Home Support Workers – underpaid, overworked and unappreciated?

Home support workers bring much-needed comfort to vulnerable clients, but in return the experience of many is being underpaid, overworked and unappreciated.

And according to the latest research from Massey University, the lot of New Zealand’s thousands of home support workers has not been improved by the introduction of cost-saving networked digital technologies.

Dr Leon Salter from Massey's Centre for Culture-Centered Approach to Research and Evaluation says, “Digital technology such as phone apps are sold to home support workers as something that will make their lives easier, and their clients’ experience better, but usually it does neither."

He is working with PhD student Lisa Vonk, who herself spent several years as a support worker in the community and in rest homes.

Lisa says that in New Zealand there are many different care providers who receive funding from bodies like the Accident Compensation Commission and DHBs to deliver care to people in their own homes.

“This can be personal care – things like showering, getting in and out of bed, getting dressed, changing catheters. But also more practical things like vacuuming, making dinner or changing the sheets. The workforce is mainly women, particularly older women. It’s hard physical work – there are a lot of injuries – and for a long time it’s been poorly paid. So in this context, our concern is how the introduction of digital technologies will have impact.”

Most home support workers are now required to use a smartphone, tablet or similar device for work, often at their own expense. Interviewees in the research project said they find it frustrating to deal with the technology that assigns them their tasks and can even track their movements using GPS.

“The use of this technology has coincided with increasing rationalisation of the home support sector, as human middle managers with local, contextual knowledge are being replaced by centralised call-centre staff,” Dr Salter says.

“So you have private for-profit providers competing for government contracts by cutting costs and paying home support workers on a piecemeal, per-client basis. They say ‘Look at this shiny piece of technology, it’s going to solve all our problems and make everything much more efficient.'"

The researchers found significant differences across the workforce in the technologies and the way in which they are used to tell the home support workers where to go, what to do on their shift and how to fill out their time sheet. Workers have been given no decision-making power on the design of apps.

Lisa says it's very piecemeal.

Dr Salter says, “Basically it’s like being treated as a cog in a machine when you might have 30 years’ experience as a home support worker and you really care about your clients.”

Relationships between home support workers and their clients built up over time make the job more rewarding for the worker and less stressful for the client, particularly when personal services are required. In the interests of efficiency, however, it is now common for client calls to be swapped around at the last minute.

“The client thinks they’re going to get their regular carer and all of a sudden someone they've never met before and who knows nothing about them knocks at the door,” Dr Salter says.

He adds that the arrival of the Covid pandemic made life harder for home support workers and their clients. While nurses and supermarket workers were recognised as essential workers, home care workers had to carry on though the lockdowns with little or no recognition for the service they were providing.

To date, the open-ended research undertaken by Dr Salter and Lisa centres around interviews with 14 home support workers who responded to a Facebook call organised through the Public Service Association which represents them, along with E Tū. The next stage is a focus group to determine how the research should be used, to be followed by the establishment of an advisory group that will guide future research.

Dr Salter says their approach is culture-centred research and evaluation. “It’s a participant-led methodology where the advisory group members are given the tools to devise their own solutions on their own terms.”

One possible future direction for the project includes a survey of home support workers to learn more. In time, this may lead to the production of a support worker-led document with solutions for better technologically-enabled care.