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8 September 2022

What makes the work in home care stressful: too many clients, low care continuity, work organization or interruptions?

Timo Sinervo , Finnish Institute for Health and Welfare , Finland

Visa Väisänen, Laura Corneliusson, Salla Ruotsalainen, Tiina Pesonen, Anja Noro
Finnish Institute for Health and Welfare

Abstract

Background: In Finland the service structure for older people has moved from residential care towards home care. There are efforts to increase productivity and the direct care time for clients in home care by for example using ERP-systems to allocate care time. Home care services suffer from shortage of work force as well as high levels of sickness absence and disability pensions. In line with demands for higher productivity complaints of higher time pressure have also increased. Thus, the challenge is, how to increase productivity and worker well-being at the same time. One of the possible answers is self-organized teamwork increasing care continuity and autonomy at work.

Objectives: The aim of this study was to explore the factors relating to time pressure and job satisfaction among home care workers. We aimed to find out which organisational factors, time allocation factors, and client-related factors are relating to experienced time pressure and job satisfaction at work.

Methods: The study is a part of two larger projects: Staff time measurement study and Ensuring the availability of staff and the attractiveness of the sector in elderly care services -study. In the staff time measurement study care workers in home care documented their work time allocation for one week using paper forms and filled a short personnel survey. Managers of the work units filled in a survey on their work organization, staffing and management practices. To obtain information of care needs, the data were merged to Resident Assessments (RAI-data).

In 16 home care units 431 employees filled in the staff time measurements and 385 answered surveys, of which 304 were practical nurses and 68 supervisors or registered nurses. The effects of the team autonomy, number of unique clients, direct care time per day, break time, mean of care needs of daily clients, and the experience whether the workday went as planned on time pressure and job satisfaction were studied using variance analysis.

Results: The preliminary results showed that higher direct care time with clients, higher service needs of clients and less time for breaks explained the higher experienced time pressure. Of the organizational factors higher team autonomy and lower number of unique clients explained lower time pressure. The evaluation whether the day had went as planned had the strongest association with time pressure. In regard to job satisfaction the results were rather alike, but team autonomy and service needs of clients had smaller effects while the number of unique clients had a stronger effect.

Conclusions: The results showed that time allocation and clients' service needs are related to time pressure and job satisfaction. The results also showed that care continuity (less unique clients) and team autonomy may relieve stress and increase job satisfaction. Thus, it is important not only to straightforwardly increase productivity, but also to improve work organization. It was also revealed that disruptions at workday are a major source of time pressure and dissatisfaction and it's important that organizations are prepared for disruptions.


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