“I’ll go from working here to living here.” places

“I’ll go from working
here to living here.”
Rural personal care homes as
workplaces
Dr. Bonnie C. Hallman, Associate Professor
Department of Environment and Geography,
Clayton H. Riddell Faculty of Environment, Earth and
Resources
University of Manitoba
The Study
• Manitoba portion of larger study
conducted 2003-2005
• Collaboration with Centre for
Families, Work and Wellbeing,
University of Guelph, Ontario
• Status of Women Canada Policy
Research Fund
• http://www.sfc-cfc.gc.ca
• The Impact of Patient Classification Systems on
Women Frontline Care Workers in Rural Nursing
Homes
Dr. B. Hallman, University of Manitoba
Project Context:
Restructuring, Rurality and LTC Work
• Reduction of many local government
services
– Smaller / closed hospitals, schools, banks,
post offices
• Rural labour markets drastically
changed
– Significant changes to agricultural and
rural landscape as economy diversifies
• International trade, loss of Crow Rate etc.,
• Services only expanding rural labour sector
Dr. B. Hallman, University of Manitoba
Manitoba:
Restructuring = Decentralization
• mid-1990s reductions in CHST
• Cut costs
• Decision-making away from ‘big’ provincial
bureaucracies
• Greater accountability
• Decentralized delivery and financing of
health care delivery into 11 regional health
authorities
– Regional focus mediated by provincial and
federal policy
Dr. B. Hallman, University of Manitoba
PCH
Residents
• Only 5% of
Manitobans aged
75-79 live in PCHs
• 90% of those aged
90 or older do
• 55%+ ‘old-old’ and
Level 3 or 4 care
• Average age of
rural PCH
residents: 84.3
Dr. B. Hallman, University of Manitoba
Manitoba Challenges in LTC
• Small scattered
communities
• Tendency for seniors
to remain in small,
rural communities
• Increasing (frail)
elderly population
• Lasting effects of
healthcare
restructuring /
decentralization /
regionalization
Dr. B. Hallman, University of Manitoba
Rural Communities,
Long-term Care and Women
• Women are the majority of front-line
workers in long-term care
– Nurses, health care aides
• LTC policy disproportionately affects
women
– As frontline and administrative employees
and as clients / residents
• Rural LTC facilities often are one of the
few local sources of employment for
rural women
Dr. B. Hallman, University of Manitoba
Frontline Workers:
Issues in a Rural Manitoba Context
• Interviewed home
care case
coordinators
/nurses (RHA and
direct PCH
contacts) – n=15
• Focus groups with
health care aides
(union contacts) –
n=24 (4 groups)
Dr. B. Hallman, University of Manitoba
Frontline Workers:
Issues in a Rural Manitoba Context
• Rural labour
shortages = no
time / too
exhausted to
reliably
document
accurately
• Long distances +
winter weather
= high
absenteeism
Dr. B. Hallman, University of Manitoba
When you get up to (town name) there are people
there for the paycheque. So, you can imagine what
kind of care these people are getting. I mean that,
this is not a job you should be doing if you don’t
like it! And I think in your rural areas you’re going
to find that a fair bit. And then you’re also stuck in
the sense that, well, you don’t get…there aren’t
enough people, there aren’t enough people doing
this and … you’re scrambling and switching shifts,
to cover the shifts so that three of us could be
away [for their union meeting]. Yeah … and it’s just
kind of an ongoing problem. And like ___ said,
we’ve talked about this, we’ve got daughters that
are 23 and there’s no way in hell we’d ever
encourage them to go into health care.
(HCA, Manitoba)
Dr. B. Hallman, University of Manitoba
Frontline Workers:
Issues in a Rural Manitoba Context
• Lack of training =
inaccurate
documentation /
undocumented care
• Aging work force =
high rates repetitive
strain injury
• Aging work force =
special consideration
re:computerization
of documentation
Dr. B. Hallman, University of Manitoba
I’ve worked construction and I’ve never been so
tired as I have working in a nursing home…But
working in a nursing home is very stressful…I’ve got
to go home and have a nap and I’ve never done that
and I’ve always worked two jobs! I’m just getting
older…(laughs). I work one job now and it’s like, I
get home and I [makes sleeping motion] for a
couple of hours. It’s the stress. Emotionally,
physically and mentally it is very stressful; very,
very stressful. Especially when you have kids.
We still have people that lift residents. One of
my girls hurt herself; she still lifts people up. I do
not lift anybody manually anymore … wait until
they’ve been there 20 years and they can’t
walk any more on certain days.
Dr. B. Hallman, University of Manitoba
For the aides themselves…I mean I’ve done some
education, but there are some that haven’t and
they can’t handle that [dementia]. They slam the
door or say ‘I’m not going in that room, I don’t
even want to look at them!’, and they have to
provide care to them.
When you’re stressed out, you injure yourself a lot
easier than you would if you’re … you’re tense,
you’ll injure yourself a lot faster than you would
We calculated it and it was three minutes per resident for 30
residents. That’s Hoyer [lifting with a device], wash, groom, the
whole bit. Three minutes per resident, is what the average time
is. That’s not including the baths we have to do, the four baths.
You get ready in three minutes! Ha!
Dr. B. Hallman, University of Manitoba
I think that using a computer will be a
challenge for the older worker, but I also
think … I’ve been in some homes where I’ve
seen maybe three computers. One’s in the
administration office, one’s in the DON’s
[Director of Nurses] office, and one’s at the
main desk.
Dr. B. Hallman, University of Manitoba
Frontline Workers:
Issues in a Rural Manitoba Context
• Rural frontline
workers know their
residents = affect
assessment
consistency, impacts
on workers
• Delay between
assessment and
funding = inability to
react to acuity level
increases
Dr. B. Hallman, University of Manitoba
When somebody does pass away you don’t even
have time, or they won’t let you have time, to
spend with that person if there’s nobody to be with
them. It’s hard when they are dying and there’s no
one there and you want to hold their hand …
they’re grabbing for your hand and you can’t stay.
That’s the hard part … and they die alone. I told
one nurse ‘get lost’. I was staying. Nobody’s going
to die alone when I’m there … but I mean it has
happened that they’ve chased people out ‘get to
work, we’ve got other people to get to.’
Well, it took us what, three years of heavy, heavy;
we had all Level 4s. It took us a strike before we
got an extra person!
Dr. B. Hallman, University of Manitoba
When you hear Level 4 you know it is heavy as in
physical work. Level 2 can be just as heavy only
mentally…trying to prevent a mixed up person
when they can’t leave, when they are looking for
their parents, or they have to go look after the
horses and they are crying. You have to tactfully,
gently soothe them, redirect them. So it is a lot
harder mentally on me. Sometimes you just want
to go into another room and scream.
About 5 years ago, instead of just 1,2,3, and 4…you could
be a 2y, and that would be ‘with behaviour’. So that’s
closer to a level 3…they wanted the government to fund
behaviour as well, but it’s not being done.
Dr. B. Hallman, University of Manitoba
Remember when we used to have time in the
afternoon, say 2 o’clock, when we would get
together to have a discussion about how bad or good
things are going, or whatever? But you know, there is
never enough time for that. It takes us until 2
o’clock or 2:30 to get everybody panned after lunch
and laid down for his or her nap. Then we have these
forms – the flow sheets – to fill out and it’s time to
go home… Sometimes it’s just too busy there.
Dr. B. Hallman, University of Manitoba
Conclusions
• Rural communities are struggling to find
ways to sustain themselves
• Rural care homes can and do make
positive contributions to the sustainability
of rural communities
• BUT
– Using patient classification to determine
funding has detrimental consequences for
frontline workers in rural care homes
– Set out 18 recommendations to ameliorate this
situation
Dr. B. Hallman, University of Manitoba