Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, USA.
Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, USA.
Gerontologist. 2021 Aug 13;61(6):838-850. doi: 10.1093/geront/gnaa190.
Personal care, home health, and nursing aides provide the majority of care to chronically ill and disabled older adults. This workforce faces challenging working conditions, resulting in high turnover and workforce instability that affect the quality of care for older adults. We examine financial security, work-life balance, and quality of life of Black, Hispanic, and workers of other race/ethnicity compared to White workers.
We hypothesize that Black and Hispanic workers experience greater financial insecurity, spend more time on work-related activities and have less time available for leisure activities, and have a lower quality of life compared to White workers. To test these hypotheses, we analyze the American Time Use Survey using descriptive analyses and multivariable and compositional regression.
Black and Hispanic individuals were 2-3 times more likely to live in poverty than White individuals. The time use analysis indicated that Black and Hispanic workers spent more time on work-related activities and less time on nonwork-related activities, including longer work commutes and less time exercising. In analyses of aggregated paid/unpaid work and leisure, Black workers were the only group that spent significantly more time working and less time on leisure activities compared to White workers. This may explain the lower quality of life that we only observed in Black workers.
Racial/ethnic disparities in well-being among direct care workers may affect the care older adults receive and contribute to widening inequities in this workforce and society. Policymakers should direct efforts toward securing funding for workers, incentivizing employer provisions, and implementing racial equity approaches.
个人护理、家庭保健和护理助理为大多数慢性病和残疾的老年患者提供护理。这一劳动力群体面临着具有挑战性的工作条件，导致高离职率和劳动力不稳定，从而影响了老年患者的护理质量。我们研究了黑人和西班牙裔以及其他种族/族裔工人与白人工人相比的经济保障、工作与生活平衡和生活质量。
我们假设黑人和西班牙裔工人比白人工人经历更大的经济不安全感，花费更多的时间从事与工作相关的活动，用于休闲活动的时间更少，生活质量更低。为了检验这些假设，我们使用描述性分析和多变量及成分回归分析对美国时间使用调查进行了分析。
黑人和西班牙裔个体比白人个体更有可能生活在贫困之中，其可能性是白人个体的 2-3 倍。时间利用分析表明，黑人和西班牙裔工人花费更多的时间从事与工作相关的活动，而用于非工作相关活动的时间较少，包括更长的工作通勤时间和更少的锻炼时间。在对有偿/无偿工作和休闲活动的综合分析中，只有黑人工作者与白人工作者相比，工作时间明显更长，休闲时间明显更短。这可能解释了我们只在黑人工作者中观察到的生活质量较低的原因。
直接护理工人在幸福感方面的种族/族裔差异可能会影响老年患者所接受的护理，并导致该劳动力群体和社会中的不平等现象进一步扩大。政策制定者应努力为工人提供资金保障、激励雇主提供规定，并实施种族公平方法。
