WORK SKILLS OF FORMAL CAREGIVERS AND QUALITY OF LIFE OF SENIORS IN GERIATRIC CARE INSTITUTIONS

Antonio MENDOZA-COLIN (1), María Guadalupe DELGADILLO-RAMOS (2)
Keywords: formal caregivers, satisfaction, seniors.

DOI: https://doi.org/10.26758/14.1.3

Both authors of the article have contributed equally.

(1), (2) Faculty of Medicine and Psychology, Universidad Autónoma de Baja California, México, e-mail: (1) antonio.mendoza@uabc.edu.mx

Address correspondence to: María Guadalupe DELGADILLO-RAMOS, Faculty of Medicine and Psychology, Universidad Autónoma de Baja California, México, e-mail: lupitadelgadillo@uabc.edu.mx

Abstract

Objectives. The aim of this study was to describe some experiences of formal caregivers in geriatric care institutions in the city of Tijuana, Baja California, Mexico, particularly those feelings regarding satisfaction and care interactions with the elderly.

Materials and methods. This study is based on the preliminary results obtained from qualitative methods, which primarily focused on the analysis of speeches from a set of twelve interviews conducted with a sample of formal caregivers who are working within geriatric care institutions for more than 8 hours in their shift. For the analysis of the data, Atlas.ti version 9 was used.

Results. In the code “Feeling regarding the satisfaction of caregivers”, the participants expressed that despite doing a very demanding job and having working conditions such as low salaries, a lack of work material, and the stress of the caregiver, their greatest reward is helping the seniors. According to the code “Interaction in Care with the Elderly”, the caregivers expressed that the gratitude on the part of the elderly and practicing empathy, love, and positive communication produce a state of emotional well-being, motivation, and perseverance within the institution.

Conclusions. The effort and responsibility of formal caregivers within geriatric care institutions allow the caregiver to be humanized since it contacts him with satisfaction and strengthens his self-esteem and professional development by making him feel useful and productive within his work, where he seeks to promote the quality of life of vulnerable seniors.

Keywords: formal caregivers, satisfaction, seniors.

Introduction

 The accelerated growth of life expectancy in recent years has brought about new challenges in the area of health, which demand the implementation of plans and programs to promote quality care and sustainable development from a multidisciplinary perspective (Sistema Nacional para el Desarrollo Integral de la Familia [National System for the Integral Development of the Family] [DIF], 2021). According to the World Health Organization [WHO] (2020), a progressive growth of 34% of the elderly population in 2030 is estimated to double by 2050, where 80% of the elderly will live in low- and middle-income countries.

In addition, the WHO (2019) indicates that the lack of healthy habits leads to chronic diseases and disability, making the lack of autonomy a great risk for the functionality of the elderly; particularly, the deterioration in the cognitive, sensory, motor, and affective areas impacts the well-being and quality of life of the elderly (Carrillo, Rivera, García & González, 2020; Laguado, Camargo, Campo & Martín, 2017; Salamanca-Ramos, Velasco & Baquero, 2019).

Care for older adults should be understood in terms of the search for the maintenance and improvement of quality of life through the prevention of physical and mental illnesses (Martin, 2019), understanding that quality of life is, according to the WHO, the “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (Mesa, Valdés, Espinosa, Verona, & García, 2020).

Regarding the quality of life of older adults in geriatric care institutions, several researches developed in Latin America (such as Colombia, Chile and Mexico) indicate that certain working conditions directly affect the care of care services, such as: work organization, physical and mental workload, autonomy in the performance of activities and social context; causing absenteeism in staff, decreased productivity and quality of services, (Blanco-Colunga, Monier-Rodríguez, & Turtos-Carbonell, 2019; Calzada & Ocampo, 2018; Jimenez, Orozco & Caliz, 2017) consequently neglecting care, safety, as well as the emotional, social and spiritual aspects of the older adult (Segura, Miranda, & Guillén, 2015).

In Mexico, the care of the elderly is associated with the social security system, which is mostly provided by governmental or public institutions but also by private institutions such as retirement homes, daycare centers, and residences (Ronzón, Méndez, & Jardón, 2021). According to the Sistema Nacional para el Desarrollo Integral de la Familia (DIF, 2021), the protocols for prevention, treatment, and services developed in geriatric institutions in Mexico show various socioeconomic and information systematization limitations, which reveals the need to evaluate the quality of the care provided, as well as the training received by the staff.

In this sense, formal caregivers are defined as those persons trained through theoretical-practical courses, dictated by multidisciplinary and interdisciplinary teaching teams, with the purpose of providing preventive, assistance, and educational care to the caregiver and his or her family nucleus (unlike informal caregivers, who are generally family members), who are hired by an organization or institution or by a person who is in charge of providing them with a salary, benefits, and other regulations. It is worth mentioning that their work can be carried out in institutional care (nursing homes, retirement homes, day hospitals) or home care (patient’s home), where the demands, workload, activities to be carried out, remuneration, and schedules tend to vary (Calzada & Ocampo, 2018; Hormaza & Amezquita, 2018).

The importance of developing competent practices in formal caregivers lies in the fact that it favors the implementation of strategies adapted to improve the quality of life of older adults and facilitates the incorporation of the most appropriate models or methods that favor well-being and satisfaction within the aging process (Hernández-Sampieri & Mendoza, 2018; Mastrapa, Gibert, & Espinosa, 2020).

Different studies indicate that a healthy work environment for the formal caregiver improves the levels of job satisfaction and the service that the collaborator offers (Aliaga-Zamora, Delgado-Céspedes, Romero-Cueva, Cholán-Valdez, & Rondon-Jara, 2022), so in addition to taking care of the user, the institution must also take care of the caregiver. Since formal caregivers are constantly facing multiple stressors when offering their services within the institutions, such as increased workload, lack of supplies for the provision of services, low wages, and increased demands for care, they are likely to present burnout syndrome, which can affect their own quality of life as well as that of the people who are under their care (Albán & Santafe, 2023). Also, according to several studies (Fajardo, Nuñez, & Henao, 2021), the act of caregiving implies an emotional burden resulting from empathizing with the cared person; however, very few studies have addressed the issue of caregiver well-being and satisfaction as a result of the caregiving interaction or interpersonal bond with the cared person, in particular with older adults.

Material and methods

 General objective

 Describe some experiences of formal caregivers in geriatric care institutions, particularly those regarding satisfaction and care interactions with the elderly.

Design of research

A qualitative design of a phenomenological hermeneutic type, in which the experiences lived by formal caregivers in geriatric institutions were collected through the use of in-depth interviews to then reflect and interpret their subjective nature, with the purpose of validating the meanings attributed by the participants based on their values, perceptions, beliefs, thoughts, and, in general, all their intersubjective reality (Fuster, 2020).

Participants

 Convenience sampling is conducted in long-term care institutions in the city of Tijuana, Baja California. The study participants were 12 formal caregivers (nursing assistants, paramedics, and nursing technicians) working in a geriatric care institution (nursing homes, retirement homes, and care centers, among others), of both sexes, with working days longer than 8 hours and studies in a technical career, course or diploma that guarantees some degree of knowledge or study in relation to geriatric care.

Instruments

 A semi-structured interview was developed to explore the work competencies of formal caregivers and their relationship to the quality of life of older adults.

The instrument was constructed based on two categories, each of which contains different dimensions to be assessed:

1) Core competencies in gerontological care centered on long-term care institutions.

  1. a) Attention to activities of daily living
  2. b) Attention to psychological activities
  3. c) Professional relationship

2) Caregiver profile

  1. a) Basic knowledge of the care of older adults
  2. b) Meanings of caregiving practice

In addition, sociodemographic variables such as sex, age, schooling, marital status, and occupation of the formal caregivers were included.

The instrument includes 31 questions, but for the purposes of this article, the answers to the following questions were analyzed:

  1. In general, what daily activities do you carry out in the institution with older adults?
  2. What do you think are the main emotional needs of an older adult?
  3. Do you have the material and human resources to achieve them? If not, what resources do you need to be able to perform your work according to your expectations?
  4.  How satisfied are you with the work you do within the institution? What makes you feel this way?
  5. How do you think your level of satisfaction with the service or attention you provide within the institution influences your level of satisfaction?

Procedures

In Baja California, Mexico, 60 geriatric care institutions with civil association status were identified, 25 of which are registered in the city of Tijuana by the DIF, of which 23 were included because they provide long-stay care (care longer than 24 hours) and have formal caregivers on their staff. Two institutions were excluded because they focus exclusively on providing home care, short-term care of less than 24 hours (day care centers), and because they are located outside of the Tijuana city delegations.

Once the 23 institutions that met the inclusion criteria were identified, a simple random sampling was carried out, stratified geographically in the 9 delegations that make up the city of Tijuana, finally selecting 6 civil associations concentrated mostly in the “La Mesa” delegation.

Finally, of an approximate universe of 70 formal caregivers, 12 were invited to participate (2 per institution) to maintain homogeneity in the institutions; their ages ranged from 23 to 60 years, with the majority (66.66%) being women (8 interviewed compared to 4 men), of which 74.99% had a nursing assistant certification, 16.66% paramedics, and 8.3% had a degree in nursing; and an average of 4 years of seniority in the position.

Each step of the procedure is summarized in Figure 1 (next page).

The interviews were conducted in a private space in the facility, under appointment, so as not to interfere with their caregiving activities. This allowed participants to feel comfortable and safe expressing their opinions without fear of being overheard by other superiors, caregivers, and older adults within the facility.

 Ethical aspects of research

Once the research project had been approved by the Bioethics Committee of the School of Medicine and Psychology of the Autonomous University of Baja California (file number D318, valid for one year from October 2022), an informed consent document was given to each participant, explaining the objectives of the study, the data collection instrument, the risks and benefits of their participation, and the confidentiality of the data.

Figure 1

Strategy for the selection of participants (to see Figure 1, please click here) 

Data analysis

 The transcription of the interviews (audio material) was carried out in the computer program Atlas.ti version 9, following the 5 phases proposed by Ulin, Robinson, and Tolley (2006) for discourse and content analysis within the qualitative paradigm: 1) immersion, where notes are read and reviewed; 2) coding, which consists of the development of labels or codes; 3) presentation, which aims to present the information in detail for each category; 4) reduction, which aims to reduce information to essential points; and 5) interpretation, which consists of interpreting all the results globally.

Results

 When exploring the experiences of the 12 formal caregivers in geriatric institutions, some types of occupational hazards could be recognized, the most representative being understaffing, lack of materials, caregiver overload, salary risk, physical risk, and lack of initiative among colleagues (Figure 2).

Figure 2

Occupational hazards in Caregivers in a geriatric institution (to see Figure 2, please click here)

According to the testimony of the participants, the main risks are: the lack of work materials (such as medicines and diapers) since they depend on donations and the resources of the families to obtain and cover this demand; the lack of personnel that leads them to have difficulties in caring for the elderly because they experience lack of time and fatigue, as well as greater pressure to perform the additional tasks of basic daily care (which could lead them to suffer from caregiver overload). Finally, they explained that it would be important to adjust salaries according to the activities performed, especially with staff working as volunteers who do not have an employment contract and receive only in-kind payments, such as free food and lodging at no cost within the institution (Table 1).

Table 1
Occupational hazards in Caregivers in a geriatric institution (to see Table 1, please click here).

According to the perception of formal caregivers, older adults experience certain emotional needs such as love, attention, and companionship, as well as the need for listening and understanding. Figure 3 indicates that the words with the highest concurrence are “love”, “family”, “time”, “tranquility”, “cuddle”, “affection” “health”, “smile”, “visit” and “service”.

Figure 3
Emotional needs of older adults as perceived by formal caregivers. (to see Figure 3, please click here)

Consequently, Table 2 analyzes the testimonies on the emotional needs of the elderly. It highlights the importance of providing care, listening, and companionship from a loving perspective, offering dignified and humane treatment that covers both the physical and emotional care of older adults.

Table 2
Emotional needs of older adults as perceived by formal caregivers (to see Table 2, please click here).

Figure 4  shows that formal caregivers perform “basic care activities” such as taking vital signs, administering medications, providing palliative care, offering hygiene assistance, and providing mobility support for older adults. They also provide “support for emotional health in seniors” by maintaining a positive and loving attitude in caregiving. This contributes to the development of “care interaction with the elderly”, which is essential for stability in the relationship between older adults and caregivers.

Figure 4
Care interaction with the Elderly (to see Figure 4, please click here)

Finally, Figure 5 describes the “feelings regarding the satisfaction of caregivers”, highlighting work motivation and happiness as a result of providing care to seniors and learning skills. The participants expressed that the affection they receive from the elderly gives them happiness because providing help to others makes them feel useful and satisfied with their vocation, as well as invigorated. They emphasized the importance of giving a lot of “love” to the seniors and not transmitting their personal problems, of having warm approaches to avoid loneliness and suffering (which they experience both for their past lives and for being away from their family in the present).

Figure 5
Feelings regarding the satisfaction formal caregivers (to see Figure 5, please click here)

Discussions

 Throughout the interviews, formal caregivers were talking about their perceptions of the different occupational hazards and emotional needs of the elderly, as well as the feelings of satisfaction they experience while interacting with them and providing them basic care for daily life and for their emotional health.

In this research, it was possible to verify, as other authors refer (Augusto, Teixeira, Falcão, Costa, & Pimentel, 2019), that formal caregivers within geriatric care institutions contribute to the quality of life of residents and their families, so it’s necessary to establish goals aimed at medical, functional, and social support through daily routines, occupational activities, etc., where an adequate relationship between caregivers and seniors is favored. It is also necessary to provide personalized care, adjusted to the specific needs of each user, in order to ensure more effective interventions.

About the occupational risks identified in this study, other authors agree that these can influence the fulfillment of the care and quality of life objectives of older adults and even cause caregiver overload (Fajardo-Ramos, Soto-Morales, & Henao-Castaño, 2019). Along the same lines, it has also been shown that the multiple responsibilities involved in caring for older adults affect the physical and emotional well-being of caregivers and consequently their optimal work performance (Lara, Lemus, & Iglesias, 2019). Finally, Bringas, Naveiras, and Rodríguez (2020) explain how lack of materials, understaffing, overload, and payment in kind can produce stress and dissatisfaction in caregivers and thus have an impact on the quality of care provided to older adults.

In relation to the care interaction with the elderly, as could be observed, formal caregivers provide basic care activities and support for emotional health in seniors with a positive and loving attitude. Similarly, López (2017) highlights the importance of including in the professional training of caregiver competencies related to communication, information, support, and accompaniment to improve the performance of their care tasks. Therefore, when training is offered, it allows the caregiver to be open to making decisions aimed at improving their quality of life and that of the person they are caring for, something that the literature refers to as resilient transformation (Zuluaga-Callejas et al., 2021); likewise, other researchers have emphasized that the relationship between formal caregivers and older adults should focus on reciprocity and humane and moral treatment to procure harmony (Morales-Castillo, Hernández-Cruz, Morales, & Landeros, 2016).

Finally, regarding the feelings regarding the satisfaction of caregivers, the participants confirmed that despite the perceived occupational risks, they feel motivated and satisfied, in line with the findings of Bringas et al. (2020). According to Zuñiga, Fernández, & Aguilar (2020), when formal caregivers perceive that they are developing activities that are related to their training, skills, and experience, they feel a sense of well-being and satisfaction within their work in the institution, so to achieve the ideal level of commitment, it is necessary to work on the motivation of employees and improve working conditions, such as communication and collaborative work. Similarly, other findings demonstrate that discovering personal skills (Pérez, Díaz, Cabrera, Llontop & Callejas, 2020); exploring values of love, commitment, and dedication (Cerquera et al., 2021); valuing the importance of the activities performed (Lara et al., 2019); and providing affection to older adults (Medina et al., 2020) are valuable for formal caregivers and contribute to improving their care.

Conclusions

 This paper sheds light on the limited amount of evidence-based data available in the northwestern region of Mexico regarding formal caregivers and their contribution to the quality of life of older adults. Most of the research in this area focuses on informal caregivers, demonstrating that it is necessary to continue exploring the labor competencies of this population, especially because they often do not have the training, material resources, salary, and attention to their own emotional needs to prevent caregiver overload and the negative consequences on their physical and mental health, as well as that of their environment.

 Acknowledgements

 A summary of this paper was presented at the online international conference: Individual, family, society:contemporary challenges, fifth edition, October 4–5, 2023, Bucharest, Romania, and published in the journal Studii şi Cercetări de Antropologie, No. 8/2023.

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