Exploring paid home carers’ experiences in providing care to older Tasmanians

The ageing of Australia’s population is expected to continue, with the proportion of Australians aged 65 and over reaching 22 percent of the population by 2056 (Australian Institute of Health and Welfare 2017). Influenced by ageing-in-place, the home-based care model has been promoted by governments in Western countries as a preferred social and community model to assist older adults to live independently in their home environment. Driven by marketisation and personalisation of care within the neoliberal political contexts, the Australian Government in 2017 announced significant reforms to home care policy to change towards a more consumer-directed care system, in which older adults are expected to make their own decisions in self-directing their care choices.
Under this current political context and consumer-directed care model, a growing number of Australian and international researchers have sought to investigate the experiences of older adults who receive home care services. However, there has been a lack of empirical research that examines the experiences of paid home carers who provide direct care services.
The thesis explores and interprets home carers’ experiences in their everyday practice by employing a qualitative research approach with a semi-structured interview method. A purposive sampling strategy was utilised for recruitment. Fourteen in-depth interviews were conducted with paid home carers in Hobart, Tasmania. In addition, to address the impacts of conceptualising care as a ‘commodity’ on aged care delivery, the theory of ethics of care was chosen to guide this thesis as it values the relational and reciprocal aspects between home carers and older recipients.
Three overarching themes were identified through the thematic analysis of the interview transcripts: ‘Care is a relational and reciprocal process’, ‘Challenges in doing care’ and ‘Costs in doing care’. It is argued that care is a relational and reciprocal process rather than a ‘commodity’. Rather than just emphasising care recipients’ choices or home carers taking control over recipients’ decisions in care provision, care is a negotiating process in which home carers need to work collaboratively with care recipients and to support them to live well in the home environment. The costs of doing care need to be recognised at the individual, organisational and policy levels. The thesis argues when home carers provide care support to older people through a relational and reciprocal care-giving process, they are challenged by three core factors: (1) complex needs of care recipients, (2) inadequate organisational training and support, and (3) the social stigma on home care work.
The findings of this thesis have potential policy and practice implications for the Australian home care industry. The findings could be translated to acknowledge the relational aspect of home care work, which would involve policies that encompass both needs and rights of home carers and older adults receiving care. This could include developing targeted training resources in the areas of dementia care and grief management; improving the workplace health and safety; and increasing home carers’ accessibility of employee assistance programs. Such changes would improve home carers’ health and wellbeing and the overall quality of care in the Australian home care industry.