Working in clients' homes: the impact on the mental health and well-being of visiting home care workers

The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.     

Self-reported musculoskeletal disorders among visiting and office home care workers

This paper examines the associations between self-reported musculoskeletal disorders (MSDs) and work factors and injuries among home care workers. Based on 99 focus group participants and 892 survey respondents, results show a high level of MSDs among both visiting and office home care workers. While visiting home care workers tend to feel pain in the back, office workers tend to report pain in the neck and shoulder. Hazards in clients' homes, injuries moving clients and stress are associated with self-reported MSDs for visiting home care workers. Repetitive tasks and stress are associated with self-reported MSDs for office home care workers. Age and months in the profession have no affect on self-reported MSDs.     

The impact of work and organizational characteristics on the health status, job dissatisfaction and turnover intentions of workers in an information service industry]

Based on the conceptual model of "healthy work organization", we conducted a questionnaire survey of 612 Japanese workers in an information service industry company to investigate the effect of work stressors and organizational characteristics on workers' health status, job dissatisfaction and turnover intentions from July to August 2001. The response rate was 96.2%. For the statistical analysis, data on 488 computer technical support staff were used. To grasp the occupational stressors, we used a focus group to clarify work stressors and organizational characteristics. After factor analysis, we identified seven factors composed of 29 items and created seven scales of work and organizational characteristics. As scales of "organizational characteristics", "insufficient evaluation system", "undeveloped management system", and "career and future ambiguity" were used. The remaining scales, "poor coworker support", "poor supervisor support", "insufficient office amenities" and "high job demands and control", were used as scales of "work and workplace characteristics". The results of multiple regression analysis showed significant relevance of organizational characteristics to health status, job dissatisfaction and turnover intentions of workers. They supported "healthy work organizations" as useful conceptual tools for the study of organizational health.     

An examination of employer-provided benefits in the health care industry

Organizations that depend on a highly-skilled, stable workforce must be attuned to the needs of their employees and provide adequate compensation and benefits that enhance job satisfaction and lessen job mobility. Hospitals, like other organizations that compete for hard-to-find workers, use both traditional and non-traditional benefits to attract and keep skilled employees. This nationwide survey of hospital human resource managers assesses the types of benefits offered to health care workers and gauges the perceived impact of those benefits on job satisfaction and employee retention. Survey findings reveal that certain basic benefits, such as health insurance, are provided to all hospital employees. Other benefits, such as signing bonuses and reimbursement of relocation costs, are used as inducements to attract individuals in hard-to-fill job categories.     

Stress management in the workplace in the era of industrial and economic change]

The globalization of the economy and the recent economic recession in Japan has accelerated down-sizing or restructuring of corporations and has resulted in the induction of a wage system according to achievement instead of the traditional seniority wage system, break-down of the life-long employment system, excess labor and increased unemployment. These rapid changes in the labor situation have increased job stress. It was reported in the survey conducted by the Ministry of Labor in 1997 that 62.8 percent of 16,000 workers had anxiety, worry and stress regarding their working life. The need for effective stress management at work has been increasing in this situation, but in the survey mentioned above only 26.5 percent of 12,000 companies replied that they had incorporated mental health measures. The characteristic features of the approaches for stress management in Japan are summarized as follows: 1) The most popular approaches are education and consultation for individual workers. 2) Systematic preventive approaches such as work control, working environment control, organizational change in the health management system, and systematic and continuous educational programs for managers are inadequate. 3) Systems to evaluation the effectiveness of these interventional approaches are also inadequate. Considering the current situation in which there is increasing job stress and a need for the occupational mental health promotion, we propose a series of mini-reviews regarding stress management at work and mention the composition of this series.     

Job satisfaction among hospice workers: what managers need to know

The purpose of this study was to investigate the perception of job satisfaction among hospice interdisciplinary team members, which included social workers, nurses, spiritual care providers, and home health aides. Interdisciplinary team members (n = 72) from 4 hospice organizations in the Midwest participated in the study. Results of this study show that job satisfaction as defined by hospice workers includes having task significance, supervisory support, integration, distributive justice, positive affectivity, autonomy, routinization, no role overload, and high levels of work motivation. These same workers also stated that (1) working with patients and families and carrying out the hospice philosophy (task significance), (2) being comfortable with their level of knowledge and skills (competence), and (3) having good relationships with team members (integration) play a significant role in their degree of satisfaction on the job. These results have implications for managers in hospice organizations. Specifically, managers in health care organizations like hospices need to be apprised of what factors result in job satisfaction among employees.     

Approach to easing occupational stress for high-stress workers: applying the brief job stress questionnaire to workplace mental health promotion]

We investigated job stress among 442 employees from 19 divisions in a Japanese company using the Brief Job Stress Questionnaire. Job stress of the employees was estimated by the score for total health risk. Among the 19 divisions, two divisions showed over 120 points of mean total health risk score. Intervention with a stress-reduction program was carried out in these 2 divisions. First, to assess the job stress, health care staff interviewed all workers in the 2 divisions. Second, the results of the interviews were reported to the divisions' managers. Third, the managers applied the best remedy for job stress in their workplaces. In addition, occupational health staff conducted mental health education as well as individual interviews for the workers from the 2 divisions. At reevaluation one year later, both divisions showed a decreased general health risk (under 120 points). No sick leaves for depression occurred within the 2 divisions during the intervention. The results of the present study suggest that the intervention was effective in easing occupational stress for high-stress workers. The stress reduction program also seemed to have helped managers to change their recognition of occupational mental health and enabled close cooperation with occupational health staff, which may improve mental health in the workplace.     

The actual condition of musculoskeletal disorders of workers working at new special nursing homes for the aged in Osaka Prefecture--comparison of musculoskeletal disorder between manager's awareness and care workers' complaints by questionnaire survey]

In order to examine the actual condition of health problems of workers working at new special nursing homes for the aged, we conducted an interview survey with the managers and a questionnaire survey among the workers. Subjects of the interview survey were managers at the 7 nursing homes. Subjects of the questionnaire survey were 362 workers employed at the 7 nursing homes, 214 care workers (CWs) and 104 workers other than care workers (non-CWs); 299 questionnaires were returned. The response rate was 82.6%. We asked the managers "How many CWs are complaining of low back pain (LBP) and upper extremity pain at your nursing home?" One manager answered that 80% of CWs were complaining of LBP, but other managers answered that a few but no more than 5 CWs were complaining of LBP. On the other hand, the prevalence of LBP among CWs by the questionnaire survey was high. The point prevalence of LBP was 70.0%, the one month prevalence of LBP was 81.6%, and the period prevalence of LBP in present job was 88.6%. The managers had less interest in upper extremity pain than in LBP. But more than 60% of CWs had complained of upper extremity pain in the previous 1 month. Seventy-three percent of CWs had not received any education about work-related musculoskeletal disorders although about half of them had got some education or training to minimize the risk of injury in training school. Regarding female workers (77% of all CWs, 73% of all non-CWs), the percentages of current smokers and night shift workers were higher in CWs than in non-CWs with statistically significant differences. The percentages of workers working without work breaks and working overtime were higher in non-CWs than in CWs with statistically significant differences. For prevalence of LBP among female CWs and female non-CWs, the workers having LBP now, having had LBP in present job, and having first experienced LBP in present job were higher in CWs than in non-CWs with statistically significant differences. All nursing homes surveyed had provided no special health examination for LBP. For managers to grasp the actual condition of musculoskeletal disorders of workers working at the nursing homes for the aged, we recommend that care workers should have a special health examination for LBP.     

Survivor's Syndrome: A Comparison of the Perceptions of Administrators,Managers, Nurses and Physicians during the Restructuring of Ontario Hospitals

Leaders must approach organizational restructuring by addressing employees’ concerns, or risk many potentially negative consequences among “survivors”. This article provides important insights for administrators, managers and planners about the perceptions of people remaining on the job during the restructuring of Ontario hospitals. The findings, relevant to most organizations undergoing or considering restructuring, support the need for proactive change management, including tailored intervention strategies, to assist “survivors”.     

Job characteristics and problems related to home care services for the elderly. A comparison among employment categories in Sapporo

OBJECTIVE: The aims of this study were to describe job characteristics for daytime and shift workers in home care services for the elderly and to clarify health care in the work setting, social support, and job satisfaction and possibilities. METHODS: A self-reported questionnaire was given to 433 home care workers, both full time and part time (more than 15 hours), at 35 institutions that provide home care services to residents of Sapporo (return rate; 80.2%). The following issues were investigated: job content (physical care, assistance with housework, and advice), specialty, job satisfaction, possibilities, job training, health care and social support. The results were compared among employed types: full-time and part-time daytime and shift workers using the t-test or the Fisher's test. RESULTS: The participants demonstrated high dissatisfaction with wages, physical uneasiness themselves and limited social support from their supervisors. Especially full-time workers were dissatisfied with the payment, whereas part-time workers complained about insufficient attention to the prevention of lumbago. It was found that part-time daytime workers were given insufficient on-job-training and education for prevention of infection, and that full-time shift workers greatly wished to leave the employment. However, the home care workers were satisfied with their job itself and expected to continue their work. Furthermore, half of the part-time workers hoped to work full time. CONCLUSIONS: Health management and educational training for part-time workers may be necessary to improve the quality of care services and protection of health. Promotion of full time employment and reconsideration of working condition might be necessary to provide sufficient home care services.     

Restructuring home care in the 1990s: geographical differentiation in Ontario, Canada

Through exploring the geographically differentiated effects of restructuring on the work of home care practitioners, labor process change is found to be spatially specific. It is through examining the spatiallity of labor process change that the differential impacts of health care restructuring on human health care resources can be determined. This has implications for human health care resource availability and service provision, which is particularly an issue for medically under-serviced regions. The restructuring approach, together with regulation theory, is used in this paper as tools for exploring the effects of health care reform on the local labor process. Both quantitative and qualitative data collected from home care practitioners in Ontario (Canada) show that the general trends in labor process change (work transfer down the home care hierarchy, increased time constraints, and enhanced job stress) are being similarly experienced, while shedding light on specific local differences. Findings show two working life factors to be differently experienced across the size of the place in which practitioners live and work. Two representative localities provide a closer examination of local differences in labor process change via the examination of local service cultures, local institutional practices, and local practitioner advocacy. The two sites are Sault Ste. Marie, located in northern Ontario's medically under-serviced northern health region, and Guelph, found in the province's well-serviced southern region.     

Factors Explaining the Job Satisfaction of Home Care Workers Who Left Their Older Care Recipients in Israel

There are high levels of turnover among home care workers. The study goal was to examine factors connected with job satisfaction of home care workers who resigned from their jobs. A survey (self-administered questionnaire) was conducted of 197 home care workers who resigned from their jobs with a home care agency in Jerusalem. Overall job satisfaction of the home care workers was low to moderate. Memory impairment of the care recipient and quality of the relationship between the care worker and the care recipient were significant in explaining overall and intrinsic job satisfaction of the workers. Functional status (activities of daily living) and the impact of the care recipient’s cognitive status on the care worker were significant in explaining job benefit satisfaction. Home care workers who provide care to severely disabled and cognitively impaired older persons experience great work stress. They need ongoing support and training as well as better job benefits.     

Maintenance of subjective health during a merger: the role of experienced change and pre-merger social support at work in white- and blue-collar workers

Prospective research on psychosocial effects on employees' health associated with organizational mergers has been scarce. The first aim of this study was to explore the subjective health effects (exhaustion and functional incapacity) of an organizational merger among employees who had experienced a change in their own job position differently (improved, unaltered, and declined). Secondly, the effects of pre-merger social support (organizational, supervisor, and coworkers) at work on the experienced change in job position and on subjective health were examined. The merger took place in 1999 between two multinational firms of equal size. The study is based on two surveys (n=2,225) carried out in 1996 and in 2000 in the Finnish part of the company. The data on age, sex, pre-merger sickness absence (1996-98) and subjective health status (1996) were used as covariates. The results indicate that all sources of social support had a significant effect on the experience of change in one's job position. A decline in job position strongly increased the risk of poor subjective health after the merger. Weak organizational support was associated with impaired subjective health, especially in blue-collar workers, while weak supervisor support impaired functional capacity in white-collar workers. In turn, strong co-workers' support increased the risk of poor subjective health among blue-collar workers when their job position declined. We conclude that negative changes experienced in one's job position and lack of upper-level social support at work create a potential risk for health impairment in different employee groups in merging enterprises.     

A cultural economy approach to workplace health promotion in Australian small and medium sized workplaces: a critical qualitative study

Workplace health promotion (WHP) is advocated to progress the health and well-being of employees. However, research findings on its uptake and impacts are equivocal, particularly in smaller workplaces. This paper describes managers’ and workers’ responses to a WHP programme in the Australian Capital Territory. Informed by a cultural economy framework, in-depth interviews were conducted with 44 workers and managers from 10 small to medium sized enterprises (SMEs). Examining their availability and acceptability to workers and managers, we found a limited array of health promotion activities were adopted; a caring environment, provision of healthy foods, occasional health checks and health advice. Physical activity programmes during work hours were unlikely to be accepted by managers due to time costs, and workers were reluctant to spend their non-paid time on them. Casual workers were often excluded from WHP activities because their work times did not synchronize with other employees’ hours. This study illuminates how WHP is shaped by a complex of employment regulations that stress individual performance, associated limits on employer and worker time and resources, and organizational, cultural norms and practices regarding healthy work environments. We conclude that SMEs are implementing a limited array of behaviour change initiatives reflecting a particular view of health promotion. While organizational change may expand adoption of health practices during the workday, there are impediments to workers adopting wholesale changes in their health practices given a national culture of long hours, and intense job demands embedded in Australia’s neoliberal employment system.     

Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: implications for the care management model

The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.     

Job Stress and Job Satisfaction: Home Care Workers in a Consumer-Directed Model of Care

Objective. To investigate determinants of job satisfaction among home care workers in a consumer‐directed model. Data Sources/Setting. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Data Collection and Analysis. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Principal Findings. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work‐health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Conclusions. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer‐directed models of care and efforts to retain long‐term care workers.     

New York state case manager survey: Urban and rural differences in Job activities,job stress,and job satisfaction

The impact of stress in the workplace on employees' well-being and effectiveness has been increasingly recognized in recent years. The purpose of this research was to study the quality of working life of case managers in urban and rural community mental health programs in New York State. The objectives were to describe specific job activities and examine differences in the perceptions of job stress and job satisfaction. Urban case managers attributed greater job stress intensity and frequency than did rural workers to stressors relating to collaborating and coordinating services. Urban case managers reported higher levels of perceived job stress due to organizational support deficits than did rural workers. No differences were found for the 2 groups on job pressure stressors. The significance of the findings for mental health agencies is discussed.     

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

Background

Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.

Methods

All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.

Results

One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.

Conclusion

Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.     

Employee reactions to managed care.

Employee reactions to managed care get less managerial and research attention than organizational reactions to it. This article examines the manner in which health services employees react to managed care and finds that their reaction affects perceived job insecurity, organizational commitment, and job satisfaction. Organization-based self-esteem, role conflict, and supervisory support moderate these relationships. The managerial implications of these findings are discussed.     

Status of mental health problems and care in Japanese business establishments]

In order to clarify the status of mental health problems and care in Japanese business establishments, a questionnaire was administered to occupational health staff in various enterprises (243 valid responses, 17.0%). The results reveal that, in most enterprises, there are workers suffering from stress-related disorders. Depression was most often seen (47.2%). Additionally, the results suggest that depression lead to long periods of time off. Therefore, measures against depression in employees are important. There were a lot of offices that executed mental health care by supervisors and managers or occupational health staff, or by educational training, or medical examination, etc. However, a clear statement of the plan concerning mental health care by employers had been executed by only about a half of employers. As the rate of patients or workers with long periods off work was not correlated to the care executed in the office, mental health care in its present status dose not seem to be effective.