Ethical Burden and Resource Limits in Home Care

Ethical burden, restricted resources and poor management cause home care workers to leave their jobs: According to a new study by the University of Eastern Finland, difficulties in home care have persisted for a long time – and also taken a toll on home care workers’ wellbeing.

Many of Finland’s newly established wellbeing services counties are looking to cut costs in eldercare services, especially in round-the-clock care and home care. At the same time, the sector suffers from a significant shortage of workforce, which means that a growing number of older adults, many with high needs for support, have to manage in their own homes without adequate help.

“We examined home care workers’ reasons for leaving their jobs and could identify four main drivers: a mismatch between older clients’ needs and the available resources; measurement-driven practices and various digital systems taking up too much time; demands posed on the employee and the inflexible nature of the work; and ethical burden,” Postdoctoral Researcher Marjo Ring from the University of Eastern Finland says.

According to the researchers, home care workers should be seen as professionals who want to take responsibility for their work and be involved in the development of their field. Home care workers expect increasingly personal management and better consideration of the needs of the employee and the client alike. There is also a need to discuss the values associated with the work. This requires the development of indicators for home care, as a mere focus on care procedures is not enough to meet older adults’ needs. In addition, interaction and encounters between clients and home care workers should also be prioritised.

The study examined home care workers’ reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Gaining in popularity since the 1990s, NPM has sought to rationalise eldercare services by developing management and relying on market-oriented thinking.

“We observed that the principles of New Public Management were clearly reflected in home care workers’ experiences and reasons for leaving their jobs. Decisions on eldercare taken at the national level and solutions made within organisations were reflected on the day-to-day work of home care workers even to such an extent that caused them to leave their jobs,” Ring explains.

The study was conducted as part of the SOLDEX project, which examined old-age social exclusion especially from the perspective of older home care clients.

“A significant proportion of those receiving regular home care live alone or with an older spouse, and they need a lot of support due to, e.g., physical or cognitive decline. We know that older home care clients have a high risk for social exclusion if the services provided at home are not adequate. The situation is thus extremely concerning also from the perspective of those needing home care,” says Associate

Professor Elisa Tiilikainen of the University of Eastern Finland.
The study was funded by the Finnish Work Environment Fund and the Research Council of Finland.
Research article:
Ring, M., Ristolainen, H., & Tiilikainen, E. (2024). From Restricted Resources to Ethical Burden—Former Home Care Workers’ Reasons for Leaving Their Jobs. Journal of Applied Gerontology, 0(0). https://doi.org/10.1177/07334648241231404
Website of the SOLDEX project: https://uefconnect.uef.fi/en/group/old-age-social-exclusion-in-home-care-prevalence-meanings-intervention-soldex/