Department of Sociology
University of British Columbia
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.
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