Comparing Nursing Home Assistive Personnel in Five Countries
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Assistive personnel are the primary caregivers in long-term residential care (LTRC) in industrialized countries. Our goal is to describe and compare the work-related characteristics of assistive personnel in LTRC in five countries (Canada, Germany, Norway, U.K., and U.S), which may reflect how various societies view their responsibility to aging populations and the workers who care for them. OECD and national statistical databases are used to assess and compare the work context for assistive personnel. Analysis of the statistical data is informed by on-site observations in nursing homes with reputations for high quality, close readings of these organizations’ documents and records, and interviews with LTRC staff. Pay is generally low and the work required of assistive personnel is often demanding in all countries studied. While most assistive personnel have completed high school, formal certification requirements vary considerably. Professionalization is increasing in Norway with its high school major in eldercare, and in Germany, which has a 2-year certificate program. Financial compensation for assistive personnel in Norway and Canada is greater than in the other countries. Union membership for assistive personnel ranges from very high in Canada to negligible in the U.S. Some countries studied have training programs of only a few months duration to prepare assistive personnel for highly demanding jobs. However, in Germany and Norway, training aims to professionalize the work of assistive personnel for the benefit of workers, employers, and residents. There are high rates of part-time and/or casual work among assistive personnel, associated with reduced employment-related benefits, except in Germany and Norway, where these benefits are statutory for all. Data suggest that unionization is protective for assistive personnel, however union coverage data were not available for all countries. The need to improve the qualifications and training of assistive personnel was observed to be a national priority everywhere except in the U.S. Compensation is relatively low in the U.K., the U.S. and Germany, despite the important jobs performed by assistive personnel. Finally, to improve future research, statistical mapping of this critical component of the labour force in LTRC should be a greater priority across high-income countries.
KeywordsLong-term residential care Human resources Comparative Assistive personnel Care aides Nursing homes
This article is based, in part, on data obtained from the MCRI project, “Re-Imaging Long-Term Residential Care: An International Study of Promising Practices,” funded by the Social Sciences and Research Council of Canada – Major Collaborative Research Initiative.
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Conflict of interest
Authors of this research declare that they have no conflict of interest.
As there is no person or personal data appearing in the paper, there is no one from whom a permission should be obtained in order to publish personal data.
Ethical Treatment of Experimental Subjects (Animal and Human)
This article does not contain any studies with human or animal subjects performed by any of the authors.
- Altenpflegegesetz in der Fassung der Bekanntmachung vom 25. August 2003 (BGBl. I S. 1690), geändert zuletzt durch Artikel 1 des Gesetzes vom 13. März 2013 (BGBl. I S. 446), cf. http://www.gesetze-im-internet.de/bundesrecht/altpflg/gesamt.pdf. Accessed 26 June 2014.
- Armstrong, P., Armstrong, H., & Scott-Dixon, K. (2008). Critical to care: the invisible women health services. Toronto: University of Toronto Press.Google Scholar
- BMAS. (2014). Mindestlöhne im Sinne des Arbeitnehmerentsendegesetzes. from: https://www.bmas.de/SharedDocs/Downloads/DE/pr-mindestloehne-aentg-uebersicht.pdf?__blob=publicationFile
- Bureau of Labor Statistics, U.S. Department of Labor (2010–2011). Occupational Outlook Handbook. http://www.bls.gov/ooh/. Accessed May 2015.
- Bureau of Labor Statistics, U.S. Department of Labor (2014–2015). Occupational Outlook Handbook. http://www.bls.gov/ooh/. Accessed May 2015.
- Cavendish, C. (2013). The Cavendish Review: an independent review into healthcare assistants and support workers in the NHS and social care settings. Google Scholar
- Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens F. (2011). Help wanted? Providing and paying for long-term care. OECD Publishing.Google Scholar
- Comparative Perspectives on Precarious Employment Database. (2014a). Education by detailed HSC occupation, Canada, United States, and EU countries, 1983–2011 (HSC DE-1). Retrieved from from http://www.genderwork.ca/cpd
- Comparative Perspectives on Precarious Employment Database. (2014b). Annual income for basic HSC occupation, EU countries 2004–2011 (HSC IB-5). Retrieved from from http://www.genderwork.ca/cpd
- Die Johanniter. (2014). Ausbildung Schwesternhelferin/Pflegediensthelfer: from: http://www.johanniter.de/aus-und-weiterbildung/ambulante-und-stationaere-pflege/schwesternhelferin-pflegediensthelfer/schwesternhelferin-pflegediensthelfer-region-aachen-dueren-heinsberg/accessed. Dec 27 2014.
- Gender and Work Database. (2014). Table HC SLID E1. Retrieved from http://www.genderwork.ca/gwd/
- GKV. (2008). Spitzenverband der Pflegekassen. Richtlinien nach §78b Social Code Book XI (SGB XI) zur Qualifikation und zu den Aufgaben von zusätzlichen Betreuungskräften in Pflegeheimen.Google Scholar
- Gospel, H., Nishikawa, M., & Goldmann, M. (2011). Varieties of training, qualifications and skills in long-term care: A German, Japanese and U.K. comparison. SKOPE Research Paper No. 104.Google Scholar
- Hermansen, Å. (2011). Personell og yrkesfordeling innen pleie- og omsorgssektoren. Oslo: Fafo.Google Scholar
- Høst, H. (2010). Helsefagarbeiderutdanning for voksne. Oslo: NIFU.Google Scholar
- Hussein, S. (2011). Estimating probabilities and numbers of direct care workers paid under the national minimum wage in the U.K.: A Bayesian Approach. Social Care Workforce Periodical, 16. Retrieved from http://www.kcl.ac.uk/sspp/policy-institute/scwru/pubs/periodical/2011/issue16.aspx
- Khatutsky, G., Wiener, J., Anderson, W., Akhmerova, V., Jessup, E. A., & Squillace, M. R. (2011). Understanding direct care workers: a snapshot of two of America’s most important jobs. Washington: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.
- Kühnlein, G., Stefaniak, A., & Wohlfahrt, N. (2011). Wettbewerb in der Sozialwirtschaft – Auswirkungen auf tarifliche Entwicklungen. In B. Stolz-Willig, J. Christoreridis (Ed.): Hauptsache billig? Prekarisierung der Arbeit in den sozialen Berufen (pp. 144–162). Münster.Google Scholar
- Kuemmerling A. (2009) Der lange Weg zur Professionalisierung der Altenpflege und seine (nicht?)-intendierten Folgen. In: S. Lehndorff (Ed.): Abriss, Umbau, Renovierung? Studien zum Wandel des deutschen Kapitalismusmodells. Hamburg: VSA, 136–165Google Scholar
- Landesregierung Nordrhein-Westfalen (2006). Gesetz zur Durchführung des Altenpflege-gesetzes und zur Ausbildung in der Altenpflegehilfe.Google Scholar
- Laxer, K. (2013). Counting carers in long-term residential care in Canada. In P. Armstrong & S. Braedley (Eds.), Troubling care: critical perspectives on research and practices. Toronto: Canadian Scholars’ Press.Google Scholar
- Meyn, C. (2012). Occupational health and safety in elderly care in Germany: (Un)healthy work organization and workplace health promotion. unpublished paper for ReLTC.Google Scholar
- National Health Service. (n.d.). NHS careers in detail: Healthcare assistants/auxiliary nurses. Retrieved from http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/healthcare-assistant/
- Norwegian Ministry of Health and Care Services. (2013). Future Care: Meld. St. 29 (2012–2013). Report to the Storting (White Paper) from the Stoltenberg II Government. Retrieved from http://www.regjeringen.no/pages/38452288/PDFS/STM201220130029000EN_PDFS.pdf
- Norwegian Ministry of Labor and Social Affairs. (2014). Lov om arbeidsmiljø, arbeidstid og stillingsvern mv. (arbeidsmiljøloven). LOV-2005-06-17-62 (revised 01.01.2014).Google Scholar
- NUMGE. (2011). Kjappe løsninger på deltidsfella? Retrieved from http://oss.fagforbundet.no/tags/deltid/?article_id=64033.
- OECD. (2011). Health at a glance 2011: OECD indicators. OECD Publishing. doi: 10.1787/health_glance-2011-en
- OECD. (2014). Average annual wages. OECD employment and labour market statistics (database). Retrieved from doi: 10.1787/data-00571-en
- Ontario Ministry of Health and Long-term Care. (2007). Long-term care homes act. S. O. (2007) (Vol. c. 8). : http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_07l08_e.htm.
- Ontario Ministry of Health and Long-term Care. The regulation of personal support workers the minister’s question on February 7, 2005 the Honourable George Smitherman, Minister of Health and Long-Term Care. http://www.health.gov.on.ca/en/common/ministry/publications/reports/personal_support_workers/personal_support_workers.pdf
- Personal Support Network of Ontario. (2011). PSW training organizations comparisons for Ontario. Retrieved from http://www.psno.ca/uploads/1/0/1/9/10197937/psno_summary_of_psw_training_in_ontario_july_2011.pdf
- Robbins, I., Gordon, A., Dyas, J., Logan P., & Gladman, J. (2013). Explaining the barriers to and tensions in delivering effective healthcare in U.K. care homes: a qualitative study. BMJ Open, 3(7). doi: 10.1136/bmjopen-2013-003178 PMCID: PMC3717448.
- Simonazzi, A. (2009). New skills for new jobs? Status quo and perspectives for the elderly care sectors in. Europe: European Employment Observatory (EEO) Thematic Paper. Retrieved from http://www.eu-employment-observatory.net/resources/reports/NewSkillsForNewJobs-ElderlyCareSector-SIMONAZZI.pdf.
- Skills for Care. (2014). Guide to qualifications and standards in adult social care, 2014–2015 Leeds, Skills for Care. Retrieved from www.skillsforcare.org.uk.
- Statistics Norway (2012). Nursing and Care Services. Retrieved from http://ssb.no/en/helse/statistikker/pleie
- Ströver, M. (2010). Die Neukonstruierung der Pflegeausbildung in Deutschland. In Eine vergleichende Studie typischer Reformmodelle zu Gemeinsamkeiten und Differenzen sowie deren Nachhaltigkeit. Lippe Verlag: Hellweg.Google Scholar
- World Health Organization. (2010). Classifying health workers: mapping occupations to the international standard classification. Geneva: World Health Organization.Google Scholar