Barbara Da Roit, Department of Philosophy and Cultural Heritage, Ca’ Foscari University of Venice
Shereen Hussein, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine
The working conditions in long-term care (LTC) services have garnered growing attention from both scholars and policymakers due to rising global demand and the tragic toll of the COVID-19 pandemic on both care recipients and workers. Despite variations across and within countries, employment in this sector continues to be burdened by long-standing structural issues. These include low wages, non-standard contracts, job precariousness, increased workloads, frequent job shifting, high turnover rates, and elevated levels of stress or burnout.
These persistent challenges not only undermine the wellbeing and dignity of care workers, who often face immense physical and mental strain, but also disrupt the continuity and quality of care services. This, in turn, jeopardizes the overall sustainability of the care sector.
The situation presents a stark contrast to policy efforts aimed at balancing the provision of sufficient, high-quality LTC in ageing societies while managing costs, promoting the employment of women and older workers, and expanding “good quality” service jobs. At the same time, there is a growing need to uphold workers’ rights to fair working conditions, foster social inclusion, and ensure the physical and mental wellbeing of those employed in this critical sector.
This pressing issue demands a deeper understanding of how to measure, explain, and ultimately improve the quality of life at work for LTC workers, with the goal of building a more resilient and sustainable care system for the future.
This session brings together, illustrates, and discusses three distinct research projects that focus on understanding, measuring, explaining, and facilitating the quality of life at work of care workers in England, Italy, and the United States.
The ASCK-WELL project aims to develop a scientifically validated instrument to assess LTC workers’ work-related quality of life in England. This tool is essential for addressing the sector’s long-standing challenges, including workforce retention and emotional strain heightened by the COVID-19 pandemic. Utilising a mixed-methods approach, the study combines qualitative interviews and advanced psychometric testing (both Rasch and classical methods) to ensure the instrument is robust and applicable across diverse care settings. Key components include a conceptual framework and detailed questionnaire items that reflect the unique experiences of social care workers. The practical utility of ASCK-WELL is emphasised by its co-production with sector stakeholders and the development of an implementation strategy to facilitate widespread use. The ASCK-WELL scale’s practical relevance will enable the sector to monitor, compare, and improve worker well-being, ultimately leading to enhanced care quality, staff satisfaction, and retention. This project holds the potential to transform workforce support by providing a tailored, standardised measurement tool that can inform interventions, improve staff well-being, and enhance care quality across the fragmented care sector.
The QWoRe project, funded by the Italian Ministry of Research and University as a Research project of National Interest under the National Recovery and Resilience Plan, aims to develop a multidisciplinary and integrated analytical framework to understand quality of work in residential LTC services in Italy. The research strategy is based on a mixed-method approach, with the integration of multidisciplinary knowledge and insights ranging from care and welfare analysis, sociology of work and organisations, social psychology, employment/labour/social security law, sociology of health and illness, statistics, innovation studies. This framework theoretically apprehends how care, employment and migration regimes, service organisation and provision interact with the logics of care and with the profile and strategies of care workers in shaping working conditions and quality of work, in residential care. A combination of secondary quantitative data analysis and analysis of regulations in the field of care, employment and migration will allow the reconstruction of the distinctive features and variations over time of the working conditions in the residential care sector. Furthermore, an in-depth understanding of the quality of work in residential LTC services in three Italian Regions absorb the bulk of Italian residential care facilities draws from mapping the specific care regulation in these regions and through an original qualitative survey of care workers. The data are the object of a fuzzy-set, comparative qualitative analysis (Fs/QCA) to identify the configurations of conditions (e.g. the individual, organisational, regulative factors) that are associated with a quality of work outcomes. Finally, six organisational case studies investigate the mechanisms and processes that are at work in determining specific outcomes.
The National Dementia Workforce Study, sponsored by the NIH National Institute on Aging, is conducting the first large, annual surveys of the dementia care workforce in the United States. Survey data and other linked data sources will create an unprecedented resource for researchers to answer critical questions about the workforce and its impact on care and outcomes for persons living with dementia. The study includes surveys of nursing assistants and personal care aides in nursing homes and assisted living communities, where a large percentage of residents have dementia. Data from first round of the surveys will be available in early 2025. With the data, we will explore the factors associated with these staff reporting high levels of burnout and intention to quit their job. Such factors may include a lack of confidence in their skills, a lack of training opportunities, irregular work schedules, poor interactions with coworkers or supervisors, long commutes, stressful personal circumstances including concerns about immigration status, low wages, risk of injury, and harassment by coworkers and others in the workplace. Organizational characteristics such as facility size and for-profit ownership also will be examined. Using descriptive and multivariate analyses, this presentation will identify the factors most closely associated with burnout and intention to quit to guide future efforts to improve retention and mitigate stress.
The Symposium will be organised as follows. The objectives, research design, and preliminary findings of the three research projects will be presented. A discussion will follow that will highlight conceptual, methodological, and empirical key points based on a comparative analysis of the projects’ endeavours and findings.
Presentations:
– Shereen Hussein, Developing and Prepare for the Implementation of the ASCK-WELL Instrument for Measuring Work-Related Quality of Life in Adult Social Care
– Marco Arlotti, Barbara Da Roit, Stefano Neri, Studying the quality of working life in Italian residential long-term care facilities
– Joanne Spetz, Understanding the factors that are linked with burnout and intentions to quit among aides in nursing homes and assisted living in the U.S.
Discussant: Teppo Kröger