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Sunday, October 24, 2021

Why society cannot afford to continue overlooking the stigma of working in aged care

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While health-care workers have been recognised as heroes throughout the COVID-19 pandemic, it is a travesty that the aged care workforce remains undervalued.

Two months into the pandemic, there was insufficient personal protective equipment for the aged care sector.

People who work in aged care were left out of public displays of appreciation like the “clap for medical staff”. It begs the question – who do we value less as a nation, the older residents or the people caring for them?

The negative association has continued with the roll out of the vaccine, where the value for aged care workers again has been minimised, discounting the value of their job status and those they care for.

These incidents expose a hidden challenge in the aged care system – a stigma of working in aged care.

What is the stigma of working in aged care?

Often disguised as the latest media scandal – this stigma appears in many different forms.

Stereotypes about aged care workers, devaluation of care work, exposure to perceptions about poor pay, low status and inadequate working conditions are just a few.

Fundamentally, the stigma of working in aged care refers to when people think or feel that aged care workers, aged care work and aged care institutions have undesirable qualities.

But do not be fooled by these labels. You may come across the stigma of working in aged care without recognising it as a ‘stigma’.

Fundamentally, the stigma of working in aged care refers to when people think or feel that aged care workers, aged care work and aged care institutions have undesirable qualities. This stigma reduces the value of working in aged care.

Research findings from a systematic review, that analysed 59 articles examining the stigma of working in aged care, revealed that people may not explicitly label this stigma.

However, this does not mean people are not talking about it.

People understand the stigma of working in aged care in three general ways:

  • Unfavourable character judgments of aged care workers
  • The lower value placed on aged care work
  • Negative emotional reactions towards working in aged care
People who work in aged care were left out of public displays of appreciation like the globally popular “clap for medical staff”. It begs the question – who do we value less as a nation, the older residents or the people caring for them?

Consequences for the aged care workforce

Despite it not being overtly acknowledged, the stigma of working in aged care has been a core challenge of the aged care workforce for decades.

People who work in aged care are at risk of experiencing negative consequences associated with the stigma of working in aged care, including poor professional esteem, low job satisfaction, burnout and intentions to leave.

This stigma may also contribute to systemic workforce problems documented in the royal commission into aged care quality and safety – poor remuneration, and challenges with recruiting and retaining workers in this field.

Expert witnesses argued that a crucial way forward is to change the image of working in aged care.

People who work in aged care are at risk of experiencing negative consequences associated with the stigma of working in aged care, including poor professional esteem, low job satisfaction, burnout and intentions to leave.

This vision requires greater workforce planning and leadership to support decent work and high-quality care.

Workforce recommendations including mandated staffing ratios, improved pay, specialised training and ongoing professional development have been identified as essential areas of reform.

Wait a minute, don’t these recommendations sound familiar?

They should. These recommendations have been flagged across multiple reviews over the past decade including the 2011 Productivity Commission report and the Aged Care Workforce Taskforce in 2018.

So what actually has been done about reducing the stigma of working in aged care?

I believe that the absence of action demonstrates that the current way of addressing this challenge is just not suitable.

These existing approaches tend to fall short because they focus their energies on attempting to tame the wild beast that stigma is.

They strive to force stigma into a neat tidy box with a new label (like job titles) or apply a band-aid solution to a complex challenge (remember the UK’s so-called ‘badge of honour’?).

These strategies prioritise short term gain, which does not address the underlying problem that is responsible for reinforcing the stigma of working in aged care – how we as a society value aged care, older people and the people who care for them.

If nothing changes, nothing changes.

As a society, we cannot continue ignoring this stigma by distracting ourselves with ‘every shiny new thing’ like the latest boost in funding that may emerge out of the workforce crisis.

While there is value for fighting the current fires in our aged care workforce, there is an alternative way forward.

As a field we need to take a step towards creating sustainable change.

As a society, we cannot continue ignoring this stigma by distracting ourselves with ‘every shiny new thing’ like the latest boost in funding that may emerge out of the workforce crisis.

We owe it to ourselves- to our older, future selves to take interest in understanding the complexity of this societal challenge.

We may want and wait for a clear set of guidelines for how we can reduce this stigma.

But first, we need to step back and recognise that the stigma of working in aged care is a wicked problem without a quick fix.

Embrace the change…

It is time to recognise that it is up to us to make this change.

We cannot afford to wait for the promised positive flow-on effects from redefining job titles and increasing wages to change how society values aged care work.

We need to change the conversation from ‘we need more workers’ to asking ourselves a bigger question – ‘how valuable is this work?’

We cannot afford to wait for the promised positive flow-on effects from redefining job titles and increasing wages to change how society values aged care work.

If we continue down this route, and nothing changes – ‘what are we going to do about this?’

This perspective offers us the opportunity to entertain another approach, turning our attention to understanding the source of stigma – our attitudes and values about aged care.

Moving forward, a road map

I invite you to make proactive positive changes towards reducing the stigma of working in aged care.

Here are some starting points for addressing this stigma using the resources we each have – our attitudes and our voices.

1. What can I do? What can you do?

It’s important that we reflect on our own thoughts and feelings about ageing. How we feel about ageing influences how we value aged care and the people who provide the care.

Our attitudes are shaped by contact – direct experiences and the positive/negative interactions that people have with aged care.

People will engage with the stigma of working in aged care in a way that makes sense to them.

When people have no opportunity to experience an alternative way of valuing aged care, they may reinforce negative assumptions or stereotypes.

Those who experience less contact with aged care are more vulnerable of reproducing negative attitudes about aged care and stigma reflected in the media.

Positive contact may potentially help reduce our negative attitudes by offering another way of viewing aged care work and aged care workers.

2. Discuss the good, bad and the ugly

Talk about the stigma of working in aged care with colleagues, care recipients, families, students, community groups.

The more we talk about a negative subject, the more we can process the discomfort.

This will enable us to work through the discomfort to come up with rational and innovative solutions.

We may not all understand and describe this stigma in the same way.

However, opening up and starting conversations about this collective challenge will help us create a shared understanding and the language to talk about this stigma, together.

3. Growing value within the workforce first

We need to focus on empowering people who work in aged care at all stages of their training.

Traditionally, training in aged care is based on a medical model that values the ability to cure moreso than to care.

Health professionals are taught to prioritise practices to prolong life (ie. to resuscitate) over providing a holistic care experience (ie. to facilitate a ‘good death’).

Through following processes and procedures, we are training health professionals to reproduce this cultural narrative – pairing ageing with negative attitudes.

Let’s acknowledge how we as an aged care workforce with a diverse mix of skills can promote the value of working in aged care rather than passively maintaining the status quo (ie. devaluing ageing).

In other words, we do not have to accept that mainstream societal attitudes about aged care will always remain negative.

Instead, engage with age-friendly communities and help shift the way we talk about ageing and older adults to a more positive narrative.

4. Best foot forward

Lastly, we need to improve the public messaging around how we attract and recruit our future aged care workforce.

It is important to promote a greater representation of aged care work experiences.

This will help reframe existing negative stereotypes that reduce the perceived worth of aged care work to dirty and basic work.

The language used in training, job advertisements, promotional and educational material may need to be refined to reflect the range of positive and negative experiences of working in aged care.

So I challenge you to think about this alternative way of addressing the stigma of working in aged care.

A first step that does not depend on long-awaited system reforms to work towards alleviating fundamental workforce challenges like the undersupply of aged care workers.

Let us talk about this stigma of working in aged care.

Let this stigma be part of our everyday conversations.

Let this stigma be seen, heard and challenged in our society.

  • Asmita Manchha is a PhD candidate in the School of Psychology at the University of Queensland. Her research examines the stigma of working in aged care, attitudes towards aged care, and employee well-being, with a focus on individuals’ conceptualisations and lived experiences of stigmatised occupations.

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