care workforce. Fostering teamwork in such an environment is challenging.

METHODS

This systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) meta-aggregation approach. Six databases were searched. Retrieved articles were screened by two reviewers. This review identified 111 findings that were aggregated into 15 categories and five themes.

FINDINGS

Aged care workers' awareness of cultural diversity varies, and their knowledge of each other's cultural background is limited. However, cultural skills are demonstrated, contributing to teamwork. Their experience in cross-cultural encounters is broad, and enhanced team cohesion is desired.

CONCLUSIONS

The cultural competence of the aged care workforce shapes team building, peer support opportunities and positive cross-cultural experiences.

IMPLICATIONS FOR NURSING MANAGEMENT

Recommendations are provided for the adaptation of aged care workers to culturally diverse teams, fostering teamwork to enhance care outcomes for clients. Interventions for improvements in cross-cultural leadership and management, and staff experience of cross-cultural encounters are much needed.

Discrimination in In-Patient Geriatric Care: A Qualitative Study on the Experiences of Employees with a Turkish Migration Background

In most studies, nurses with a migrant background report experiences of interpersonal discrimination. These often occur in interaction with those in need of care. However, in Germany this topic has remained largely unexplored, although a large proportion of the employees in geriatric care have a migration background. The aim of the study was to investigate whether care workers with Turkish migration background in in-patient geriatric care are exposed to discrimination from residents. Furthermore, the reasons for discrimination, handling of discrimination and recommendations for in-patient geriatric facilities to avoid/reduce discrimination were examined. In a qualitative, explorative study, 24 employees with Turkish migrant background working in in-patient geriatric care were interviewed in 2017. The semi-structured interviews were evaluated using a qualitative content analysis according to Mayring. The majority (N = 20) experienced or observed discrimination. This occurred mainly in the form of xenophobic insults and rejections. They perceived visible traits (dark hair and eye color, clothing) as potential reasons. To deal with the discrimination, most of them temporarily left the scene. They recommend that institutions should primarily make the diversity of the workforce transparent to avoid/reduce discrimination. More research is needed about discrimination against care workers with migration background because discrimination may have serious psychological effects that impact employee retention and the quality of care.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team

Background:

The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges.

Purpose:

The aim is to explore minority healthcare providers, trained nurses and nurses’ assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context.

Research method:

The study has a qualitative design, using narrative interviews, and a phenomenological–hermeneutic analysis method to explore the experiences of challenges in dementia care.

Ethical considerations:

The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services.

Participation and research context:

Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit.

Findings:

The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness.

Discussion:

The findings are discussed considering Løgstrup’s ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood.

Conclusion:

The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.

Health situation of migrant and minority nurses: A systematic review

INTRODUCTION

Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health.

MATERIALS AND METHODS

A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT).

RESULTS

Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries.

DISCUSSION

Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.

A real job? Regulating household work: The case of Spain

This article is contextualized within the recent evolution of household employment in Spain. In the context of the strong demand for personal care services – due to rapid population ageing, mass incorporation of women into the labour market and insufficient collective provision of care services – the growth of domestic work is closely related to the overall social organization of care and specific migration policies that have eased, both implicitly and explicitly, the labour supply of foreign women into Spanish households. In line with ongoing debates in the academic literature as well as in the political sphere, this article seeks to explain the extent to which domestic work can or should be considered as any other job in terms of social and employment rights and obligations. To that end, it evaluates changes in the regulation of household employment in Spain since the creation of the Special Regime for Household Employees (SRHE) in 1969 until the most recent 2011 reform. Following the recommendations of the ILO Convention for Domestic Workers (2011), this latest reform puts domestic workers on equal footing with other dependent employees. It thus implies a sea change in relation to the discriminatory treatment embedded in previous legal frameworks. The main hindrance to the effective transposition of the norm however remains the strong presence of the informal economy and a dubious political commitment to ensure its application.