Cultivating care-full futures

The Gilbrea Centre

The “Burned out” “Backbone of health care”. The “Thankless” “Hero”. The “Discriminated” and “Disrespected” “essential” worker. Just some of the words used by personal support workers (PSWs) labouring in long-term care homes and living through public awakenings to COVID-19 and systemic racism; two, mutually serving, public health pandemics. In a precarious line of work that sees an overrepresentation of Black, Indigenous, and other Persons of Colour, these awakenings have only amplified the amount of emotional labour needing to be done by PSWs and other care workers in an already fractured system. PSWs and other health care professionals are celebrated with words like “hero” [sic] amid staffing shortages, lockdowns, vaccine refusals/protests, outbreaks, and profound illness, death, and loss casting doubt on personal worth, effectiveness, and promises for change. Further, for individuals who live with racism, a widespread awakening to racial injustice in addition to performances of allyship become difficult to process and support over time when little change is made. There is little doubt that these storms have brought rage, tension, struggle, and exhaustion to many. This presentation will discuss the danger of attending to (anti-)racism (among other -isms/-phobias) in a time of “woke” (a co-opted Black watchword, *used critically here) for care labourers of colour in a system compromised by COVID-19.

Watch the recorded presentation (VIDEO).

For more information on this presentation, please contact us.

Kimberly J. Lopez, Jaylyn Leighton, Crystal-Jade Cargill, Giana Tomas, Ashley Flanagan, Michelle Fleming, and Sherry L. Dupuis
Ottawa, Ontario - 17^th Canadian Congress of Leisure Research 

“Inclusive” futures are contingent on an understanding of the vast efforts needed to rebuild relations from past/ongoing harm. In this presentation we describe Transformative Justice (TJ) as our conceptual starting point for inquiry, informing ways of relating and interpreting stories in partnered inquiries. Shaped by Indigenous peoples of Turtle Island and Aotearoa (McCaslin, 2005), TJ attempts to unpack systemic harms and conditions that enable harm (Kim, 2021). In our work on genderacialised care labour, we engage in praxis through TJ to ensure that any relations we establish, methods we employ, stories we examine, and recommendations that may arise from our work recognises the TJ priority to do-no-more-harm. For example, in a Health Standards Organization report (Flanagan & Chen, 2022), safety in Long-Term Care Homes (LTCHs) through a TJ frame is exemplified by considering how “individuals under surveillance (i.e., frontline staff) are more likely to have direct connections to the harm and injustice of historical hyper-surveillance of people of colour, migrant, and 2SLGBTQIA+ communities” (p. 20). In another example, racialised non-white women’s welfare – how and by whom it is maintained – is of concern as it relates to mitigating arduous (Ungerson, 1983), emotionally labourious (Lopez, 2018), and uncertain livelihoods of women of colour in care work. “Welfare” describes one’s condition of being well and is often connected to how one’s wellness is facilitated/hampered by the government (Veenhoven, 2000). Though, TJ recommends developing pathways for reparation apart from government resource allotment and control. From a TJ perspective, worker welfare must be in the hands of the people for individuals to feel secure in their resource making, not made more vulnerable by government indecision and claw-backs.

Entangled theory framing transformative justice inquiry

The very definition of leisure in women’s lives has been problematised in the leisure literature (Henderson, 1996). Stormann (1984) described leisure as an illusion for the everyday worker due to leisure existing in an industrial society focused on overconsumption and overspending. However, we imagine expressions of leisure in rest and respite from depleting care labour. TJ involves resisting the perpetuation of harms (i.e., genderacialised, exploitative labour) preventing respite, restoring energy (e.g., rest, quiet space) from the labouriousness of systemic oppressions, and seeking restitution for harm (e.g., community building, reporting). This is a radical approach to equity in LTCHs (especially in the present landscape of healthcare in Ontario). Now, more than ever, radical and entangled theory is needed to disrupt the failing status quo. We advocate that TJ may be a more “humane and just approach than punitive discipline” (p.3, APA, 2008; Sandwick, et al., 2019) as it emphasizes remediating harm, supportive dialogue, privileging relationships, attending to root causes of misunderstanding, and developing collective accountability (Fronius, et al, 2019; Morrison, 2013; Zehr, 2014). As we strive to be as liberatory as possible, we plan to develop and share a TJ informed care considerations (Kim, 2021) that interrogate interest convergence, worth, (racial) capitalism, labour reproduction, and extraction (Ahmed, 2012, 2016; Bonnett, 2005; Wing, 1997) embodying care-fullness (McGregor, 2004; Sotiropoulou & Cranston, 2022) with which relationships, labour, and justice may be navigated and negotiated. Specifically, this presentation will present implications for future inquiry through TJ in leisure studies/science by sharing how we consider the tenets of TJ (alongside social reproduction theory, critical race feminisms, other intersectional anti-oppressive frameworks) in our work on precarious care labour and living.

Kimberly J. Lopez, Giana Tomas, Ashley Flanagan, Michelle Fleming, and Sherry L. Dupuis
Toronto, Ontario - Ontario Long Term Care Association’s (OLTCA) This is Long Term Care

Personal support workers (PSWs) often incur additional stresses (e.g., poor work/life balance, and lack of financial security) in their work at long term care homes (LTCHs). COVID-19 has also made PSWs vulnerable to race and gender-based care labour precarities (RGBCLPs) and harm which created a greater need to attend to critical gaps in LTCH structuring and resourcing. To re-imagine a more just, equitable, and care-full future for PSWs employed in LTCHs, we ask, how can we protect employees of LTCHs from RGBCLPs? The “Free-from-Harm" project mobilizes efforts to reduce harm for front line care staff through transformative justice frameworks. We began a realist review to synthesize existing policies on RGBCLPs and harm, which initially reveals a paucity in available reporting protocols in LTCHs. In our work, surveys and interviews with LTCH care staff and administrators will identify the ways LTCH care workers are vulnerable/subject to hate, discrimination, and violence in their places of employment due to race or gender expression.

By attending this presentation, you will be able to:

1. Describe race and gender-based harms (RGBHs);
2. Identify useful mechanisms for interrupting RGBHs; and
3. Learn about opportunities for participation in ongoing FFH initiatives.

We advocate that collectively finding solutions to RGBCLPs and harm experienced in LTCHs is imperative to maintain survivability in LTCHs and among LTC staff in their positions, moving forward. We see this as essential for LTCHs to prioritize as advocating for reporting systems to safeguard LTCH care workers against RGBCLPs and harm is the first step in interrupting normalized systemic racism and gender inequity. Advocating for reporting systems to safeguard LTCH care workers against race and RGBCLPs and harm is the first step to work towards accountability through reporting systems for remediating RGBHs.

Kimberly J. Lopez
Toronto, Ontario - Ontario Centres for Learning, Research, and Innovation in Long-Term Care - EDI in LTC Community of Practice: Addressing Racism in LTC

[Abstract to follow in the near future]

Kimberly J. Lopez and Diya Chowdhury
Toronto, Ontario - Canadian Association on Gerontology 52nd Annual Scientific and Educational Meeting

A 2021 scoping review described significant psychosocial burdens experienced by care workers, including moral job injury, poor communication, poor work/life balance, increased violence, and lack of financial security (Franklin & Gkiouleka, 2021). Further, legacies of gender and race politics and labour allocation have shaped the nature of PSW and other “minority”-dominated care labour, facilitating a disproportionate number of persons of colour and women living perpetually under-waged, precariously employed, susceptible to chronic stress, and vulnerable to race and gender-based care labour precarities (RGBCLPs), including harm from LTCH administration and colleagues, family members, and residents. In our team’s work to understand RGBCLPs in LTCH, our priority was to ensure that harm was not reproduced through the process of narrative data generation.

To redress harm, work through a Transformative Justice (TJ) framework may be a more “humane and just approach than punitive discipline” (Sandwick, 2019, p.3); it emphasizes remediating harm, supportive dialogue, privileging relationships, attending to root causes of misunderstanding, and developing collective accountability (Fronius et al, 2019; Zehr, 2014). Influenced by Indigenous peoples of Turtle Island and Aotearoa (McCaslin, 2005), TJ attempts to unpack systemic conditions that enable harm (Kim, 2021). TJ involves resisting the perpetuation of these harms, restoring energy from the labouriousness of systemic oppressions, and seeking equity. To disrupt extractive research practices and move towards “free-from-harm” labour and inquiry, this discussion will centre the importance of a critical researcher politic, decentring of actor personal narrative in justice work, and the role of establishing mechanisms for remediating RGBCLP and harm.

Forthcoming presentation, Leisure Studies Association Conference 2024 (Scotland, United Kingdom)
Jaylyn Leighton, PhD, Giana Tomas, PhD(c), Kimberly J. Lopez, PhD, Ashley K. Flanagan, PhD, Dr. Sherry Dupuis, PhD, and Michelle Fleming

Personal support workers (PSWs) make up 58% of the long-term care workforce and account for 70–80% of paid care work. Despite the critical role PSWs play in Canadian health care system, unregulated professions (like PSWs) are often excluded in research on experiences of care-giving that inform care labour policies. Systemic shortcomings of LTCHs (care staff shortages, poor wages, over-work, burnout, high stress environment, etc.) leave genderacialised – racialised, gendered, and classed - care workers vulnerable to race and gender-based harms (RGBHs).RGBHs in LTCHs perpetuate care work as labour that (re)produces genderacialised bodies that labour solely for capitalist production; further burdening PSWs, compromising ability to rest, recover, and temporarily relieve oneself from the physical, mental, and emotional load of care work. Care in labour that prioritizes holistic well-being can (re)produce possibilities of care for self and community outside of work through restoration and leisure. The ‘Free from Harm’(FFH) Projectaims to lay the groundwork for reporting RGBH harm in LTCHs.Informed by critical feminist concepts and theories -- reproductive labour and social reproduction theory) -- this presentation will highlight RGBHs experienced by genderacialised folx labouring in LTCHs. paper will share the experiences of genderacialised LTCH workers as they describe embodiments of safety and un-safety in the workplace. Shared conceptualizations of systemic support can be used to inform harm-reducing policy reform across intersections of race, gender, and care labour equity in spaces where genderacialsed folx labour, play (leisure), and live. This work can aid in restoring trust in a fractured care system and promote leisure as a rights-enhancing environment. 

Selected references available upon request.

Forthcoming presentation, Leisure Studies Association Conference 2024 (Scotland, United Kingdom) 
Kimberly J. Lopez, PhD, Giana Tomas, PhD(c), Jaylyn Leighton, PhD, and Ashley Flanagan, PhD

Social reproduction theory is a Marxist critique of capitalism that focuses on the ways labour functions to “produce” ill people through synergistic processes that structure and define individuals in society (e.g., type and status of worker, education, migration status). Tithi Bhattacharya a scholar in South Asian studies describes workers as producing labour power to create commodities. Bhattacharya goes on to ask, then, “who produces the worker?” From a leisure standpoint, some might argue that leisure is a process/practice that resists confining and defining “the worker” in a capitalist society. Further, as leisure scholars we might consider the ways labour, a practice with which leisure is entangled, contributes to and detracts from the well-being of working bodies. The working body incurs harm and trauma from its labour in the broader system effecting its ability to access or benefit from restoration, care, and leisure. These traumas and harms are often the focus of humanist critical qualitative inquiry in leisure studies. The hope is that some theoretical and conceptual frameworks, like Trauma-informed Inquiry, Transformative Justice, and Restorative Justice, might provide insight on how we might negotiate the use and centring of narratives of harm in leisure studies. This paper will describe the theoretical and conceptual framework underlying a project focused on free-from-harm labour and learnings from engaging this inquiry. More specifically, our team will discuss how social reproduction theory, trauma-informed inquiry, and transformative justice was useful for our focus on care labour and considerations for future anti-oppressive research in leisure studies. 

Selected references available upon request.

Forthcoming presentation, West Coast Conference on Aging: Equity influencers: Transforming Healthcare for Aging Populations (May 31 – June 1, 2024) Rachel Almaw, BSc, Kimberly Lopez, PhD, Jaylyn Leighton, PhD, Giana Tomas, PhD(c), Ashley Flanagan, PhD, Sherry Dupuis, PhD and Michelle Fleming 

Care workers such as personal support workers (PSWs) provide essential care labours to support Canada’s aging population across the long-term care (LTC) sector. Systemic processes rooted in and reinforcing neoliberal, capitalistic production work to racialise, gender, and class bodies who engage in care work. Many care roles are taken up by women of colour who are overrepresented in labours of care (pink labour) when compared to other sectors of the workforce. Labouring bodies are not only forced to over-work in systems that undervalue their care labours, but they also face inequitable and inhumane racial, gender, and class disparities that limit their potentials and impacts their care (care-for-others and care-of-self). Inadequate responses to workplace stress and safety across LTC homes creates further disparities for labouring bodies as they navigate inequitable pay, poor working conditions, and harms incurred while at work. Systemically, Canada's health and social care systems fail to acknowledge institutional stratification's entrenchment of structural racism, highlighting an oversight in addressing racialized differences for care workers. Using a critical race and feminist lens, [AUTHOR 2’s] doctoral work explored the marginalized and oppressive processes that continue to shape caring practices (both care-of-others and care-of-self) through experiences of racialisation, gender, and class. Examining care literature in a revealed politics of genderacialisation – that is, the intertwining gendering, classing, and racializing of labouring bodies [9] – work to identify systemic deficiencies (who is engaged in care and how does pg. 2 care happen) and points of tension navigated by labouring bodies working in a stratified care environment like LTC. In this presentation we will speak to eight processes related to caring work that shape the politics of genderacialised care that were identified in this work, including: (1) lack of clear, accessible information leading to PSW readiness; (2) visible over-representation and labours of care; (3) racialising and gendering reproductive labours; (4) stigmatization of LTC homes and PSW care; (5) labour force invisibility and precarious working conditions and stressors; (6) crises of care in Canada that maintains systemic inequity through transnationalization of care work; (7) invisibility of stress and burnout in caring work; and (8) the politics of leisure in welfare and self-care. The politics of genderacialisation help recognize how labouring bodies are differently racialised, gendered, and classed and commonly experience race- and gender-based harms while performing care work. This work has the potential to remediate harms of race- and gender-based care labour precarities and injustices across the LTC sector by offering recommendations for establishing useful reporting systems and transformative justice-informed care for affected labouring bodies. This work advocates for needed systemic changes that acknowledge and appreciate the critical role care workers (in this case, PSWs) play in promoting wellness for all by upholding the health and dignity of aging individuals to move towards more equitable and compassionate approaches to care across Canadian health and social care systems. 

Selected references available upon request.

Giana Tomas, PhD(c), Kimberly J. Lopez, PhD, Lauren Mitchell, Ashley Flanagan, PhD, Michelle Fleming, Jaylyn Leighton, PhD, Sherry Dupuis, PhD
Submitted Abstract, Canadian Association on Gerontology 2024 Conference 

Background: Many personal support workers (PSWs) in Canadian long-term care (LTC) homes are racialized and/or migrant women (Lightman & Akbary, 2023). In addition to stress, burnout, worker tensions, and moral distress that PSWs experience while at work, racialized PSWs experience harms that are race- and gender-based in nature (Sethi, 2020). Race- and gender-based harms (R&GBHs) are commonly dismissed (unreported and/or unacknowledged), leaving racialized PSWs to experience harms while at work.

Objective: We conducted a realist review to examine practices established in Canadian LTC systems that work to protect racialized LTC workers from R&GBHs.

Method: A realist review is an appraisal method of gathering and analyzing information to understand approaches that work for a given intervention (Pawson et al., 2005). Our review examined 46 sources, which revealed that articulation about whether protective policies or practices for racialized PSWs experiencing R&GBHs at work, exist or are clearly articulated/acknowledged.

Results: Our realist review generated three considerations to address the lack of existing policies protecting racialized PSWs, including: a) migrant care labour, b) normalization of harm, and c) silencing of harms.

Conclusions: Thematic considerations drawn from our review reveal conditions that need to be improved to create a safer working environment for racialized PSWs. This review helps to unravel the complexities of race, gender, and harm experienced by racialized PSWs. We call upon LTC systems to be more responsive by considering more holistic policies to protect, and care for, racialized workers in LTC. 

Selected references available upon request.

Kimberly J. Lopez, PhD, Jaylyn Leighton, PhD, Giana Tomas, PhD(c), Ashley K. Flanagan, PhD, Dr. Sherry Dupuis, PhD, Michelle Fleming, and Rachel Almaw
Submitted abstract, Canadian Association on Gerontology 2024 Conference

Objectives: Personal support workers (PSWs) make up 58% of the long-term care workforce¹ and account for 70–80% of paid care work². Systemic shortcomings of LTCHs (care staff shortages, poor wages, over-work, burnout, high stress environment, etc.) leave genderacialised – racialised, gendered, and classed³ - care workers vulnerable to experience race and gender-based harms (R&GBHs)¹ while at work. Leisure, then, offers an potential to reconcile some of the RGBHs experienced by direct care workers through forms of self-care This presentation will name RGBHs experienced by genderacialised folx labouring in long-term care homes (LTCHs) as they describe embodiments of harm.

Method: To date, we have interviewed 14 direct care workers via phone/Zoom, who work in LTCHs across Southern Ontario. 

Results: Our reflexive thematic analysis⁴ of the data begins to name embodiments of harm that LTCH direct care workers navigate, including: (1) physical harm (understaffing, high-work demands, burnout, resident aggression), (2) workplace systemic harm (conflict with colleagues, power struggles, and job insecurity), (3) verbal harm (experiencing racial slurs or macroaggressions), and (4) emotional harm (feeling undervalued, unrecognized, and un-cared for). To help mitigate RGBH issues, direct care works asked for transparency in communication with management, secure, prompt, and dependable reporting measures, and agency in decision-making.

Conclusions: Direct care workers’ experiences of harm(s) expose the reproduction of lack-of-care-for-self (leisure) in LTCH labour systems. The aims of this presentation are to unravel the complexity surrounding RGBHs and reporting measures to advance transformation in the way harms (physical, workplace, verbal, emotional) are addressed in LTCH workplace settings. 

Selected references available upon request.

Rachel Almaw, Kimberly J. Lopez, PhD, Jaylyn Leighton, PhD, Giana Tomas, PhD(c), Ashley K. Flanagan, PhD, Dr. Sherry Dupuis, PhD, and Michelle Fleming 
Submitted abstract, Canadian Association on Gerontology 2024 Conference

Objectives: Workplace harm is a common experience for professions that provide direct, essential care (like, personal support workers (PSWs)), particularly for genderacialised (Lopez, 2018) and migrant workers¹. The purpose of this project was to scan long-term care home (LTCH) websites to gather information on workplace harm policies and procedures for remediating harm in Ontario. The objective of this presentation is to discuss existing workplace harm policies and identify areas of improvement in relation  to protection, and care of LTCH workers. 

Methods:  An environmental scan² of Ontario LTCH websites (628 LTCH websites³⁾was conducted (January to April 2024). We gathered insights on home-specific policies/procedures, diversity/equity considerations, and organization values/mission statements. Relevant content was populated into a spreadsheet for analysis. 

Results: Analysis of the scan identified three common themes related to LTCH website and eldercare workers (like, PSWs). First, many websites lacked user-friendly interfaces, posing challenges for staff to access organizational policies. Second, worker-focused employment information is limited, compared to that for residents and supportive care partners. Third, care workers and care labour is not often acknowledged on LTCH websites, making care workers feel undervalued.

Conclusion: The absence of accessible and transparent communications on procedures for reporting/being accountable for workplace harms across LTCH websites for workers underscores a broader issue related to underreporting and silencing in LTCHs. The findings from this scan emphasize an urgency to create change around the visibility of LTCH workplace harm policies. This presentation is a part of the Free-from-Harm care work research project that advocates for policy-level changes to ensure safer environments for care workers in LTCHs. 

Selected references available upon request.

Kimberly J. Lopez, Giana Tomas, Lauren Mitchell, Ashley Flanagan, Michelle Fleming, and Sherry L. Dupuis
Toronto, Ontario - Canadian Association on Gerontology 52nd Annual Scientific and Educational Meeting

In 2020, approximately 100,000 PSWs were employed in Ontario 58% of which were PSWs working in LTCHs (MOLTC, 2020). Reports advocate for more PSWs in LTCHs, data, and transparent processes to improve working conditions and resident life quality, especially as care demands and the complexity of care increases (Estabrooks et al, 2015). Difficult and persistent conditions in LTC resulted in care staff shortages, poor wages, burnout, stress, and tension during the pandemic. Though, COVID-19 and race-focused protests simultaneously created an important opportunity to question how we might go about protecting LTCH employees from race and gender-bsaed harm. Several reports call for work to address these harms by, first, making incidents visible through race and gender-based data collection and reporting (cf. MOLTC, 2020) and, second, finding solutions to protect LTCH care workers from such harms.

A realist review provides the “policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level” (Pawson, et al. 2005, p. 21). This presentation will describe the findings of a realist review conducted to understand the nature and availability of existing race and gender-based harm reporting processes for staff working in LTCHs and the possibilities for establishing a consistent reporting protocol. This presentation will also discuss literature on related reporting mechanisms in other contexts to develop literature-based recommendations for reporting tool(s) to be used in LTCHs.