Working in a blurred domain: The health care assistant in aged residential care
Clark, Christine Frances
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The world population is ageing, and as the years increase so to do the consequences for the older people, with this population often experiencing longevity combined with comorbidities. Correspondingly those able to provide care are decreasing in number and it has been predicted that many countries are going to be competing for the services of the Health Care Assistant (HCA), the person who provides 90% of the direct care work in aged residential care (ARC). Researchers have explored how to attract and retain this person within the ARC environment; however, many reports focus on a narrow role, not explaining the role from the perception of the HCA. The research question for this study was ‘how do health care assistants manage their work in aged residential care?’ Using social constructionist grounded theory, 16 participants were interviewed from eight ARC facilities, including rest homes, hospitals and dementia care units, located in a major city in New Zealand. The findings explained the domain in which the HCA worked; a blurred domain, a domain with no defined boundaries, extending into the realm of the Registered Nurse and working, at times, with little supervision. Responding to this environment the HCA participants used strategies associated with protecting self, balancing the workload and engaging self, moving between the strategies depending on the conditions. Feeling responsible to fulfil needs associated with the employer, resident and self, the HCA responded to conditions associated with time and support available, with the knowledge and skill base of the HCA integral to the strategies employed. This study has contributed an explanation of the blurred domain and the strategies employed by the HCA to manage working in this role. These finding may be used to inform practice and support legislative efforts to protect the HCA, enabling this person to work within defined parameters, no longer subject to employer discretion. Increasing the safety of the role, providing increased support, and improving employment conditions will attract more people to work in this very complex environment, supporting New Zealand’s most vulnerable people.