Ed:  As you may know this month our #pallanz tweetchat in partnership with PCA is focused on Caring for the Carers.  In this article Tessa Morgan, Merryn Gott, and Lisa Williams explore the experience and care needs of women who are palliative carers.  This piece is part of an ongoing series of blog articles entitled “Gender in palliative care” .

It doesn’t take an expert to conclude that the palliative care workforce is dominated by women. Globally, women make up the vast majority of the paid palliative care workforce. Ninety percent of the nurses and health care assistants involved with end of life care are women and there are a higher proportion of women in Palliative Medicine than in most other specialities. Over half of Palliative Medicine physicians in Australia, for example, are women. This is in addition to the vast (and ever-increasing) number of women who provide unpaid care for their dying relatives. It is hardly a stretch, then, to regard palliative care as essentially a woman’s domain. Indeed, with the rise in population of the oldest-old, the need for more people – presumably women – to provide palliative care in hospice, aged care and community settings will continue to grow.

That palliative care is overwhelmingly dominated by women makes sense when we consider how caregiving has been gendered as a fundamentally female activity. Furthermore, paid caregiving, because it is regarded as a role for women, is typically regarded as a ‘low status’ occupation and is poorly remunerated. As a result, the palliative care sector reflects the wider economy in which a growing number of, particularly indigenous and immigrant women are being employed in low-paid, low-status caregiving jobs. It fact it was precisely this issue of wage equity which compelled a New Zealand health care assistant Kristine Bartlett to lodge a complaint to the Employment Court in 2013  citing a breach of the Equal Pay Act. During the proceedings it emerged that she was paid almost $2.00 less an hour to care for dying residents than the male gardener who also worked at her Aged Care Facility.

In order to understand the implications of these factors, our research team has been investigating how the feminisation of care has important ramifications for the health and dignity of the palliative care workforce.

For example, we have found that Health Care Assistants (HCAs) working in New Zealand Aged Residential Care (ARC) experience similar levels of stress and burnout to clinicians working in highly pressured Intensive Care Units. It isn’t much of a stretch to relate this to the lack of value placed on their work by society as large, reflected in low levels of pay and support. What we found, however, was novel. Namely that burnout correlates with a decreased willingness to engage in palliative care education. A debilitating cycle results: poor mental health outcomes and feelings of helplessness for those providing this care.

Rosemary Frey, the Research Fellow in our group who led this work, concluded that the most constructive way to counteract this burnout is to build resilience amongst staff. Effective means include providing more gender-sensitive education strategies, such as role-modelling and on-the-job training that stress the importance of communication between staff, which women are known to prefer to didactic top-down teaching methods. In addition, a study by one of our Master’s students, Susan Fryer, highlighted the need to recognise the ways in which professional hierarchies within the facilities themselves impact upon whether or not HCAs feel valued  in their work. She identified that the HCAs, who were all women, felt their opinions were not valued, particularly by medical professionals, who were predominantly men.

Finally, the culture of the organisations who employ this women-dominated workforce need to adapt. Although women make up the vast majority of workers at the palliative care ‘coal face’, it is predominantly men who are making the decisions about resources and personnel at an individual service provider, and wider policy, level. Ultimately, therefore, it is unsurprising that the culture of palliative care organisations is still predominantly male and that the vast amount of palliative care that women do in a paid and unpaid context is typically overlooked a and devalued.

Change needs to be top-down just as much as it needs to be bottom-up.

Merryn Gott, Lisa Williams, Tessa Morgan

Te Ᾱrai Palliative Care Group, School of Nursing, University of Auckland

For open access to Rosemary’s paper click here

Ed: If anyone else in the palliverse has work, ideas or conversations that need reach our community then feel free to get in contact with us.  (Ed: @mchapmanonline)

Image:  Roy Lichtenstein. Crying Girl (1964) via Seclusive Nature CC