To explore the social organization of food provision in publicly funded and regulated long-term care facilities.Observations were conducted, along with 90 interviews with residents, families, and health providers in two Southern Ontario sites using rapid site-switching ethnography within a feminist political economy framework as part of an international, interdisciplinary study investigating healthy ageing.Food is purchased within a daily $7.80/per resident allotment, limiting high quality choices, which is further problematized by privatization of food services. Funding restrictions also result in low staffing levels, creating tensions in aligning with other Ministry mandated tasks such as bathing, and documenting: competing demands often lead to rushed meals. Regulations, primarily set in response to scandals and to ensure appropriate measured nutrition, reinforce the problem. Further, regulations regarding set meal times result in lack of resident agency, which is compounded by fixed menu options and seating arrangements in one common dining room. Rather than being viewed as an important part of resident socialization, food is reduced to a medicalized task, organized within a climate of cost-containment.Findings warrant Ministry financial support for additional staff and for food provision. Policy changes are also required to give primacy to this population's quality of life.
In this comparative chapter, we explore family members’ engagement in nursing home care in Ontario, Canada, Stockholm and Sweden during the Covid-19 pandemic. Covid severely impacted residents, and accentuated pre-existing structural issues. In Ontario, Canada, families, who often fill in care gaps, were suddenly banned from nursing homes. Severe staffing shortages created gaps in care and communication issues, leaving families extremely worried about their relatives’ health and safety. Family members collectively advocated for resident information, policy clarification and re-entry. In Sweden, although families were also denied access, higher staffing levels and a system of key contact persons facilitated more trust in care quality and better communication between homes and families. Moving forward, in both jurisdictions, families must be involved in resident care policies. In Ontario, improved staffing levels would allow for relational engagement with residents and families and enable families to be involved in meaningful ways rather than filling in care gaps.
ABSTRACT Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents’ social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.
This chapter draws on staff interview data and fieldnotes to examine the perspectives of staff and the relationships they have with relatives' families in Canadian, Norwegian and Swedish nursing homes. Jurisdictional contextual differences, including models of care, staffing levels and work organisation, vary considerably. These different contextual conditions shape the various roles that families navigate alongside and with staff, and the amount and form of unpaid work in which they engage. These conditions also shape the types and depth of relationships that form between staff and families. Such factors as having a contact-person model, small units and high staffing levels leave room and space for closer social connections between residents, family and staff and more continuity. However, these systems are not achievable without sufficient staffing levels and managerial support. Without them, there will continue to be tensions between staff and families and demands on both families and staff to bridge care gaps with unpaid work.
Mealtimes are among the busiest times in nursing homes. Austerity measures resulting in insufficient staff with heavy workloads limit the amount of time available to assist residents with eating. Within a feminist political economy framework, rapid team-based ethnography was used for an international study involving six countries exploring promising practices and also for a study conducted in one Canadian province in which interrelationships between formal and informal care were investigated. Data collection methods included interviews and observations. In addition, dining maps were completed providing a cross-jurisdictional comparison of mealtime work organization, and illustrating the time spent assisting residents with meals. Dining maps highlight the reliance on unpaid care as well as how low staffing levels leave care providers rushing around, preventing a pleasurable resident dining experience, which is central to overall health and well-being.
According to the Canadian Health Care Association (1), there are 2,577 long-term care ("LTC") facilities across Canada, with the largest proportion (33.4%) located in Ontario. Most studies focus on residents' health, with less attention paid to the health and safety experiences of staff. Given that the work performed in Ontario LTC facilities is very gendered, increasingly racialized, task-oriented, and with strict divisions of labour, this paper explores in what ways some of these factors impact workers' experiences of health and safety.
This chapter explores the unpaid work of family members with elderly relatives in the lead-up to nursing home care in two jurisdictions: Ontario, Canada, and Sweden. Unpaid work includes providing care, as well as the navigation and the advocacy work required to seek, apply for and enter nursing home care. Although Sweden has a universal social democratic approach, and Canada a selective liberal approach, both countries have seen rationing in long-term care funding and reduced access to nursing homes. In both jurisdictions, families take on extensive unpaid work and experience increasing stress leading up to nursing home admission. In Canada, after admission, families often experience a sense of guilt and continue their unpaid work in an attempt to fill care gaps. This contrasts to Sweden, where families express relief, as safety and continuity of care increase, enabling them to be visitors rather than care providers, which may reflect higher staffing levels.
Nursing homes for seniors are an integral part of the Canadian and Swedish welfare states; however, daily work takes place within different organisational contexts. In contrast to Sweden, Canadian nursing homes are larger, have lower staffing levels and are oriented towards a medical care model. In both countries, shaped by staffing shortages, there are more racialised workers employed in the care sector. Earlier research has noted how racialised staff might be exposed to racism from residents. In this study, we explore care workers’ experiences of racism and their perceptions of how racism is managed in the different organisational contexts.
Family members and friends provide significant support for older relatives in long-term residential care (LTRC). Yet, they occupy ambiguous positions in these settings, and their relationships with LTRC staff can involve conflicts and challenges. Based on an ethnographic project carried out in North America and Europe, this article identifies practices that promote meaningful family participation in care home life. We consider instances of rewarding family involvement upon admission to LTRC, throughout the time a relative is living in a care home, and during the final stages of life. Furthermore, we identify working conditions needed to support the well-being of family/friend carers as well as residents and staff. These include greater appreciation of relational care work, time for effective communication, teamwork, and appropriate, inclusive physical spaces. Findings make visible the importance of relational care and have implications for improving living and working conditions in LTRC.
