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What Being a Home Care Worker Taught Me About Emotional Labor

May 28, 2019

Anyone who has worked in direct care knows this occupation requires physical strength. Assisting another person with activities of daily living and health management takes substantial physical effort. But paid caregivers also support clients in the intensely personal experiences of aging, illness, or physical limitation, requiring significant emotional strength.

I experienced these demands firsthand as a home care worker in Florida in the mid-2000s. Over two years in the field, I learned that the emotional labor required of home care workers takes numerous forms. It is work that is critical to clients’ well-being, but if not supported, can also take a toll on caregivers and contribute to the field’s high rates of turnover.

Connecting with Clients

My first client was a man in his nineties and one of the most outgoing and quick-witted people I’ve known. Fred’s smile was as expansive as his Southern drawl, and he used both to greet me warmly at the start of each shift. He was deeply engaged in his own health, determined to maintain as much independence as possible with the support of his caregivers.

Fred worked for nearly a year to recover his ability to walk following a fall. But the slow pace of progress also created anxiety for him. Together we spent hours strategizing about how to manage chronic pain in his legs, ensuring he had ready access to topical analgesic creams around the house and taking notes for his physical therapist. When I was out of solutions, we told stories as a distraction until a painful episode had passed. Some days were harder than others, and I learned to gauge his mood from the way he stressed certain syllables while using his walker.

Sensitivity to clients’ emotions is a key aspect of the emotional labor required of paid caregivers. There are psychological tasks associated with observing, interpreting, and responding appropriately to client sentiments. And by engaging emotionally with clients, home care workers help them feel heard and understood — and are in a better position to identify their unmet needs (such as hunger or persistent pain). But the high volume of emotional work in home care, particularly relative to the low levels of compensation and job supports in this profession, can also create strain and drive caregiver burnout.

Coping with Isolation

While home care work entails close interactions with clients, it can also be uniquely isolating. Fred took a genuine interest in getting to know each of his home care workers, some of whom had been with him for several years. Building a strong relationship with Fred allowed me to deliver more personalized care and reduce misunderstandings between us. But my connections to colleagues mainly took place through a tattered notebook we used to leave status reports to one another at the end of each shift.

Absent the familiar signifiers of a workplace, like a centralized location and the presence of other employees, a home care worker must alone carry the burden of professionalizing caregiving interactions. For example, workers often suppress their emotions to avoid upsetting their clients. Several aspects of emotional labor that have been correlated with depression among home care workers are exacerbated in isolated work environments, including suppression of emotions and coping with unfair treatment on the job.

Managing Stressful Situations

The ferocity that Fred brought to improving his health was present in his frustrations as well. When he was unable to carry out a routine activity as easily as he once had, his irritation could be searing. Some days, his voice echoed off the sliding glass door that led to his patio, doubling the urgency of each complaint. My best option in these cases was to listen and reflect Fred’s concerns back to him, keeping my responses even-toned. It wasn’t easy, but over time this usually allowed us to reset and return to our regular rhythm.

Relational skills that support respectful and effective communication, collaborative problem-solving, and de-escalating emotionally charged situations are critical to home care work. But they are rarely offered in the limited training provided for personal care aides and home health aides. Some employers have integrated content on interpersonal skills into their trainings — the PHI Coaching Approach® curricula are designed for this purpose. But many workers are expected to either inherently possess these competencies or develop them on their own, as they work; when this is not the case, both job quality and quality of care suffer.

Supporting Condition-Specific Needs

Another client of mine, a woman in her eighties named Chris, was managing lung disease and full-time oxygen support. Throughout my shifts, I checked the levels on her nebulizer and made sure she didn’t trip on the machine’s cords that followed her around the house. Multiple times an hour, I reminded Chris to reapply the tubing that delivered oxygen when she left it on the bridge of her nose.

Dementia and weight loss contributed to Chris’s fragility in those years, but her disposition was uncommonly sunny. Most days, she welcomed the assistance she needed with bathing, toileting, and dressing. She was patient with the time it took to blend in Noxzema cream or pull on a compression sock. But occasionally during these tasks, I’d find Chris consumed with a memory — a regret or misunderstanding from her past — that needed mourning. Sometimes this meant we paused to have a conversation, other times Chris was only able to cry. In these moments, it was my turn to be patient.

Quality care for clients with dementia requires specialized skills, including recognizing emotions and behaviors as nonverbal communication. Rather than ignoring or stifling a client’s agitation, home care workers can interpret it as an indication of an unmet need. Emotional management is critical in these caregiving relationships; workers are called on to determine within seconds an appropriate response to prevent escalating their client’s frustration.

Valuing the Work

In the time I spent assisting Fred and Chris, I did my best to ensure my clients felt valued, safe, and engaged. Millions of home care workers do the same each day despite the challenging employment conditions in this field.

Paid caregiving is among the most poorly compensated occupations in the country, with few benefits or programs available to help workers cope with its physical and psychological demands. Despite the diverse set of competencies needed to deliver quality direct care, it is still mistakenly considered unskilled work.

The activities involved in personal engagement, emotional suppression, and de-escalation of stressful situations are frequently discounted when it comes to defining compensable work. But the emotional labor performed by caregivers — like the labor performed to physically maneuver clients and monitor changes in their health — is work. It requires skill, consumes energy, and drives quality care.

As we push for a future in which direct care is better valued, we should consider the importance of direct care workers’ emotional labor in creating value for clients and support them appropriately for this, and all, aspects of their work.

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