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Does type of provider matter for staff well-being? A cross-sectional study of residential care home workers’ job demands and resources
University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work, Criminology and Public Health Sciences, Social Work.ORCID iD: 0000-0003-0979-3986
University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work, Criminology and Public Health Sciences, Social Work.ORCID iD: 0000-0001-7028-8247
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.ORCID iD: 0000-0002-9912-5350
2025 (English)In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270Article in journal (Refereed) Accepted
Abstract [en]

BACKGROUND: Marketisation trends have introduced new elements in residential care homes, potentially related to the psychosocial work environment and well-being of care workers. OBJECTIVE: This study examines differences in job demands and resources across public, outsourced, and private residential care home providers and their associations with care workers’ burnout, job satisfaction, and turnover intentions. METHODS: Data from 253 care workers across 19 residential care homes in three municipalities were analysed using a cross-sectional design, with a 45.3% response rate. We applied the Job Demands-Resources theory and the Copenhagen psychosocial questionnaire, conducting analyses of variance to assess differences and multiple regressions using Generalised Estimating Equations, accounting for the nested structure of the data. RESULTS: Our findings were mixed, with job demands and resources differing across provider types. Outsourced care workers reported higher emotional demands than public sector ones, while private providers offered greater autonomy and supervisor support than public ones. Outsourced workers rated higher levels of burnout than those in public settings, although this difference was non-significant after adding other factors to the model. Statistically significant differences in burnout levels were observed between municipalities. Private care workers reported higher job satisfaction than public ones. About 60% of respondents sometimes or more frequently considered leaving their jobs. Public care workers reported higher turnover intentions than those working for for-profit providers. CONCLUSIONS: This study contributes to understanding how provider type, job demands, and resources relate to care workers' well-being. Further comparative research could help clarify the impact of municipal differences versus provider types.

Place, publisher, year, edition, pages
IOS Press , 2025.
Keywords [en]
Assistant Nurses; Burnout, Psychological; Job Satisfaction; Nursing Homes; Ownership; Personnel Turnover; Psychological Well-Being; Working Conditions
National Category
Social Work
Research subject
Health-Promoting Work
Identifiers
URN: urn:nbn:se:hig:diva-44827DOI: 10.1177/10519815241300294OAI: oai:DiVA.org:hig-44827DiVA, id: diva2:1874914
Available from: 2024-06-20 Created: 2024-06-20 Last updated: 2025-01-28Bibliographically approved
In thesis
1. Residential care homes in the age of marketisation: Care workers’ and first-line managers’ psychosocial work environment and well-being across public, outsourced, and private providers
Open this publication in new window or tab >>Residential care homes in the age of marketisation: Care workers’ and first-line managers’ psychosocial work environment and well-being across public, outsourced, and private providers
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Särskilt boende för äldre i marknadiseringens tidevarv : Omsorgspersonal- och första linjens chefers psykosociala arbetsmiljö och välbefinnande hos offentliga, upphandlade och privata utförare
Abstract [en]

The aim was to investigate care workers’ and first-line managers’ (FLMs) psychosocial work environment and well-being across public, outsourced, and private residential care homes. A mixed-methods approach was used, including a systematic review and qualitative and quantitative data. Data included 11 procurement and tender documents, 19 semi-structured interviews with FLMs, and a survey with 253 care workers from three Swedish municipalities. The results did not indicate clear advantages regarding the psychosocial work environment and well-being for any provider type. Internationally, results favoured nonprofit settings for care workers’ well-being concerning commitment, stress, and turnover intentions. The Swedish context had mixed results. FLMs in outsourced and private settings felt they had more influence and better managerial support than in public settings. Care workers in outsourced settings rated emotional demands and burnout higher, while FLMs faced additional stress and demands due to the outsourcing process. Public care workers reported fewer work–life conflicts than private ones. Most care workers reported good job satisfaction, yet about one in four considered leaving their jobs. Marketisation has brought procurement processes that overlook care worker empowerment, with documents emphasising care users while imposing demands on the workforce. There were municipal variations in the documents, FLMs’ work structure, and care workers’ burnout ratings, challenging equality ambitions. The dissertation highlights persistent issues in the psychosocial work environment with high workloads, recruitment challenges, inadequate organisational support, conflicting care logics and a disconnect between political ambitions and the realities of residential care homes. Political decisions do not come with corresponding resources. To address these issues, care workers and FLMs must be prioritised in decisions and policy documents, which could also improve care quality.

Abstract [sv]

Syftet var att undersöka omsorgspersonal och första linjens chefers (FLC) psykosociala arbetsmiljö och välbefinnande inom offentliga, upphandlade och privata driftformer för särskilt boende för äldre (SÄBO). En mixad ansats användes, inklusive en systematisk översikt samt kvalitativa och kvantitativa data. Data omfattade 11 upphandlings- och förfrågningsunderlag, 19 semistrukturerade intervjuer med FLC och en enkätundersökning med 253 omsorgspersonal från tre kommuner. Resultaten visade generellt att personal i icke-vinstdrivande driftformer, internationellt sett, hade bättre välbefinnande vad gäller engagemang, stress och avsikter att sluta. Den svenska kontexten hade blandade resultat, med inga tydliga fördelar för någon driftform gällande arbetsmiljön och välbefinnande. FLC i upphandlade och privata driftformer upplevde att de hade mer inflytande och bättre stöd från ledningen än de i offentlig driftform. Personal i upphandlade driftformer rapporterade högre emotionella krav och utmattning, medan FLC upplevde stress och en hög kravbild på grund av upphandlingsprocessen. Personal inom offentlig sektor upplevde färre konflikter mellan arbete och privatliv än de i privata driftformer. Personalen skattade överlag hög arbetstillfredsställelse, samtidigt som cirka en av fyra övervägde att sluta. Marknadisering har medfört upphandlingsprocesser som förbiser omsorgspersonalens empowerment, med dokument som betonar omsorgstagarna men ställer höga krav på personalen. Resultaten visade på kommunala variationer, vilket utmanar jämlikhetsambitioner. Avhandlingen belyser ihållande problem i den psykosociala arbetsmiljön som hög arbetsbelastning, rekryteringsutmaningar, otillräckligt organisatoriskt stöd, motstridiga logiker och en klyfta mellan politiska ambitioner och verkligheten i SÄBO. Politiska beslut åtföljs inte av motsvarande resurser. Omsorgspersonal och FLC måste prioriteras i beslut och policydokument, vilket också kan bidra till att förbättra omsorgens kvalitet.

Place, publisher, year, edition, pages
Gävle: Gävle University Press, 2024. p. 93
Series
Doctoral thesis ; 50
Keywords
Eldercare, for-profit, job demands–resources theory, marketisation, outsourcing, psychosocial work environment, public sector, social care, structural empowerment, well-being, Jobbkrav–resursteori, marknadisering, offentlig sektor, psykosocial arbetsmiljö, Social omsorg, strukturell empowerment, upphandling, välbefinnande, vinstincitament, äldreomsorg
National Category
Social Work
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-44829 (URN)978-91-89593-40-4 (ISBN)978-91-89593-41-1 (ISBN)
Public defence
2024-09-27, Sal 33:202 och Zoom, Kungsbäcksvägen 47, Gävle, Gävle, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2024-09-03 Created: 2024-06-20 Last updated: 2024-09-03

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Lindmark, TomasTrygged, SvenEngström, Maria

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