On the frontlines: Structural violence in Canadian long-term residential care

Comparisons between Scandinavia and Canada indicate that the frequency of violence against workers in Canadian long-term residential care is extreme, with Canadian frontline careworkers nearly seven times more likely to experience violence than their Scandinavian counterparts. This dissertation presents the findings of a mixed method, international comparative study of long-term residential care serving primarily elderly populations across three Canadian provinces (Manitoba, Nova Scotia, and Ontario) and four Scandinavian countries (Denmark, Finland, Norway, and Sweden). It focuses on the experience of Canadian frontline careworkers, who perform the bulk of direct care. The dissertation documents violence from residents and relatives as a constant and ongoing part of their work. The violence frontline careworkers experience is physical, verbal, racial and sexual. Ninety percent of the sample report some form of physical violence on the job and 43 percent experience physical violence on a daily basis. Focus groups revealed a culture of tolerance, where violence is considered routine. This dissertation draws on Galtung's (1969; 1990) typology of personal, structural and cultural violence to support the systemic analysis of the patterns of violence that this study documents as pervasive. Excessive workload was the key structural factor that workers pointed to when accounting for the high levels of personal violence that they experienced on the job. As a result of an excessive workload careworkers were required to rush complex and intimate forms of care, fostering dangerous situations and potentially violent reactions. Structural violence was also used to name working conditions within long-term care facilities as violent, for they led to intense levels of stress and worker exhaustion. Canadian frontline careworkers were twice as likely to be physically exhausted, three times as likely to experience back pain, and four times as likely to be mentally exhausted at the end of their shifts than Scandinavian workers. Lack of autonomy, flexibility and work routines that did not support relational forms of care were also identified as contributing to workplace violence, inhibiting worker's capacity to tailor care to residents needs or to respond appropriately to unsafe situations. Galtung's theory of violence offers a useful lexicon to speak of violence in ways that help make links between personal violence and the broader structural and cultural forms of violence that sustain it. This framework politicizes violence in residential care. It also allows for the explanation of the striking differences between the experiences of Scandinavian and Canadian long-term care workers, suggesting that these are partially the result of policy choices and approaches to care. The analysis developed in this dissertation raises questions around the politics of care, which sets the context for the development of the long-term care sector at the macro level, the organization of caring labour at the meso-level and the experience of violence at the micro-level.