Making it Work: A Study of the Decision-Making Processes of Personal Support Workers in Long-Term Residential Care

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dc.contributor.advisorArmstrong, Pat
dc.creatorDay, Suzanne Louise
dc.date.accessioned2015-08-28T15:02:53Z
dc.date.available2015-08-28T15:02:53Z
dc.date.copyright2014-10-27
dc.date.issued2015-08-28
dc.date.updated2015-08-28T15:02:53Z
dc.degree.disciplineSociology
dc.degree.levelDoctoral
dc.degree.namePhD - Doctor of Philosophy
dc.description.abstractThis dissertation explores the decision-making processes of personal support workers (PSWs) in long-term residential care (LTRC). These workers are lowest in the LTRC labour hierarchy, performing the majority of "hands-on" care. Research has shown that PSWs have little input in formal care planning and organizational processes, but retain some limited control over how they work on a daily/nightly basis. Given this, my study asks: where can PSWs make decisions, what factors shape their capacity to decide and, when they can make decisions, what are the factors that these decisions respond to? I use a feminist political economy framework to answer these questions, and begin by examining broader social, political, economic, and historical features of the LTRC landscape on a global, national, and provincial level. Located on this landscape is “Riverside Home”, a multi-unit LTRC facility in a large urban city in Ontario. My analysis draws on data from a rapid ethnography conducted at this site, obtained through my participation as a student researcher on the project Re-Imagining Long-Term Residential Care: An International Study of Promising Practices. I use both observations of and interviews with personal support workers at Riverside Home, examining their daily/nightly experiences of care work including feeding residents, bathing/grooming, toileting/continence care, and clothing/laundry. My analysis demonstrates that PSWs experience a narrowed capacity to make decisions about care, and both regulations and restructuring have impacted their workload, work organization and working conditions. However, amidst this narrowed capacity to decide, PSWs make numerous important decisions throughout their daily/nightly care work, including adjusting the tempo of their work, prioritizing tasks, rearranging their workload, and coping with abuse. My findings demonstrate that PSW decision-making in LTRC is a complex social process shaped by and in response to social location (i.e. the intersecting variables of race, gender and class), work organization, regulations, LTRC (re)structuring, and models of care. By locating PSW decision-making within these multi-layered “nested” contexts, I demonstrate that the conditions of PSWs’ direct care work in LTRC are neither natural nor inevitable, and thus are transformable for the benefit of both workers and the residents they care for.
dc.identifier.urihttp://hdl.handle.net/10315/29922
dc.language.isoen
dc.rightsAuthor owns copyright, except where explicitly noted. Please contact the author directly with licensing requests.
dc.subjectSociology
dc.subject.keywordsPersonal support workers
dc.subject.keywordsCare workers
dc.subject.keywordsNursing assistants
dc.subject.keywordsNurse aides
dc.subject.keywordsCare aides
dc.subject.keywordsCare work
dc.subject.keywordsDecision-making
dc.subject.keywordsDecisions
dc.subject.keywordsFeminist political economy
dc.subject.keywordsLong-term care
dc.subject.keywordsResidential care
dc.subject.keywordsNursing homes
dc.subject.keywordsCare homes
dc.subject.keywordsWork organization
dc.subject.keywordsRestructuring
dc.subject.keywordsModels of care
dc.subject.keywordsWorkload
dc.subject.keywordsWorking conditions
dc.subject.keywordsDirect care
dc.subject.keywordsCare theory
dc.subject.keywordsOntario
dc.subject.keywordsCanada
dc.subject.keywordsRestructuring
dc.subject.keywordsGender
dc.subject.keywordsClass
dc.subject.keywordsRace
dc.subject.keywordsPrecarious labour
dc.subject.keywordsRapid ethnography
dc.subject.keywordsEthnographic
dc.subject.keywordsTeam ethnography
dc.subject.keywordsSociology
dc.subject.keywordsTime
dc.subject.keywordsScheduling
dc.subject.keywordsFunding
dc.subject.keywordsDivision of labour
dc.subject.keywordsHierarchy
dc.subject.keywordsPerson-centred care
dc.subject.keywordsMedical model
dc.subject.keywordsMarket model
dc.subject.keywordsSocial model
dc.subject.keywordsMarketization
dc.subject.keywordsNeoliberal
dc.subject.keywordsPaid care
dc.subject.keywordsAccountability
dc.subject.keywordsRegulation
dc.subject.keywordsFeeding
dc.subject.keywordsBathing
dc.subject.keywordsToileting
dc.subject.keywordsContinence care
dc.subject.keywordsLaundry
dc.subject.keywordsClothing
dc.subject.keywordsWork tempo
dc.subject.keywordsRule breaking
dc.subject.keywordsViolence
dc.subject.keywordsAbuse
dc.subject.keywordsStress
dc.subject.keywordsCare relationships
dc.subject.keywordsChoice
dc.subject.keywordsAutonomy
dc.subject.keywordsStrategy
dc.subject.keywordsKnowledge
dc.titleMaking it Work: A Study of the Decision-Making Processes of Personal Support Workers in Long-Term Residential Care
dc.typeElectronic Thesis or Dissertationen_US

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