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She needed somebody on a one-to-one basis; otherwise she would be left alone. She needed the social interaction.


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Gradually we cut out the night and just recently for financial reasons we had to cut out, um, she had a private companion here from eight in the morning until noon and then again from five to seven. So somebody gets her up in the morning and then somebody gets her into bed again. Site 4, Family member. Social and emotional care was an important theme. In many cases, families hired companions to provide care that they could not do or would not do.

One companion reported that:. Families hired companions because they identified a care gap and they could not or would not provide the care themselves. In most instances, it was families with wealth who hired caregivers; however, we heard stories of families that scraped together everything they could in order to pay for the care. In more than one instance, we spoke with families who had scaled back or who were no longer able to afford companion care.

These stories were often framed with guilt and worry. The relationships with families were equally complex to those with facility management and staff. Because some companions were hired directly by the family, they often established close relationships. When companions were hired through an agency, they usually do not interact directly with families.

Companions report to an agency administrator who then communicates to families. It seems that agencies fear that families will hire good companions directly if they are allowed to communicate with them. The personal relationships that developed between companions and residents existed in the liminal space between worker and friend, and sometimes resulted in companions performing care work for which they were not paid. An exchange about hours reveals one of the forms that this volunteering took:.

I; So you come at and you do feeding from to And then to is supposed to be your free time? Three hours, I need to call somebody to work with her. So my free time I like to stay with her.

You know, she is sleeping…I am not going to leave her. I love her very much. She was paid to simply spend time with the resident at other times when not doing these tasks. Nonetheless, as this exchange illustrates, her free time was indistinguishable from her work time, because she had split shifts and did not work close to home. This strategy was done as a way of securing their own employment, and often reflected the fact that they cared for more than one resident in a day.

In This Review

Companions often spoke about other residents that they had previously cared for and whom they still cared about. They noted that residents would often ask them to come to visit them afterwards. There was usually a desire on the part of the companion to do so; however, work hours, distance and other factors prevented them from doing so. Families relied on companions to be their eyes and ears and to do things that they could not.

Companions talked about how they cultivated this feeling. One companion wanted the daughter to increase the hours. They never get outside, never feel the sun on your face. Families did a significant amount of unpaid care work in the form of coordinating and scheduling companion care. Many had assumed that this form of unpaid care work would diminish once their family member had entered a publicly funded care facility.

In our interviews, we heard the opposite, as daily communication, coordination of activities and supplies, and mediating between management, staff and companions took the place of care work families previously performed at home. Theirs is a laudable goal worthy of pursuit and their archetypes do much to advance our thinking about care work.

Nonetheless, their current conceptualization requires refinement because it fails to take account of several issues. They provide the example of Italy where costs and culture make institutionalization less attractive; however, their cursory review of institutional care lacks important context.

For instance, policy makers do argue that home care is preferred and better, but this can be an economic rather than an absolute argument. In most countries the focus on home care has not curbed the high demand for institutional care, which remains so because some care needs are not and cannot be met in home care settings because of the acuity on the one hand and the inadequacy of the home environment on the other.

Limited space also results in only the most acutely ill gaining a spot. In some countries and regions there has been greater public sector investment in home care; however, it may be at the expense of public funding resulting in a degradation of institutional care quality. Regional jurisdictions within countries may differently fund and allocate resources between home and institutional care.

Thus, they argue that there are big differences between countries but there may be just as many differences within countries. Furthermore, how does household wealth impact the care configuration within a country? This is important to consider because insufficient public home care funding requires additional private payments; this is a class issue as not everyone can afford to pay privately for care.

Third, they provide the example of home care in Modena, Italy to argue that hiring personal assistants allows for the practical maintenance of a familial care ideal Hiring companions may then represent privatization Ungerson and Yeandle, and a re-alignment from more to less generous welfare state provision or represent an artefact of a residual approach to the provision of publicly funded care. For instance, they have limited the market care category to for-profit companies. Companions — who may be directly employed by one family or by a few families as independent contractors or employed by for-profit agencies — are nonetheless bound to the family but not to the market in their model.

There are few empirical studies that directly examine private companions working in LTCF or that identify the complex interplay of relations between facility staff and management, family, residents, companions, volunteers and students. We would argue that companion care, particularly when provided in residential settings, requires additional study to expand our empirical and theoretical understandings.

As a starting point, our study found that too few staff meant that families were paying out of pocket for private care for services that were supposed to be publicly funded.

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Most families had neither the time nor the skills to make up for the deficit. In every facility the scope of their practice and the types of policies to address what they can and cannot do, as there are neither common standards nor common job descriptions. In many cases there are no organizational policies. Companions are not directly supervised, and facilities hesitate to intervene directly with companions, choosing instead to deal with families when there is a problem.

Many work for an agency but agency work is precarious, and tightly controlling of the relationship with the family. Being hired directly by the family may involve cash payments and rarely includes even statutory benefits. Thus, private companions are in spaces that are in-between. They are paid workers but not employees where they work. They are invisible in terms of organizational rules but often have rules applied to them. Companions are also liminal in a regulatory sense.

Whereas the LTCHA enforces screening for qualifications, training and criminal history of staff and volunteers, there is no obligation to screen companions. Sometimes they are employed by formal agencies and have statutory benefits but rarely extended health benefits, but many times they are employed directly by families and lack even the most basic of statutory benefits. Existing ways of comparatively theorizing care work do not adequately account for the causes, contradictions and conditions of liminality for companions.

We need models that can better account for the blurry lines between formal and informal, paid and unpaid care work. To date this has not been taken up in the LTCF research except in descriptive ways. There is a growing body of research that documents the nature of informal home care, but almost no research documenting informal care in LTCF unpaid nursing home care by family, volunteers or students , or the other wage labour of privately private companions.

The notion of liminality allows us to highlight the spaces in between informal and formal, paid and unpaid and to begin to theorize the forces that shape this kind of work and the nature of relations within it. Addressing these spaces has importance for theory, practice and policy.

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Especially as companion care represents more informal care in formal care settings. Furthermore, we need studies to enable us to better understand the intersecting and contradictory funding, delivery and regulatory roles held by the state, voluntary organizations, households and markets. But, in doing so we should better account for how care differs between private homes and institutions, how class and other social locations make a difference within countries and how some people are marginalized within systems that are insufficiently staffed.

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This article has been cited by other articles in PMC. Keywords: Private companions, informal and formal care, long-term care, care work, gender. Method and methodology This mixed methods convergence model study Creswell and Plano Clark, involved three aspects. Findings This section presents our findings with respect to how companions exist in a liminal space within the public policies governing the care of older adults living in facilities, as workers in the facilities and within the context of family relationships.

Site 1 Manager We found that while many homes had companions, they lacked policies to address or limit the types of care provided by companions. I; What would happen? Site 1, Companion In some instances, there were policies; however, these were circumvented depending on the companion or the resident.

Site 4, Companion One companion noted that she was hired to take the resident outside for walks and to do some feeding. Site 5, Companion Finally, even though many companions held PSW qualifications, they lacked the protections felt by PSWs whose work tends to be protected by unions and provided with benefits. Liminality in the familial realm The reasons families decided to hire companions were complex. Site 4, Family member Social and emotional care was an important theme.

Site 4, Companion Families hired companions because they identified a care gap and they could not or would not provide the care themselves. An exchange about hours reveals one of the forms that this volunteering took: I; So you come at and you do feeding from to A; Free time, yeah.