This chapter explores the unpaid work of family members with elderly relatives in the lead-up to nursing home care in two jurisdictions: Ontario, Canada, and Sweden. Unpaid work includes providing care, as well as the navigation and the advocacy work required to seek, apply for and enter nursing home care. Although Sweden has a universal social democratic approach, and Canada a selective liberal approach, both countries have seen rationing in long-term care funding and reduced access to nursing homes. In both jurisdictions, families take on extensive unpaid work and experience increasing stress leading up to nursing home admission. In Canada, after admission, families often experience a sense of guilt and continue their unpaid work in an attempt to fill care gaps. This contrasts to Sweden, where families express relief, as safety and continuity of care increase, enabling them to be visitors rather than care providers, which may reflect higher staffing levels.
Taking care of bodies – body work – is central to nursing home care. Typically, it encompasses the work involved in cleaning, dressing, feeding and toileting people unable to perform these tasks on their own, and the interpersonal interactions that facilitate these tasks. Yet many residents are active in caring for their own bodies. In nursing homes resident bodily care is an institutional responsibility, and this resident self-care is a variety of ‘unpaid work’, contributing to the overall work required to maintain the nursing home population. It is rational to surmise that if some residents do this bodily care for themselves, workers will have less to do, but supporting residents’ autonomy in self-care can take more, not less, staff time. This is ‘body-work-that-isn’t’: the work involved in promoting and supporting resident autonomy in bodily self-care and sexual expression. This chapter describes and analyses this unpaid work, which is both important to residents’ well-being and dignity and mostly uncounted in job descriptions, policy and organisational workflows.
This chapter offers an analysis based on ethnographic research in six Norwegian nursing homes with different degrees and forms of integration into local communities, with community understood as the local neighbourhood, a village or a city. It is also informed by fieldwork carried out in nursing homes in Canada, the UK, the US and Sweden, adding an international, comparative dimension to our analysis. COVID-19 has made clear the urgent necessity of opening up nursing homes, in Norway and elsewhere. This unbracketing furthermore implies opening up for wider social relationships and for beneficial forms of unpaid work from families and friends. However, and in alignment with other chapters in this volume, this is a benefit that should add to, as opposed to replace, paid care work.
Beginning with an overview of the various forms of unpaid labour done by and for those who live in, visit and work in nursing homes, this chapter identifies the conditions in Norway, Sweden and Canada that shape this work in particular, and different ways to bring both rewards and tensions to the various players. It demonstrates that the boundaries between paid and unpaid work are flexible, based more on conditions than on choice. It argues that naming unpaid labour as work does not eliminate care – or love for that matter. Rather, it calls attention to the conditions that are required to keep the care and the love in this labour.
This chapter discusses contextual and social mechanisms in rural areas in Norway, Sweden and Ontario and how they create and shape interactions between older people in care homes, their families, the staff and the volunteers. Geographical and physical conditions frame the outer context and impact service provision and how people depend on and relate to each other. Building relationships and helping out are important social mechanisms of reciprocity and reputation at work in transparent and tight communities. When residents, families and staff have close and binding relationships, as is often the case in tight or rural communities, there is more at stake, which means that they might increase their efforts and commitments. Familiarity, community, and blurred and flexible boundaries between private and professional positions and spheres might encourage or force families and staff to extend themselves in doing unpaid work.
This chapter explores the over-reliance on the unpaid work of families in nursing homes in the Canadian province of Ontario, with a focus on work processes, working conditions, and lack of worker protections and supports. Through a document scan analysis of the labour of family/friends, the chapter reveals the range of work families do, and how they are understood in organisational policies, procedures and processes, and analyses how conditions of work intersect with conditions of care. The concept of ‘family worker’, is developed to offer a lens on family contributions in nursing homes. Used in practice and alongside adequate staffing, the concept could facilitate staff collaboration with family workers in order to have the work of the latter recognised and their conditions of work improved. Such collaboration would include the development of work processes as well as means for documenting the work, while identifying the resources needed to improve conditions of work and support relations between staff and families.
This chapter begins by defining nursing homes, before moving on to set out the feminist political economy theory that guides the research and the teams’ multiple methods that provide the data for this book. It then explains what nursing homes look like in Canada, Sweden and Norway. These homes are located within the different normative frames dominant in these countries, with those values, along with other forces, used to help explain the different funding and ownership patterns. The chapter then turns to showing how these factors in turn shape the staffing and physical structures of nursing homes in the three countries. It ends with an explanation of how the various chapters explore the implications for the relatively unexplored unpaid work done by residents and staff, as well as for the more researched work of families and volunteers, revealing the forces that make boundaries flexible among the various forms of labour.
Drawing on feminist ethnographic research conducted in three nursing homes in Ontario, Canada, this chapter examines the unpaid work that nursing home residents do, as they negotiate and respond to their own and others’ care needs. It shines a light on residents’ practices of care, social glue and boundary-setting, as well as on their critical insights and jokes. Making links to everyday organisational conditions, and to circulating narratives of care and disability, it elaborates how residents’ practices are socially and organisationally mediated, with staff and others playing an important role in overseeing, facilitating and limiting residents’ contributions. The chapter illustrates how the boundaries between paid and unpaid work are boundaries that nursing home residents actively negotiate.
This chapter draws on staff interview data and fieldnotes to examine the perspectives of staff and the relationships they have with relatives’ families in Canadian, Norwegian and Swedish nursing homes. Jurisdictional contextual differences, including models of care, staffing levels and work organisation, vary considerably. These different contextual conditions shape the various roles that families navigate alongside and with staff, and the amount and form of unpaid work in which they engage. These conditions also shape the types and depth of relationships that form between staff and families. Such factors as having a contact-person model, small units and high staffing levels leave room and space for closer social connections between residents, family and staff and more continuity. However, these systems are not achievable without sufficient staffing levels and managerial support. Without them, there will continue to be tensions between staff and families and demands on both families and staff to bridge care gaps with unpaid work.
Based on a thematic analysis of 35 interviews with family members, volunteers, staff and residents in three Ontario care homes conducted between 2017 and 2019, this chapter explores the unpaid yet critical contribution of family members and volunteers, as well as of residents and staff, to enriching the quality of life for nursing home residents. We identify five key areas for developing promising organisational practices for supporting living: gaining knowledge of residents’ past lives and interests; bringing the outside interests of family members, volunteers and residents into long-term care homes; encouraging friendships with other residents, family members, staff and volunteers; developing intergenerational initiatives that regularly bring children into long-term care sites; and the key role of family members and volunteers in getting residents out of their rooms.