Thematic Panel 18: COVID-19 and Long-term care for older people – international policy responses and learnings

Elena Bogdanova, European University at St.Petersburg (EUSPb)
Tine Rostgaard, Roslkilde University

The COVID-19 pandemic took the long-term care systems around the world by surprise. Facing unknown virus, each country developed its own urgent and ad hoc measures of coping with the challenge. Some introduced strict quarantine measures, others avoided such restrictions. Overall, measures were mainly aimed at the nursing home sector, neglecting the home care sector, and measures often did not consider the effect for members of staff. The effect of COVID-19 on long-term care users and staff has varied by countries and may depended on different factors, including institutional features, cultures of care, integration of health and social care etc. Different countries entered the pandemic at different stages of evidence of how it spread, with different resources for coping with the infection, different cultural models of care, and relying upon different organizational modes of care provision. Therefore, the issue of successful resistance to the pandemic in a time pressure situation is an important empirical and theoretical question, which requires broad discussion, sensitive to a variety of circumstances. With this Thematic Panel, we invite single-country and comparative studies about COVID-19 policy responses and learnings from the long-term care sector.

Symposium 13: Disputed temporalities: long-term care services in times of Covid-19

Convenors: Matxalen Legarreta (University of the Basque Country UPV/EHU) and Tomasa Báñez (University Barcelona).

Long-term care services are intended to meet care needs of the most vulnerable population. For this reason, COVID-19 especially affects them. However, the response to the pandemic differs depending on the context, given the structural and sectorial specificities as well as political and socio-cultural factors (Daly, 2020). In all cases, intensifies tensions between clock time, that governs care services, and process time, which characterises care (Davies, 1993). Our proposal attends to how Covid-19 is shaking the temporality of long-term care services, by comparing south and north Europe and using qualitative and quantitative data. We hope to share our findings, and to enlarge our research network.
Comas d’Argemir, Sagastizabal and Lores study the incidence of changes produced in the time- frames of residences (schedules, vacations, attention times …) and problems for reconciling work and family life, caused by them. They use qualitative data to carry out a comparative analysis in the Spanish context,
Roca, Cayuela, Rico and Alcázar, by using a qualitative methodology and from a temporal perspective, analyse the discourses of the involved agents in three community based care services at Spain, day centres, home care service and personal assistance, to find out how the work hours have changed.
Degavre, Casini, Desmette and Mélotte, by using a longitudinal and quantitative methodology, examine how the outbreak has affected the specific situation of in-home nurses in Belgium regarding their work/family balance and highlighting the reasons that lead them to consider, or even decide, to change jobs or organizations and whether these reasons have changed due to the COVID-19 outbreak.
Giordano explores the consequences that time schedule adjustments had on front-line elderly carers, from the material collected before and after the striking of the pandemic in Brussels, which includes in-depth interviews and semi-structured questionnaires to a sample of public and private elderly care providers.

Paper authors:

  • Working in a residence in times of Covid-19: dislocations in work times and in life time
Dolors Comas d’Argemir, University Rovira i Virgili
Marina Sagastizabal, University of the Basque Country UPV/EHU Fernando Lores, University Complutense de Madrid
Redefining Space and Time of care during the COVID-19 in Spain
Mireia Roca University Rovira i Virgili
Salvador Cayuela Sánchez University of Castilla la Mancha
Juan Ignacio Rico Becerra University of Murcia
Ana Alcázar University of Granada
  • The covid-crisis: a risk for work/family balance and career for in-home nurses?
Florence Degavre, CIRTES UCLouvain
Annalisa Casini, CIRTES UCLouvain
Donatienne Desmette, CIRTES UCLouvain
Patricia Mélotte, CRPSI/ULB
  • Home care service providers in Brussels: time adjustments in times of COVID-19 and the consequences for front-line elderly carers
Chiara Giordano, Université Libre de Bruxelles

Discussant: Raquel Martinez-Bujan (University of Da Coruña) and Encarnación Gutiérrez Rodríguez (Justus Liebig University)

Symposium 12: Rhythm is Gonna Get You: the Tempo of Care Policy and Practice

Convenors: Catherine Needham (University of Birmingham) and Matthew Lariviere (University of Sheffield)

Discussant: Dr Jason Danely (Oxford Brookes University)

One of the characteristics of time is its rhythm: the tempo of events, interventions and innovations. The papers look at different elements of care policy and practice to bring out more explicitly the rhythms which shape the experiences of people in the care system.
In her paper, ‘Quick, quick, slow – The time tactics of adult social care reform’, Catherine Needham draws on empirical research with policy makers in the UK to surface the time tactics that are at work within policy reform. She suggests that the lack of progress on care reform to date can be understood in terms of the clash of reform tempos between different stakeholders.
In ‘Comparing the UK’s four care systems: context, change and time’, Patrick Hall (University of Birmingham) draws on interviews with senior and local policy makers in England, Scotland, Wales and Northern Ireland, to compare the tempo of care practices in the four nations – and the clash between notions of modernity, progress and tradition.
In ‘Artificing care: Resolving contemporary care problems in imagined techno-futures’, Matthew Lariviere explores discourses focused on the tempo of innovation in care technology. He highlights tensions between a burgeoning evidence base of negative trial results and the promised potential of technologies to transform care in consistently unrealised and re-imagined futures.
In ’Progress towards co-production practices in care services’ Nanna Møller Mortensen (Aalborg University) draws on a Danish qualitative case study to explore implementation difficulties and timescales for co-production in care services. She highlights the use of implementation phases in order to discuss the possibility of triggering progression between phases, towards more co-produced public services.

Symposium 11: The negotiation and regulation of time in formal care arrangements

Convenors: Diane Burns and Cate Goodland (University of Sheffield)

The majority of organisations offering formal care services operate within a context shaped by neoliberal market conditions. In response, for-profit and non-profit care providing entities variably design and/or adapt their business models, managerial processes and operational arrangements with the aim of striking a balance between achieving organisational longevity and serving the needs of people using their services. Issues of organisational fragility and poor care quality are a global concern, effecting many countries. An indicator of good quality in formally arranged care is that provision is both timely and responsive to people’s needs. However, many scholars have illustrated that the level of in-job autonomy care workers require to enable responsivity, is often restricted by managerial processes, rigid care schedules and objectives to use care workers’ time in the most cost-efficient way.
Papers in this proposed symposium are highly relevant to the conference theme. Various aspects important to the negotiation of time within formal care arrangements will be un-packed, examined and discussed. The symposium will focus on the issue of time in the context of care delivered in people’s homes and in long-term care settings. This approach will allow a fuller exploration of time within particular organisational context and from the different perspectives of employers, managers, and care workers – along with people receiving care and trade union officers organising in the sector. Using in-depth ethnographic, case study and interview methods, the papers draw on research data gathered from a range of nursing home, home care, and support providers in the UK and Germany to illuminate the ways in which time is both utilised and controlled, and the subsequent effects for care worker jobs and wellbeing.
The convenors and discussants are members of an international network linked to the UK ESRC-funded programme: Sustainable Care: Connecting people and systems (PI Sue Yeandle).

  • Paper 1: The control of care workers’ unpaid time in innovative home care provider organisations.
Dr Diane Burns, Sheffield University Management School and Dr Cate Goodlad, Centre for International Research on Care Labour and Employment, University of Sheffield, UK

This paper examines how innovative home care businesses structure their operations by controlling time within the design of care worker jobs and operational arrangements they assemble. Drawing on case study data of 4 innovative high achieving home care companies in the UK, we identify how time is differently functioned. In particular, we identify how paid and unpaid care worker time is constructed within employment contracts and the labour process. Through this lens we show how the central features of temporal controls stabilise and destabilise care and discuss the opportunities and risks consequently engendered for individual care workers and care companies.

  • Paper 2: Working unpaid hours in ‘customer-centred’ nursing homes: Implications for workers’ care and personal time in Germany and Sweden
Dr Lander Vermeerbergen, Radboud University/KU Leuven; Juliane Imbush and Professor Valeria Pulignano, KU Leuven; Professor Aoife McDermott, Cardiff University, UK; Ella Petrini, KU Leuven

An increasing number of nursing homes have adopted a ‘customer-centred’ care model. The few studies examining the impact of such organisational models for workers point to over involvement with residents’ lives and a huge increase in work intensity. In this paper, we examine how this influences (unpaid) care and personal time of workers at home and in the nursing home job. We collected 30 narrative interviews and daily diaries on (unpaid) working time with workers in six nursing homes in Germany and Sweden.

  • Paper 3: Live-in care: Migrant care workers’ negotiation of time across boundaries and boarders
Obert Tawodzera, Researcher and Doctoral Student, Professor Majella Kilkey, Dr Magda Lorinc, University of Sheffield; Professor Louise Ryan, London Metropolitan University; Professor Shereen Hussein, Dr Agnes Turnpenny, University of Kent

In live-in care settings, care arrangements are formalised through an employment contract between the family and the care worker (often on zero-hours contracts), where the care worker both lives and works in the private home of their employer. Drawing on in-depth interviews with 27 migrant care workers in the UK, this paper unveils the challenges, complexities and nuances around how formal and informal time is experienced and negotiated in live-in care arrangements. We show how care worker’s responsibilities and duties often drift into more informal arrangements, including picking up domestic work tasks. As a result, time is governed by the task rather than the clock (Daly, 2001) leading to long-hours of work and a blurring of the boundary between work-life and personal-life. Consequently, for migrant care workers the time available to care for their own family members who often live across national borders, become compromised and compressed.

  • Paper 4: Mobilising a time-poor workforce: how time affects union resistance in social care
Grace Whitfield, Researcher and Doctoral Student, Centre for Decent Work, University of Sheffield

This paper focusses on the role of time in shaping trade union mobilisation in England’s social care sector, drawing on interview data with care workers, support workers, company managers, and union organisers. The workers were employed at four companies: a home care provider, a residential nursing home, and two support providers. The findings demonstrate that overwork in the sector – long shifts or large numbers of short calls – stymie the mobilisation efforts of unions, with organisers describing difficulty accessing time-poor workers and difficulty embedding union activism in workplaces.

Discussants: Professor Norah Keating (University of Alberta) and Helena Hirvonen (University of Eastern Finland)

Symposium 10: Intersectional perspectives on care and care needs in older adults

Convenors: Ricardo Rodrigues (European Centre for Social Welfare Policy and Research) and Susan Phillips (Queen’s University Faculty of Health Sciences)

Socially mediated definitions of time spent care giving and receiving are deeply gendered. Thus far only limited consideration has been given in the care literature to intersecting social characteristics of gender and social location (e.g. socioeconomic position, geographical location, etc.). Intersectionality, understood here as overlapping categorizations and (dis)advantages, is at the core of the FutureGEN project, whose broader aim is to analyse gender inequalities in health and care from a cohort perspective. This symposium brings together papers that address intersectionality in care needs (e.g. disability) and in care giving and receiving in old-age, therefore appealing to an audience that encompasses care and health scholars. The time dimension is incorporated both in terms of time needed for care and historical time, through cohort analysis. The first paper (lead author: Susan Phillips, Queen’s University) titled “Systematic review of methods used to study the intersecting impact of sex and social locations on health outcomes” sets the scene for the relevance of intersectionality by discussing methods to address intersectionality in quantitative research, with applications beyond health and care for older people. The paper titled “Sex, ageing and disabilities: cohort trajectories of functional decline among older adults in Europe 2004-2017”, (lead author: Stefan Fors, Karolinska Institute) uses quantitative methods to show how disabilities in later life in cohorts of women and men have evolved between 2004 and 2017 across geographical locations. This is followed by a paper titled “Gender differences in access to community-based caring resources in old age: An examination of the effects of widowhood and living arrangements” focusing on the impact of widowhood on use of care for women and men of different socioeconomic backgrounds (lead author: Stefania Ilinca, European Centre for Social Welfare Policy and Research). The symposium concludes with the paper titled “Caregiving across European cohorts between 2004-2015: is there evidence of changing gender patterns across care regimes?”, which analyses evolving gender differences in caregiving across different geographic locations (lead author: Ricardo Rodrigues, European Centre for Social Welfare Policy and Research). In addition, we plan to have Prof. Francesca Bettio (University of Siena) as an external discussant for this Symposium.