Aged Care Institutions Management: A study of management’s engagement strategies to support migrant careworkers’ delivery of quality elderly care.

Abstract

One of the most significant phenomenon in Western industrialised societies today is a demographic shift towards an ageing population. Improved access to better nutrition, medical care, and a growing awareness of the importance of healthy eating and exercise, have all contributed to increased life expectancies (Hussein & Manthorpe, 2005; Stone, Dawson, and Harahan, 2003). The increase in the number of those aged 65 and above has in turn led to a dramatic rise in demand for aged care services. In the same vein, the factors that account for increased life expectancies have also caused a reduction in fertility rates resulting in reduced numbers of young people who, ideally, should look after the ageing members of the population. The elderly dependency ratio has therefore continued to rise (Badkar, Callister and Didham, 2009; Hussein & Manthorpe, 2005). Coupled with this are trends that show that increasingly less young people in most of the Western industrialised world consider caring for the elderly an attractive career to pursue. To compound this elder care labour supply problem, it has become evident that most households are also growing smaller and becoming more geographically mobile as family members move around seeking better work opportunities. This has culminated in the formal and informal care-workforce failing to cope adequately with the burgeoning demand for aged care services (Walsh and O’Shea, 2009). In response to the growing gap between caregiver supply and demand, the Western countries, New Zealand included, have increasingly resorted to the employment of migrants as carers. From an academic perspective, very little is known about the implications of the increased participation of migrants in elder care delivery because research in this field is still in its infancy. In this regard, this qualitative research explores the management implications of the increased internationalization of the workforce in the Aged Care Sector in New Zealand especially in the context of quality care conceptualisation and delivery. The literature reviewed raised a number of fundamental issues regarding migrants’ participation as carers in the aged care sector (Walsh and O’Shea, 2009; Cangiano et al., 2009; Spencer, Ruhs, Anderson, & Rogaly, 2007). One of these issues is that the participation of migrants has introduced an intercultural element to how elder care is conceptualised, delivered, consumed and judged. The influence of culture on quality care delivery is further complicated by the largely intangible dimension of care. In this regard one of the major challenges impinging on the delivery of quality care, ironically, emanates from the elusiveness of the concept of ‘care’. Most of the extant studies show that elderly patients value the intangible dimensions of care, such as communication, attitude and tone of voice, more than the technical aspects of care provision (Perucca, 2001). However, because of the participation of migrants as carers, the definition of what is ‘acceptable attitude’, ‘acceptable tone of voice’ or ‘quality care’ is less certain. Accordingly, the literature prompted questions about the multifaceted cultural contexts in which practices and conceptualisations of elder care occur as well as the cultural competences that may be needed by managers to aid migrants to deliver acceptable levels of quality care. The tensions inherent in the elusive concept of care vis-à-vis migrant participation are further accentuated by other diverse challenges such as underemployment, perceived discrimination and perceived racism that most migrant carers face. These challenges that migrants encounter prompted questions about the role of managers in ensuring that these challenges do not impact negatively on how migrant carers provide care to the elderly. To inform and structure this study’s exploration of the implications of the increased participation of migrants as carers, as well as informing the analyses of the responses of managers, the study made use of a Human Resource Management (HRM) conceptual framework. The HRM framework also emphasised the strategic role of human resources management in helping aged care institutions to achieve a sustainable competitive edge over others (Barney & Wright, 1997; Barney, 1995). Methodologically, the exploration of the managers’ experiences with migrant carers’ employment is approached within the ‘interpretivist’ framework of inquiry (Crotty, 1998). The framework supports this study’s ontological perspective to the effect that there is no single, but a multiplicity of realities that are constructed by the participants (Crotty, 1998; Creswell, 1998). This perspective of knowledge and reality lends itself to a qualitative research design in which the researcher plays an important role in exploring in a natural setting, the varied perceptions of managers. The study therefore made use of in-depth personal interviews with 16 managers and unit nurse managers in elder care facilities in the specific location of Dunedin. In this case, the managers as well as the interviewer contributed to the creation of multiple realities regarding the employment of the migrant carers. Notwithstanding their admission that the participation of migrants as careworkers has improved quality care delivery, the managers highlighted the legal requirements of employing migrant workers such as VISAs/work permits, perceived racism and discrimination, underemployment and poor English proficiency skills of most migrants as major challenges compromising quality care. As regards the management intervention strategies to deal with the challenges, the study found that most managers made attempts to help migrant care workers to fit into the organisational culture. Some of the managers helped with the processing of the work permits. Other managers highlighted the need to provide job resources to lessen the burden of carework. The other managers however showed that they had not taken time to appreciate the unique challenges that are faced by their migrant cohort of workers and therefore had no visible strategies in place. These findings indicate the need for different stakeholders such as New Zealand Immigration, Ministry of Health, aged care sector, facility managers and the tertiary education sector to engage further in order to emerge with strategies that may make the employment of migrant workers less cumbersome thereby minimising disruptions to the quality of care delivered to the elderly. This Dunedin City based study’s findings provides some useful insights about the managers’ perceptions regarding the role of migrant carers in quality care conceptualisation, and management, in a multicultural aged-care provision environment. It is however suggested that in order to develop a comprehensive picture of the impact of migrants on elder care delivery, further studies be undertaken focussing directly on unravelling the experiences of the migrants carers from their own perspectives.