Subcontracting long-term care (LTC), whereby facilities contracted with third party agencies to provide care to residents, became widespread in British Columbia after 2002. This qualitative study aimed to understand the impact of subcontracting from the perspective of care workers. We interviewed 11 care workers employed in subcontracted facilities to explore their perceptions of caring and working under these conditions. Our overarching finding was one of loss. Care workers lost wages, benefits, security, and voice. Their working conditions worsened, with workload and turnover increasing, resulting in a loss of experienced staff and a loss of time to provide care. These findings call into question the promises of quality and flexibility that legitimated policies permitting subcontracting, while adding to the mounting evidence that subcontracting LTC harms both workers and residents.

We conducted a mixed-methods study – the focus of this article – to understand how workers in long-term care facilities experienced working conditions. We surveyed unionized care workers in Ontario (n = 917); we also surveyed workers in three Canadian provinces (n = 948) and four Scandinavian countries (n = 1,625). In post-survey focus groups, we presented respondents with survey questions and descriptive statistical findings, and asked them: “Does this reflect your experience?” Workers reported time pressures and the frequency of experiences of physical violence and unwanted sexual attention, as we explain. We discuss how iteratively mixing qualitative and quantitative methods to triangulate survey and focus group results led to expected data convergence and to unexpected data divergence that revealed a normalized culture of structural violence in long-term care facilities. We discuss how the finding of structural violence emerged and also the deeper meaning, context, and insights resulting from our combined methods.

This paper explores similarities and differences in the way caring work is experienced by kin, homemakers and volunteers. Under the conceptual umbrella of working conditions, issues of work milieu, isolation, communication, feedback, autonomy, motivation and choice are compared across these three groups of care providers. Although the functional capacities of the elderly persons receiving care were quite similiar, the circumstances that surrounded the performance of caring were quite different. The paper argues that the context within which care is provided will be critical in future policy discussions. It is suggested that the specific task content of providing care may be of secondary importance to understanding the context within which care providers carry out these activities.

We investigate the impact of innovative work practices on working conditions. We use a unique French dataset providing information on individual workers for year 1998. New work practices which play a key role in the success of the new economy, include job rotation and the use of quality norms. Working conditions are captured by occupational injuries as well as indicators of mental strain. Using Rubin’s causal model, we show that, even after controlling for employee and job characteristics and correcting for sample selection bias, workers involved in the new work practices still face working conditions that are significantly worse than those of non innovative workers.