About the authors:Christine Barry, BN, BPhEd, GradDipOHS, MPH, is a kaitūhono/connector for My Life My Voice. Her correspondence address is [email protected] Christina Severinsen, PhD, is an associate professor in public health in the School of Health Sciences, Massey University, Palmerston North. Andy Towers, PhD, is an associate professor in the School of Health Sciences, Massey University, Palmerston North. |
ABSTRACTAim: This study aims to explore the impact of the Care and Support Worker (Pay Equity) Settlement Act (2017) on the work-related quality of life of homecare support workers. |
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KEYWORDSHomecare, care and support workers, Pay Equity Act 2017, work-related quality of life |
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Introduction
Care and support workers play an essential role in health and disability systems worldwide by providing direct care and support in the home, community and disability services (Ravalier et al, 2019; Vassos et al, 2019). They care for older adults and people with various chronic diseases, injuries, disabilities, and mental health and addiction issues (Ministry of Health, 2016; Ravenswood et al, 2015). However research has shown that care and support workers often face poor working conditions and are susceptible to unfavourable pay and marginalisation (Ravalier et al, 2019; Strandell, 2020). Additionally, care and support work is often considered undervalued and gendered as women’s work (Hebson et al, 2015; Stranz & Szebehely, 2018). With the ageing global population, finding ways to support and improve conditions for this vital workforce is important.
Aotearoa New Zealand’s care and support workforce is primarily female, culturally diverse, and ageing, with most workers between 45 and 65 years old (Meagher, 2016; Ravenswood & Douglas, 2017). They mostly work part-time and are not regulated by the Health Practitioners Competence Assurance Act (Ministry of Health, 2016). The demand for care and support services is increasing due to an ageing population and the prevalence of disability and non-communicable diseases (Home and Community Health Association & Lattice Consulting, 2018). However, the working conditions of care and support workers have been affected by class, gendered norms, and hierarchical working relations (Charlesworth & Heap, 2020; Ravenswood & Harris, 2016). Research shows that care work is often undervalued and subjected to gender discrimination (McGregor & Davies, 2019; New Zealand Human Rights Commission, 2012).
Previous research illustrates that financial restructuring of health systems and associated resource constraints have led to intensification of the work of care and support workers, resulting in more significant stress, role ambiguity, reduced staffing rates, and reduced time to complete duties (Strandell, 2020; Trydegård, 2012). Restructuring and resource constraints have further undermined key workplace factors for care and support workers, such as remuneration, employment hours and job security (Stranz & Szebehely, 2018). International research also shows that care and support workers often have low wages, and variable contracts and employment hours, with a high percentage of workers in some countries, such as the United Kingdom, employed under zero-hour contracts (Ravalier et al, 2019; Rubery et al, 2015). In Aotearoa New Zealand, many home and community care workers have limited guaranteed hours of employment and earn the minimum wage (Ravenswood & Douglas, 2017; Ravenswood et al, 2015).
The New Zealand Government enacted the Care and Support Worker (Pay Equity) Settlement Act of 2017 in response to fiscal and work pressures facing care and support workers (Douglas & Ravenswood, 2019; Treasury, 2017). The Act provided $2.048 billion over five years to ensure pay equity for carers in residential, home, community and disability sectors (Care and Support Workers (Pay Equity) Settlement Act, 2017; Ministry of Health, 2018). However, research by Douglas and Ravenswood (2019) found the Act had unintended negative consequences, including reduced hours of work, increased workloads, and heightened work-related stress for care and support workers. Additionally, the home and community care sector saw significant changes in working conditions
affecting the job security of Levels 3 and 4 care and support workers, and many were left financially worse off. What was unclear from the Douglas and Ravenswood (2019) investigation was the different ramifications for care and support workers’ wider work life, in particular their work-related quality of life. Recent research by McFadden et al (2021) highlights that support workers’ work-related quality of life is fundamentally associated with their motivation and ongoing contentment at work. The study reported by this article aimed to explore how the Care and Support Worker (Pay Equity) Settlement Act (2017) has affected the work-related quality of life of home and community support workers.
Method
Van Laar et al’s (2007) Work-Related Quality of Life model was applied as a framework for a deductive, feminist qualitative investigation into the impact of the Act on support workers’ quality of life. The Work-Related Quality of Life model includes four components: working conditions, stress at work, work-life balance, and career and job satisfaction. This model has been widely used in research and aligns with the deductive approach. The feminist qualitative approach was chosen as the care and support workforce is predominantly female and has a history of gender discrimination.
Participants
The participants in this study were support workers primarily employed in the home and community sector, located in an urban city in the lower North Island of New Zealand. For the purposes of confidentiality, the specific location will remain undisclosed. To recruit participants, a study information sheet was distributed to an industry training organisation (ITO), home and community sector providers, unions, community health and social service organisations, and through word of mouth. Potential participants interested in this study contacted the researcher via phone or email, who checked whether they met the study’s inclusion criteria. The criteria included that participants be English-speaking females, over 18 years of age, currently working as support workers, primarily in a homecare role and holding a Level 3 or 4 experience or qualification. The study’s criteria that participants should be women was to enable women’s voices pertaining to the Act to be heard. Eight participants meeting these criteria were accepted into the study and their identities protected through pseudonyms and participant numbers. The researcher conducted the interviews, which included each participant completing a brief questionnaire enabling the collection of background information (age, years of homecare experience etc), which helped to provide a contextualised understanding of the participants. Table 1 (below) provides key participant demographic information.
Data collection
This study used in-depth, semi-structured, face-to-face interviews for data collection. The interviews were conducted using a set of open-ended questions based on the Work-Related Quality of Life scale. The study received ethical approval from the Massey University Human Ethics Committee, and all participants gave their consent before the interview. The researcher recorded and transcribed the interviews aided by a computerised software transcription service. Identifying information was removed, and the interviews were checked for accuracy by the researcher, and then by participants to ensure data quality.
Table 1. Key participant demographics
| Participant pseudonum | Age | Level 3 or 4 | Full-time or part-time | Years of experience as support worker |
|---|---|---|---|---|
| Sharon | 65 | 3 | Part-time | 7-10 |
| Lorraine | 47 | 3 | Full-time | 15-18 |
| Jill | 53 | 4 | Full-time | 15-18 |
| Helen | 56 | 3 | Full-time | 7-10 |
| Molly | 66 | 3 | Full-time | 7-10 |
| Cathy | 50 | 3 | Full-time | 11-14 |
| Sarah | not stated | 3 | Full-time | 19+ |
| Tanya | 51 | 4 | Full-time | 11-14 |
Data analysis
This study employed Clarke and Braun’s (2014) six-step process of thematic analysis to analyse the data collected from the interviews. Thematic analysis was selected due to the method’s strength in capturing the complexities of meanings and use in exploring experiences from participant interviews (Gavin, 2008; Guest et al, 2012). The transcripts were imported into NVivo software and coded and analysed according to the theoretical concepts of Van Laar et al’s (2007) framework of the four psycho-social subscale components: working conditions, stress at work, work-life balance, and career and job satisfaction. Aspects or concepts within the data perceived as important or significant were systematically assigned to codes under these components, forming coding trees relevant to the research question. Therefore, this study used a combination of deductive and inductive approaches, in which codes emerged from the data and were assigned to the components forming coding trees, and categories were created by addressing similarities and overlaps in codes and coded data. This process involved merging and re-defining codes and resulted in more extensive general codes, with some becoming promoted to potential prominent themes. The first researcher managed the process of code development, and researchers two and three facilitated in the review and refinement of the codes. The four sets of components and their thematic maps were compared to check the possible themes and their relationship to each other. This helped inform the story behind the data and in answering the research question.
Results
The study’s findings on the effects of the Settlement Act on support workers’ work-related quality of life are presented using the four components identified as underlying work-related quality of life: working conditions, stress at work, work-life balance, and job and career satisfaction. These components were used as a framework to analyse and present the data collected from the interviews.
Working conditions
The study found that six support workers reported a significant increase in their pay rate since the Pay Equity Settlement Act
was implemented. However half of the participants also reported declining employment hours. This decline was linked to a reduction in guaranteed hours, the hiring of cheaper staff, and less time allocated to clients for care. This suggests that while some workers benefited from the increased pay, they also experienced a reduction in the amount of work available to them. For example:
“Because our pay went up, they probably weren’t quite willing to give us many more hours …”
“They also changed our working … instead of giving an hour to shower, we have to do what we’re doing in three-quarters of an hour, or half an hour. Plus, we were expected to do more in that time, which was less time than what we had then when the pay went up. They didn’t do it so much for existing clients, but they did it for new clients.” (Helen)
“Once pay equity came in … what did they start doing? Us ones that knew what we were doing and had up to Level 3, we weren’t getting the work. They were actually bringing on new ones that they could pay $2 or $3 cheaper.” (Molly)
Some participants also noted that the pay increments they received over the last four years had not kept pace with inflation and living costs, resulting in their wages being similar to the minimum wage. Participants also expressed concerns about the reorganisation and scheduling of their work. Some reported experiencing work intensification, which included pressure to accept extra shifts, working alone in situations meant to be handled by two people, and a lack of time off work. These factors may have negatively affected the overall quality of their working lives.
“You do, at times, feel pressured to fill those [extra] hours, even if you don’t want to. You get the sob story of, ‘But there’s no one else to do the job, and this needs to be done.’ And quite frequently, you do give in when you shouldn’t … Two days off in three weeks is not good.” (Lorraine)