In many parts of the world ageing of the workforce has become a growing problem. The International Labour Organization has estimated that by 2025, there will be a 32 % increase in the number of people aged over 55 years which will be responsible for the shift in the demographic trend towards an increasingly aged workforce.
Designing a healthy workplace for older care workers is a particularly difficult challenge since most care workers work as home care workers travelling between clients’ homes. Issues which were raised by home care workers with us included:
- Working in unsafe home environments: Home care workers talked about the uncertainty they often face when entering a client’s home. They can be met by untidy environments, newspapers or even dog mess on the floor. Usually, they have only a small window of time to complete tasks and the risk of falls and injuries rise as they endeavour to finish their work quickly.
“We don’t even have basic devices to transfer residents, such as the wheelchair that can be opened from the side. If we, it makes a lot easier for us to perform the tasks especially to transfer the residents. But for now, everything is manually done without proper devices” (Malaysian Care Worker)
- Assistive equipment not being available or set up to be used: Assistive equipment is essential to protect both the care worker and client from injuries. However, equipment may not always be available or not set up making moving or adjusting clients difficult.
“Sometimes we do have courses on how to correctly lift and manage the elderly, but the devices weren’t available. So, there were no practical, just theory. Some more, there are inadequate number of staffs and in order to complete the tasks according to allocated time, we ended up doing it alone or with inadequate number of staffs that put us at risk of injury..” (Malaysian Care Worker)
- Constraints on travel time: Travelling between client homes was identified as a challenge for care workers. A slight overrun in spending time with one client could make meeting the next appointment very difficult.
“There is maybe someone doing an 80-hour week, but it’s not 80 hours of work time. They are maybe getting paid for 40 hours but they are out for 80. That was happening on a regular basis.” (Northern Ireland care worker)
- Abuse: Caring for elderly people can be stressful for both their family members and professionals who care for them. In times of stress and worries, family members can sometimes ‘lash out’ at care workers.
“I actually had a client’s family member become really, really verbally aggressive with me one night. In the end we had to terminate the package because me and a number of staff were threatened over it. He said, “You will not send a male into my mum.”
- Discrimination: Care workers report discrimination in multiple forms which impact both their abilities to carry out their work and their mental health and well-being. Male care workers report being rejected by families even when they are paired with female colleagues. Black and Ethnic Minorities can face discrimination and ageism can impact both on older workers (e.g. family members assuming the older care worker is not ‘up to the job) or younger ones (e.g. being called inexperienced or not up to the job).
Healthy workplace model
Healthy workplace is defined by World Health Organization (WHO) as one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, as elaborated in the WHO Healthy Workplace Model:
- health and safety concerns in the physical work environment;
- health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture;
- personal health resources in the workplace; and
- ways of participating in the community to improve the health of workers, their families and other members of the community
To improve the work design and work organizations in order to accommodate the older worker, several important questions need to be addressed:
- What is known about the performance and health of workers as they age?
- Can work for older workers be designed and managed so that it does not challenge their psychological and physical health?
- Are those aspects of work that are stressful or satisfying to older workers understood?
- Are these different from those experienced by younger workers?
- Do managers have an informed understanding of older workers’ needs and abilities?
- Are older workers subject to discrimination?
- How can work be designed to be more appealing to older workers and persuade them to remain in, or return to, work?
- How can advantage be taken of their strengths without disadvantaging them in terms of their weaknesses?
People who work in the care sector (health and social) constitute a large and diverse workforce and are expose to various work-related risk due to the nature of work, looking after a predominantly vulnerable population. Hence, the workers regardless of age have the right to work in a healthy and safe workplace, and the people using services are entitled to care and support that is safe and takes their needs, freedom and dignity into account. The typical work-related risks associated with the social care services for older persons commonly related to;
- Moving and handling – This is the key aspect in the provision of care services for older persons, ranges from moving equipment, laundry, catering, supplies or waste to assisting residents in moving. Among the common risks associated to this task are back pain and musculoskeletal disorders, which can lead to inability to work and also moving and handling accidents, which can injure both the person being moved and the employee.
- Slips and trips – Slips, trips and falls are very common among workers in the care sectors, especially those looking after older persons. It can have a serious impact on the lives of employees and those being cared for. The risks of slip, trips and falls can be higher among older workers but at the same time can be preventable.
- Violence, aggression and challenging behaviours – violent and aggressive incidents are also common among workers in the care sector. Work-related violence is defined as ‘any incident in which a person is abused, threatened or assaulted in circumstances relating to their work.’ These include bitten by residents with severe dementia, an irate visitor who considers that his relative has not been properly treated verbally abuses a social care worker and so on. Risks of violence and aggressive behaviours are higher among employees who are;
- Working alone;
- Working after normal working hours;
- working and travelling in the community
- handling valuables or medication
- providing or withholding a service;
- exercising authority;
- working with people who are emotionally or mentally unstable;
- working with people who are under the influence of drink or drugs;
- working with people under stress.
While some developed countries have made effort to make some changes to the policies, the need for change in practice to manage an ageing workforce is taking time to occur. Berlin et al. (2016) have suggested several factors that should allow successful implementation of a change in practice;
- Participation of employees in the development and implementation of workplace improvements;
- Management commitment and involvement from the top levels;
- Inclusion of age initiatives in a companywide programme;
- Combining the complementary perspectives of safety and health and human resources to develop workplace interventions;
- Taking a life-course approach focussing on a healthy workplace throughout working life;
- Having flexibility based on individual needs at different work stages;
- Systematic evaluation of any measures implemented.
The discussion among the social care workers in Malaysia revealed the needs of massive improvements in terms of availability of assistive devices and basic care equipment, working hours/ shift, the proportion or ratio of carers to residents, better communication between managers and workers, incentives and critical allowances (based on the health risks there are exposed to) and skills development through properly conducted training.
“Technically, we are experiencing almost similar health risks like those working in the hospitals, … risks for infectious diseases and many more….but we don’t receive any critical allowance like they do”
Considering older workers are more at risks of experiencing all the stated social care related risks discussed above, serious measures, initiative and strategies should be in place and implemented accordingly. The management should also be willing to accommodate the needs and issues related to older workers.
- Griffiths, A.(2000). Designing and managing healthy work for older workers. Occup. Med. 50 (7): 473-477.
- World Health Organization (WHO). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practice (2010). World Health Organization.
- Belin, A., Dupont, C., Oules, L. & Kuipers, Y. (2016). Safer and healthier work at any age: Final overall analysis report. Luxembourg: Publications Office of the European Unions.