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March 25, 2018

Challenges of Caregiving

Reuel S. Amdur

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So, you think care work is easy. That was the title of a talk given by philosophy professor Monique Lanoix to SWAG (Social Workers in Aging and Gerontology) in Ottawa on March 22.

She is in the Faculty of Philosophy and the School of Public Ethics at St. Paul University, where medical ethics and political and feminist philosophy are her areas of interest.

She noted that one of the challenges facing institutional caregivers is the heavy paper work, documenting in detail the chores accomplished. 

However, lost in the shuffle is time spent listening to residents and in demonstrating caring in non-physical ways.  Yet, such use of caregiver’s time is central to provision of good care.  Nursing, she noted, includes emotional labor such as this as a prime function of the profession. 

The institutional caregiver is burdened with an ever-increasing workload, both in number cared for and in complexity of needs. 

At the same time, the caregiver frequently finds himself in a precarious work environment.  It has been found, she stated, that secure employment of caregivers means better caring for the residents.  Insecure employment—temporary, part-time, contract work—is all too common for caregivers.

Institutional caregivers provide care that is close and sustained, but their role is not familial.  The danger is that following the detailed regulations to the letter may lead to bad work.  Violation of these regulations may be either good or bad.  She gave a couple of examples.

One situation involved transferring a man into bed.  The regulation stated that such a task requires two people.  The caregiver, faced with a lack of an immediately available person to assist and assured of his own adequate strength, undertook the task on his own.  Unfortunately, as a result, the resident fell against the headboard, causing a bruise on his neck. 

When the incident was discovered, other things went wrong.  The caregiver did not immediately acknowledge what he had done.  His supervisor did not report the incident up the line.  His colleagues rallied to his support, asking that the incident be overlooked.

In the other example, a resident was clearly unhappy.  Staff knew of her love of knitting, but the nursing home had a policy prohibiting sharp objects in the hands of residents.  Staff broke the rule and gave her knitting needles, much to her satisfaction.  One of the SWAG participants at the meeting noted that homes are very reluctant to take risks, leading to overprotection.  

Lanoix spoke of rigid rule following as “normal pathology.”  In the case of the woman allowed to knit, her needs were accommodated.  On the other hand, the incorrect transfer to bed was not adequately addressed.   There is a possibility of a slippery slope to poor care.

For Lanoix the fundamental question in caregiving is this: Are caregivers encouraged to accommodate the needs of those in their charge, or are they encouraged to work badly?   

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