Towards Free-From-Harm Care Labour: Laying the Groundwork for Reporting Race and Gender-Based Harm in LTC Homes

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.

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, 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, 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.

Jaylyn Leighton, PhD*¹, Giana Tomas, PhD(c)¹, Kimberly J. Lopez, PhD¹, Ashley K. Flanagan, PhD², Sherry Dupuis, PhD¹, and Michelle Fleming². 

¹Department of Recreation and Leisure Studies, Faculty of Health, University of Waterloo 

²Ontario Centres for Learning, Research, and Innovation in LTC (CLRI) at Bruyère  

*Primary Contact: jjleight@uwaterloo.ca

Proposed Format: Traditional Paper

Women and people of colour (POC) are subject to systems that make them more likely to take up certain forms of reproductive work, like direct care workers (DCWs), who make up 55% of the care workforce¹ and account for 70–80% of paid care work in Canada². DCWs face systemic challenges in long-term care homes (LTCHs) that exacerbate race- and gender-based harms (RGBHs).^1,3,4 RGBHs not only affect DCWs' well-being but also reinforce (exploitative) genderacialised labour —work that is overrepresented by POC and/or women.^3,5 The culture of silence surrounding harm and violence in care work maintains care worker invisibility and inaction.

The Free-From-Harm project,⁶  informed by social reproduction⁴ and critical feminist theories⁷ explores the genderacialised experiences of LTC DCWs in Southern Ontario. Between November 2023 and August 2024, we facilitated 58 surveys and 23 interviews with DCWs (including personal support workers, dietary aides, and administrative staff). 79% of respondents were aware of RGBHs occurring in LTCHs, and 69% experienced RGBHs in their workplace. Interview data described experiences of harm, awareness of reporting policies, perceptions of safety, and hopeful reimagining’s. Care work in LTCHs (re)produces genderacialised bodies, commodifying and dehumanizing care labour for capitalist production.⁴ When entangled with other systemic oppressions, DCW’s ability to rest, recover, and temporarily relieve oneself from the physical, mental, and emotional load of care work^{3, 5} are compromised. This work advocates for restoring the labouring body through leisure to mitigate harmand heal through a reapproach of care together both in and outside of the workplace.

References  

1. Ministry of Long-Term Care. (2020). Long-Term Care Staffing Study Advisory Group: Long-Term Care Staffing Study. https://files.ontario.ca/mltc-long-term-care-staffing- study-en-2020-07-31.pdf  

2. Canadian Research Network for Care in the Community. (2009). Ontario Personal Support Workers in Home and Community Care: CRNCC/PSNO Survey Results.  InFocus-Ontario PSWs in Home and Community Care.pdf (torontomu.ca) 
3. Lopez, K. (2018). " We are not a machine": Personal support workers'(ante) narratives of labour, leisure, and hope amidst politics of genderacialised care in long-term care homes. 
4. Bhattacharya, T. (2017). Introduction: Mapping Social Reproduction Theory. In T.B. (Ed.) (pp. 1-20), Social Reproduction Theory: Remapping Class, Recentering Oppression. Pluto Press.   
5. Duijs, S. E., Abma, T., Plak, O., Jhingoeri, U., Abena-Jaspers, Y., Senoussi, N., Mazurel, C., Bourik, Z., & Verdonk, P. (2023). Squeezed out: Experienced precariousness of self-employed care workers in residential long-term care, from an intersectional perspective. Journal of Advanced Nursing, 79(5), 1799–1814. https://doi.org/10.1111/jan.15470 
6. University of Waterloo (2024). Cultivating care-full futures: Towards Free-from-Harm (FFH) Care Labour: Laying the Groundwork for Reporting Race and Gender Based Harm in LTC Homes. Cultivating care-full futures | Recreation and Leisure Studies (uwaterloo.ca) 
7. Glenn, E. N. (1992). From servitude to service work: Historical continuities in the racial division of paid reproductive labor. Signs: Journal of women in culture and society, 18(1), 1-43. 

Kimberly J. Lopez

Anarchist Bakunin (1869) describes that it is material conditions or pressure on ‘the people’ from the “natural force of events” that create uprisings and protests for change. The constraints and affordances of labour production under capitalism often, if not always, shapes the nature and availability of restorative practices. Social Reproduction Theory (SRT) considers how our labour-leisure is socially reproduced by imperialism, capitalism, and colonialism. Thinking with the works of Vogel, Giménez, Weeks, Bhattacharya, Nadasen, Davis, and Ferguson through SRT, and with labels that fragment the bodymind and maintain difference (i.e., gender, race, ability, age), this conceptual paper will present the intersections of the anti-work, labouring differently, and rest-as-resistance movements. Specifically, this discussion will draw out the interstices between these concepts that may be bridged with practices of anti-capitalist care, leisure, and restoration. What role could leisure play in revolution of labour towards realization of Weeks’s (2011) “post-work imaginaries”? Efforts of structural resistance in-the-moment-ever-unfolding (Bakhtin, 1986, 1993) toward community survival, kinship, and freedom will be used to illustrate the urgent need to revise the oppressive conditions of productive and reproductive labour to live leisure that, not only sustains us amidst the need for work but also, affirms our humanity beyond capitalist labour.

Lopez, K.J. “Revolutions are not improvised…”: Occupying the interstices of the anti-work, labouring differently, and rest-as-resistance movements. Congress/Canadian Association on Leisure Studies. George Brown. Toronto, ON. June 2-4, 2025.

References

Bhattacharya, T. (ed.) (2017). Social Reproduction Theory: Remapping Class, Recentering Oppression. Pluto Press.

Davis, A. Y. (2016). Freedom is a constant struggle: Ferguson, Palestine, and the foundations of a movement. Haymarket Books.

Ferguson, S. (2016). Intersectionality and social-reproduction feminisms: Toward an integrative ontology. Historical Materialism, 24(2), 38-60.

Ferguson, S. (2019). Women and work: Feminism, labour, and social reproduction. Between the Lines. Pluto Press.

Gimenez, M. E. (2018). Marx, women, and capitalist social reproduction: Marxist-feminist essays. Brill.

Nadasen, P. (2023). Care: The highest stage of capitalism. Haymarket Books.

Vogel, L. (2013). Marxism and the oppression of women: Toward a unitary theory. Brill.

Weeks K. (2011). The Problem with Work: Feminism, Marxism, Anti-Work Politics and Post-Work Imaginaries. Duke University Press.

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.

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.