Abstract

Advanced age is connected with high co-morbidity and functional deterioration that result in increased use of medical services, in particular hospitalizations, and use of home-based care, including employment of migrant live-in home care workers. There is an increasing shortage in nursing manpower in hospitals to meet the intensive and extensive needs of hospitalized frail older patients, in particular when they are cognitively impaired. Family members are less available to spend time to provide personal care and surveillance to their hospitalized older family members. Therefore, there is a growing trend to hire paid care workers who are supposed to replace family members.

The study’s goals were threefold: (1) to examine the extent to which there are policies and rules regarding the tasks that paid care workers are allowed to perform in hospitals; (2) to examine the extent to which there is congruence between the family caregiver and the paid care worker regarding the perceived roles of the paid care worker; and (3) to examine what types of tasks the paid care workers actually perform.

The study was conducted in two general hospitals in Israel; a governmental and a non-governmental that included altogether 11 internal and 6 geriatric wards. The sample composed of 535 dyads of primary caregivers whose older family members were hospitalized and their migrant care workers. Data collection included face-to face interviews, using structured questionnaires in 3 languages: Hebrew, English and Russian. In addition, senior staff members (e.g. medical directors, head nurses) were interviewed regarding policies and rules regarding the presence of migrant care workers in the wards.

The results showed that in general there were no explicit formal policies regarding the presence and tasks that paid care workers are permitted or prohibited to perform. The majority of the patients were functionally disabled women, unmarried, with an average age of 83, who lived alone and had a migrant live-in home care worker. The majority of primary caregivers were females and adult children and their average age was 56. The majority of the paid care workers were Filipino females and their average age was 37. A moderate level of congruence was found with regard to the perceived roles of the care workers in hospitals, suggesting that there was incongruence with regard to some specific tasks. The more there was congruence the more involved were the paid care workers in providing personal care to the older patients. More involvement in providing care by the care workers was found in the non-governmental hospital and in the geriatric wards compared to the non-governmental hospital and in the internal wards. The tasks that the migrant care workers performed included: personal care, surveillance, companion and cooperation with the nursing staff with regard to the care provided to the patients.

To conclude, paid migrant care workers are becoming a significant factor in assuring quality of care to frail older people in hospitals. There is need for policies and guidelines with this regard.

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