Greener, Joe
(2011)
The bottom line: an ethnography of for-profit elderly residential care.
PhD thesis, University of Nottingham.
Abstract
In the last 20 years the UK’s elderly residential care system has become progressively more privatised with an increase in the number of for-profit organisations delivering these services. This study is a participant observation of care work in one privatised elderly residential care home (‘Meadowvale’), owned and operated by a large provider of such services (‘Moonlight Care’). It provides a rich ethnographic depiction of life at Meadowvale both from the point of view of the workers and the residents. The thesis frames these ethnographic findings against pro-privatisation discourses which argue that serious raises in standards of service delivery are to be made from instilling profit motives within social care systems.
I argue that there were a series of contradictions which prevented Moonlight Care from both achieving convincing levels of profitability whilst simultaneously improving the nature of elderly residential care. The fact that the revenue received was largely determined by the local government and the distinctive nature of care work inhibited the company from transforming the service for the better. Regulation, although crucial to ensuring that a base level of service quality was ensured, also represented a constraint on any possible restructuring. Greater gains could therefore only be increased through slashing the costs of production and enlarging the economies of scale. Both processes defined the business plan of Moonlight Care. This thesis, therefore, argues that privatisation was incongruent with quality of elderly residential care at Meadowvale. Privatisation led to a form of ‘parasitic’ production where efficiency gains and innovation were absent but business objectives were met by lowering the standards of living for the people who use the service and the wages and working conditions of the people who deliver the service. Cost rationalisation took an extreme form at Meadowvale with repercussions for both care workers and residents. Primarily the ethnographic data looks at the everyday effects of delivering care in this under-resourced labour process. The tasks of care were highly routinised within a system of bureaucratic control which emphasised the physical, “dirty” tasks of care and necessitated that all tasks were recorded. However, the numbers of workers always fell short of the workload leading to widespread falsification in the records. The high intensity of work at Meadowvale embedded various forms of mistreatment, abuse and neglect within the working routine. The system of bureaucratic control also emphasised the physical, ‘dirty’ tasks of care work, leaving little time for relational work. This instituted a particular form of emotional work which emphasised suppressing emotions in order to move from one task to the next as quickly as possible. This was considered problematic for many of the workers who felt that care work should be underpinned by emotional warmth and intimacy. The organisation of care labour at Meadowvale also ran contrary to the regulatory policy discourse which constructed quality care as personalised to each recipient, supporting lifestyle choice and personal preferences. This ‘personalisation agenda’ was a major component of the regulatory framework, but was impossible to implement under the strict routine which permeated care home existence. The responsibility of implementing the personalisation agenda was also constructed in training courses and official documentation as located with the workers, rather than with organisational structures, regimes or motives. This suggests an individualising process in which regulatory authorities and care companies attempt pass the responsibility and risk associated with providing these poorly resourced care services on to each individual worker.
The thesis also explores the implications of the system of production in structuring the inequality experienced both by care workers and residents. The process of accumulation at Meadowvale could be described as ‘parasitic’ because profit arises from reducing the cost of production. Two major strategies for reducing expenditure that Moonlight Care utilised was securing a cheap, highly exploitable workforce and reducing the costs associated with care. The search for a cheap workforce has led to the employment of large numbers of migrant workers. Many of the migrant workers at Meadowvale were unable to find alternative employment because their visa’s either tied them to working in the social care sector, or in some cases, specifically to Moonlight Care. I also argue that immigration status supported higher levels of exploitation by denying welfare rights to migrant workers and their families. At the same time the residents at Meadowvale were subject to a system of care which often failed to cater for their needs.
Not only were there were few luxuries associated with life at Meadowvale even basic care rights were frequently denied to the residents. During my time at Meadowvale the conditions for both staff and workers seemed to be deteriorating reflecting the endemic problems in the industry. The demand for cheap highly exploitable forms of labour and the denial of basic care rights for the residents can be theorised as interrelated processes connecting to the current system of residential care provision. At Meadowvale, the search for profit did not, as the proponents of privatisation suggest, lead to a system defined by choice, efficiency or quality.
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