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Time matters: Negotiating daily life and the work day for elderly clients and their home support workers
Professor Anne Martin-Matthews
Prof Anne Martin Matthews with Past President of BSG Prof Judith Phillips

The BSG 2010 Conference theme of ‘Identities, Care and Everyday Life’ implies a sense of location, of time, and the activities that typically occur in that space and time.  The notion of ‘everyday’ time suggests particular patterns of order, regularity, rhythm, pacing, and tempo of time and its use. For those elderly persons who require assistance in their homes with personal care, however, the rhythm, tempo and pacing of daily life are experienced and controlled by forces typically beyond their control.  This paper considers how time is negotiated and experienced when paid carers, often representing the public sphere of service provision, enter the homes and lives of elderly persons and their carers receiving domiciliary care.

In her book, Time Watch: The Social Analysis of Time, Barbara Adam observes that, for most of us, “time forms such an integral part of our lives that it is rarely thought about. There is no need, it seems, to reflect on the matter since daily life, the chores, routines and decisions, the coordination of actions, the deadlines and schedules, the learning, plans and hopes for the future can be achieved without worrying about what time might be” (1995: 5). However, the experience of the giving to and receiving of home care by elderly people is quite the opposite. In home care there is a heightened awareness of our consciousness of time, and all its associated elements, including: rhythm, pace, tempo, intensity, duration, synchronization, timing, and sequencing (Adam, 1995).

The changing nature of home and domiciliary care
In the UK it is estimated that approximately 751,000 people receive formal home-based care services (Cangiano, et al., 2009), while in Canada more than one million people receive home care services annually (Carrière, 2006). Recent changes in the delivery of home and domiciliary care in both Canada and the UK, such as the tightening of local authorities’ eligibility criteria, have resulted in key service delivery shifts. For example, service delivery is ‘more intense’ (i.e., a smaller number of clients are receiving more hours of care) and more specialized (e.g., clients receive more nursing care, and less help with housework).  As a result, in some cases, individual clients are consuming more resources.

Nexus Home Care Project – A Canadian research study
The Nexus Home Care Project, now in its fifth year, has collected data about home care services to elderly clients in three Canadian provinces. The study examines the perspectives of home support workers (HSWs), elderly clients, and family carers in terms of job and service satisfaction, experiences of organizational and bureaucratic structures and regulations, and the socio-spatial and temporal context of the client’s care environment. We had two interests in examining the perspectives of these three groups regarding time: what issues did they identify with respect to time, and what strategies did they use to address these issues?  The focus of this paper is on the issues identified and is based on findings from the Phase II data collected through interviews with 118 home support workers, 82 elderly clients and 56 family members in British Columbia. More details about the participant groups and additional information about the project are available at: http://nexushomecare.arts.ubc.ca  (see also Martin-Matthews & Sims-Gould, 2008; Sims-Gould & Martin-Matthews, 2010).

How time issues are experienced in home care:
Elderly clients, HSWs and family carers each have differing perspectives as to how time matters in home care. For clients, key issues include: the balance of priorities in how time is used (e.g., when workers have time ‘left over’ but cannot complete certain tasks because they are not in the care plan); the pacing of tasks; and the difference of opinion between worker and client regarding task priorities and allotment of time.  Many clients also noted the ways in which the temporal order of the bureaucracy of care affect the natural tempo and rhythm of their days, as they strive to adapt to agency timing and scheduling of service. Lexi, a home support client for 3 years, for example, receives her shower at 10:00pm; she explains I wanted it earlier but they were just so heavily booked.”

Workers and clients alike refer to the “tyranny of time”, although workers usually frame this discourse in terms of how they strive to avoid the perception of it, while clients indicate that they are well aware of worker’s efforts in this regard. Workers and clients are also both acutely aware of the compressed timeframes involved during the delivery of care in the home setting. For instance, care is most often provided in an hour appointment, which is further condensed by ten minutes to allow workers to travel between clients (i.e. ‘the 50 minute hour’). Julie, a worker for 18 years, notes “You’re pushing, and the thing is if you try to finish, then you’re late getting to your next client, so it cuts into their so-called 50 minutes.” Workers also identify such issues as the time their visits are scheduled and the amount of time (hours of work) they are given.

Time is also experienced in terms of prevalence of casual and part-time labour as a feature of this sector (with its gendered and economic implications). It is also relevant in the extent to which workers live in a kind of ‘suspended animation’ in terms of their ‘work’ time; frequently, and in some health authorities typically, not knowing their schedule from week to week, and with no assurance that hours of work will even to be allocated to them – and this, despite a shortage of workers in the sector (Fujisawa & Colombo, 2009). The ‘rush’ and ‘lack of time’ must be considered against this other backdrop of time spent waiting for work.

Family members vary in their view of the adequacy of home support hours. For some the number of allocated hours of care meets their expectations, for others they are not enough.  For many, the ‘allocated hours of care’ are not the main issue; the quality of care is of primary concern.  Some family members state that the hours are adequate but at the same time explain how much stress and strain they experience as a caregiver.  Families talked about the working conditions that workers must deal with on a regular basis: how workers are required to travel long distances between jobs and how workers are often rushed, especially on weekends. Lana, whose mother has been receiving home support for three years, explains:

Saturdays and Sundays is a bit difficult.  I don’t know how many people her Saturday and Sunday person sees, but she very often has to rush in and she just gets Mom breakfast and makes the sandwich and has a very quick visit.  And then she’s out of there. So Mom complains sometimes that she arrives late and then doesn’t stay very long.  But, really, I feel it’s important that she just has the contact with someone, just to make sure that she’s, you know, up and around.

In home care, elderly client, worker and family carer timetables are intersecting and interrelated. As Adam (1995) notes “all expressions of … time have to be appreciated together if we want to get a sense of the connections between time and health…" (51).  Elsewhere too I have noted the contingent nature of home support work and of the provider – client interaction within the private sphere of the home (Martin-Matthews, 2007).  Framed within the context of governmental home care policies and agency guidelines, for elderly clients “the worker embodies both what the system can and cannot do for them” (Bowdie and Turwoski, 1986: 44). This contingency is framed not only in terms of the nature of the work and the ‘care plan’ but the time allocated for each.  Relationships in home care are decidedly contingent on time, as allocated by the agency and dictated via the care plan.

Time is important as a measure of the value we place on the work of care, on the care of elderly persons and on the ‘tasks’ associated with their health and social care.  In earlier times, work was ‘task’ rather than ‘clock’ oriented, such that the specific activity and not the standard of the clock governed the rhythms, routines and timing of work. Today it is no longer the task but the value of time that has become dominant: time has been transformed into a central currency in the experience of family life (Daly, 2001). Indeed, time has been transformed into something which is no longer passed but spent (Eyers, 2007).  With the rationing, budgeting and compressing of time for care, time matters now more than ever in home care.

 

Acknowledgement
I thank Catherine Craven and Kerry Byrne of the Nexus Home Care project, Department of Sociology, The University of British Columbia, for their assistance. 

 

References
Adam, B. (1995). Time Watch: The Social Analysis of Time. Polity Press: Cambridge, UK.

Bowdie, R. & Turwoski, A. (1986). The problems of providing services to the elderly in their own homes. In Pelham, A. O. & Clark, W. F. Managing Home Care for the Elderly. Springer: New York. pp. 31–46.

Cangiano, A., Shutes, I., Spencer, S. & Leeson, G. (2009). Migrant Care Workers in Ageing Societies: Research Findings in the United Kingdom. COMPAS (ESRC Centre on Migration, Policy and Society): Oxford, UK.

Carrière, G. (2006). Seniors’ use of home care. Health Reports- Statistics Canada. Vol. 17, No. 4, pp. 43-47. 

Daly, K. (2001). Minding the Time in Family Experience: Emerging Perspectives and Issues. Contemporary Perspectives in Family Research. Vol. 3. Elsevier Science Ltd.: Oxford, UK.

Eyers, I. (2007). Extracting the essence of formal caregiving: A comparative study of formal caregivers in English and German care homes. In Paoletti, I. Family Caregiving for Older Disabled People: Relational and Institutional Issues. Nova Science Publishers: New York. pp. 273-294.

Fujisawa, R. & Colombo, F. (2009). The long-term care workforce: overview and strategies to adapt supply to a growing demand. OECD Health Working Paper, No. 44. OECD Publishing: Paris, France.

Martin-Matthews, A. (2007). Situating 'home' at the nexus of the public and private spheres: ageing, gender and home support work in Canada. Current Sociology. Vol. 55, No. 2, pp. 229-249.

Martin-Matthews, A. & Sims-Gould, J. (2008). Employers, home support workers and elderly clients: Key issues in delivery and receipt of service.  Health Care Quarterly. Vol. 16, No. 3, pp. 71-77.

Sims-Gould, J. & Martin-Matthews, A. (2010). Strategies used by home support workers in the delivery of care to elderly clients.  Canadian Journal on Aging. Vol. 29, No. 1, pp. 97-107. 

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