By: Rebecca Casey
McGill Sociological Review, Volume 2, April 2011, pp. 39-58
Abstract
The role of developmental services workers (DSWs) is undergoing major changes. Fewer people are entering the occupation, and at the same time, those currently in the occupation are leaving at increasing rates, presumably due to high stress levels and burnout. Some reasons for this phenomenon are the type of work preformed by DSWs (providing personal/emotional care) and working conditions (shift work, part-time, low wages). This research used field observation at locations within a developmental services agency and semi-structured interviews with five participants working in the developmental services field, including front line staff and management. The participants were asked to identify job challenges and gather opinions/suggestions for improving low retention rates and high burn out rates. The participants spoke about ways to improve the quality of care provided to people with developmental disabilities. Although this is a very small sample, all of the participants were aware that burnout rates are quite high for DSWs. The opinions of front line workers and management reflect the similarities and minor differences between these groups. The participants believe burnout can be reduced and retention improved by: increasing pay rates, improving working hours, creating safer work conditions, increasing support from management, ensuring staff have an interest in vulnerable populations, and increasing the availability of meaningful training.
Development Services Workers (DSWs) are specially trained individuals who provide personal care and non-professional services to people with developmental disabilities. Even though these individuals provide an important service that greatly improves the quality of life for people with developmental disabilities, it is becoming increasingly difficult to recruit and retain DSWs. This research examines the role of the DSWs and attempts to identify some of the factors that contribute to the declining ability to attract individuals to this type of employment, and the factors that make it difficult to retain individuals in this field. The importance of the level of service provided by DSWs to individuals with developmental disabilities reinforces the need to ensure this field of service remains viable and attractive to individuals seeking a career in personal care. This research also provides some recommendations for changes that will improve recruitment and retention of DSWs.
Ontario has a long history of providing care and support to people with developmental disabilities. Services provided by developmental services workers (DSWs) assist individuals with developmental disabilities to live and participate in their community (Ministry of Community and Social Services (MCSS) 2006). The responsibilities of DSWs include: encouraging skill development, building connections between individuals, families, and community partners, and advocating for people with a developmental disability to be fully included into society (MCSS 2008). People with developmental disabilities have access to respite services, community supports, and residential supports to help them live in the community (Parsons 2006).
The setting for DSWs can vary depending on the type of care they are providing. Some DSWs will provide care for people with developmental disabilities in a residential setting (such as a group home where at least two people with a developmental disability live), an institutional setting (a nursing care facility), at a work location, or in the community (Hewitt and Larson 2007). When working as a DSW in the community, including care provided in the homes of individuals with developmental disabilities, the worker is responsible for basic health, safety, and care needs in addition to supporting the individual to develop and achieve personal goals. DSWs are also responsible for balancing risks with choices and to help people with developmental disabilities find and maintain jobs and make personal connections with friends and family members. It is important that the person with a developmental disability is able to be a full and active member in the community (Hewitt and Larson 2007).
Some DSWs experience challenges in their job due to the characteristics of the person receiving care and the specifics of the care they require. The DSWs may have to work with someone who has challenging behaviours, has mental health problems, or needs significant assistance with activities of daily living (Larson and Lakin 1999). People working in these situations require support and training to help them with their job responsibilities. It is important DSWs feel they are adequately supported in their role.
There is limited literature available on the daily activities of DSWs and how they actually provide intimate care for people with developmental disabilities. However, their roles would be similar to those working in the social services field as personal support workers for older people or people with physical disabilities. These types of occupations are also called ‘carework’ or ‘bodywork’ (Twigg 2000; 2004). Twigg (2000) prefers the term carework as it projects qualities of warmth and love. Ancillary worker is a term that is commonly used by Armstrong, Armstrong and Scott-Dixon (2008). People who are ancillary workers in health care are typically female, work for low pay on a part-time, temporary or causal basis, and lack job security. The work is physically and mentally challenging and, in some cases, dangerous. Ancillary workers often experience overwork, lack of communication, and have little control over their job. The work can be demeaning and have undesirable traits (Armstrong et al. 2008). Twigg agrees with many of these characteristics and adds work that requires direct touch, bathing, dealing with human waste, and negotiating nakedness, to the list of occupations sharing these characteristics. Typically, more women than men are employed in occupations that involve carework and body work (Twigg 2000; 2004). These characteristics are similar to those of people working in the field of developmental services (Ford and Honnor 2000; Hewitt and Larson 2007). These characteristics may make it more challenging to recruit and retain people to work in these fields.
Twigg (2004) explains that those who work in the field of carework or bodywork often hear compliments from others because of the type of work they perform. These workers are complimented on being ‘special’. The Ministry of Community and Social Services states it takes a special person to work in developmental services (MCSS 2008). Unfortunately, it appears that complimenting workers who may perform undesirable or less desirable tasks is a concept widely accepted in society but the work is not financially compensated or valued accordingly.
The Ontario government has recently invested funding and research into transforming developmental services in the province. The Ministry of Community and Social Services have made numerous initiatives to transform “the services and delivery in the developmental services sector to create a fair, accessible and sustainable system for those living with a developmental disability and their families” (Parsons 2006: 4). There is a concern by various members in society “about the adequacy and availability of qualified support workers” (MCSS 2006: 17). Improvements such as higher wages, integrated human resources strategies, and appropriate training opportunities for DSWs are necessary for recruiting and retaining qualified workers.
Experiences of Burnout
Burnout is a problem for people working in human services occupations (Shaddock, Hill and Van Limbeek 1998), such as DSWs. Burnout impacts a person’s ability to work and can lead to the individual feeling exhausted, depersonalized, and lacking personal accomplishment (Fernet, Guay and Senécal 2004). Jobs that require providing care and support to people are more taxing as they involve emotional labour (Brotheridge and Grandey 2002). The relationship with the person requiring care can often be very demanding which can lead to burnout (Innstrand, Espnes and Mykleton 2002). Employees in people-orientated occupations often become frustrated, angry, and cynical. Feelings of ineffectiveness and failure in their jobs are also common. Once workers experience burnout, they are more likely to quit their job (Maslach and Goldberg 1998; Maslach and Jackson 1981). Burnout is one of the root problems of retention in the field of developmental services.
The issue of recruiting and retaining DSWs is not new and has been researched quite extensively in the United States for several decades (Hall and Hall 2002; Hewitt and Larson 2007). Skirrow and Hatton (2007) completed a systematic review of research that has been completed on burnout experienced by people who provide care to people with developmental/intellectual disabilities. Their review cited only one Canadian study. That Canadian article examined DSWs working in a facility for juvenile delinquents, which is somewhat peripheral to the scope for this paper (Pelletier, Coutu and Lamande 1995 as cited in Skirrow and Hatton 2007).
Burnout experienced by DSWs is blamed on several key factors. Most of the literature on burnout experienced by DSWs relate to low wages; lack of training; lack of support from management; complex job duties and responsibilities that require specialized knowledge, skill and attitudes, physical tasks of the job, lack of job security, lack of paid leaves; and, lack of opportunities for job advancement (Ford and Honnor 2000; Hewitt and Larson 2007; Larson and Lakin 1999; Robertson et al. 2005). The type of homes where DSWs are placed can have an impact on burnout and retention rates. Workers who are in homes where the residents need extensive support, have challenging behaviours, mental health problems, and require significantly more assistance with their tasks of daily living have higher rates of turnover (Larson and Lakin 1999). The demographics of the working population are changing, which poses another problem for developmental service agencies. Fewer young adults are entering this field of work, possibly because wages are low and the work can be demanding (Larson and Lakin 1999). Younger people with higher levels of education are more likely to leave the workplace after a short period of time.
Many DSWs struggle with lack of support and recognition from their supervisor or others involved in the main office of the agency (Ford and Honnor 2000; Hewitt and Larson 2007; Larson and Lakin 1999). Ford and Honnor (2000) found that many DSWs felt they were not acknowledged by the agency and there was a lack of follow-up to their concerns. Their research found it was important to the DSWs that they felt encouraged and complemented on their performance, but many of the participants were generally dissatisfied with the support they received. Older staff members in their research were usually more satisfied than the younger staff members with the support they received. To compensate for lack of support from supervisors and the central office, many DSWs relied on their co-workers for friendly, morale and ethical support (Ford and Honnor 2000).
The work done by Mitchell and Hastings (2001) on community workers for people with difficult behaviours, which can include DSWs, found that employees suffer from burnout when they have extra responsibilities, increased risks, or physical and emotional strains in the job. Other characteristics that can lead to burnout include: excessive workloads, limited chances for training and advancement, lack of resources, role ambiguity and setting. Setting can have either a positive or negative impact on job satisfaction, for example, employees who provided care in the community were less likely to experience burnout compared to employees who provided care in institutions (Mitchell and Hastings 2001).
Theoretical Explanations for Burnout
The work by Hughes on “dirty work” and Hochschild’s work on emotional labour are useful to explain why DSWs may experience burnout in their jobs. Hughes (1958) coined the tem “dirty work” as work that may be physically disgusting, or symbolizes degradation, or something that damages one’s dignity. He argues that dirty work can be found in all occupations. The concept of “dirty work” has been used to describe occupations such as nurses, doctors, care providers, lawyers, dentists, wait staff, strippers, cleaners, and many others (Anderson 2000; Armstrong, Armstrong and Scott-Dixon 2008; Ashforth and Kreiner 1999; Drew, Mills and Gassaway 2007; Godin 2000; Hughes 1958, 1962; Twigg 2000; 2004; Shaffir and Pawluch 2003; Stacey 2005). Dirty work includes jobs that are dirty in the literal sense (such as toileting and bathing people or handling garbage), mundane or repetitive (Hughes, 1971 as cited in Stacey 2005). The concept of carework, bodywork (Twigg 2000, 2004) and ancillary worker (Armstrong, Armstrong and Scott-Dixon 2008) can be used to replace the term dirty work to make the work seem less undignified and undesirable. Dirty work is relevant to the work done by DSWs because they are providing personal care to people with developmental disabilities who may be unable to complete activities of daily livings, such as showering, bathing, cleaning, etc., on their own.
Despite the negative tasks required to provide carework or bodywork, Twigg (2000) recognizes that this type of work can be rewarding. Stacey (2005) argues that people learn to take pride in their skills and de-emphasize the dirty aspects of the job to make it more redeeming. Ashforth and Kreiner (1999) recognize that people working in carework and bodywork occupations have high occupational esteem and are proud of their work. Mills and associates (2007) discuss how people who complete tasks that may be deemed dirty work, view their jobs as being valuable and having positive attributes. Workers often take pride in their work and share experiences with co-workers (Mills et al. 2007). Therefore, negative connotations and perceptions about certain occupations do not necessarily equate to low job satisfaction.
Hochschild’s (1979; 1983) work on emotional labour is useful when studying developmental service workers. Hochschild coined the term emotional labour while completing research on people in the service industry. The term emotional labour means “the management of feeling to create a publicly observable facial and bodily display” (Hochschild 1983: 7). The jobs that involve emotional labour typically have low status and are often performed by women for low pay (Hochschild 2003). Hochschild argues that because money is a symbol that is valued in society, jobs that involve emotional labour and are low paid are underappreciated and seen as less valuable. Emotional labor may also be experienced by DSWs who are required to make personal connections with their clients and may also become over-invested in their client’s wellbeing. Hochschild (1983) found that workers often become over involved in their work. Being over involvement in their work was also common for some of the home care workers included in Stacey’s (2005) research. Some of these workers experienced an emotional toll. Those who are engaged in emotional labour are also more likely to become burned out (Grandey 2000).
Hochschild (1983) distinguishes between two types of ‘acting’ that workers engage in as part of emotional labour. ‘Surface acting’ describes the regulation of emotional expressions and is more desirable to organizations. Those engaging in surface acting will hide their actual feelings. Some organizations will enforce that certain feelings are suppressed, such as the social worker in Hochschild’s work who had to suppress the feeling of concern. ‘Deep acting’ describes how we modify our feelings in order to express a desired emotion (Hochschild 1983). It takes effort to carefully manage emotions. Deep acting might be required by DSWs to not only suppress personal feelings but also replace them with an outward expression of feelings that are more appropriate to the setting. Developmental service workers may use deep acting when dealing with the more personal elements of their tasks, or the dirty work, such as bathing and toileting. This may be the least desirable aspect of their job but they need to act as though it is not a problem.
Impact of Burnout
Burnout is a serious problem because it impacts the quality of life for the people experiencing burnout and for those receiving care from them. People who suffer from burnout are likely to experience a decline in the quality of care they provide, are absent more often, and have low moral (Shaddock et al. 1998). Burnout tends to leave people feeling emotionally exhausted, cynical, lacking in professional efficacy, lacking energy, and experiencing insomnia and personal problems (Gonzálex-Roméet al. 2006; Maslach and Jackson 1981). Many people suffering from burnout become mentally exhausted and emotionally overextended. These feelings may lead them to believe they are incompetent and unsuccessful (Innstrand et al. 2002). Burnout is also highly correlated to job turnover rates. Occupations where there are high burnout rates will also experience high rates of job turnover (Shaddock et al. 1998). A problem in the field of social services, including developmental services, is that the quality of care provided often deteriorates once an employee experiences burnout (Maslach and Jackson 1981).
Reducing Burnout Rates
Reducing the likelihood of burnout can be initiated by either the employee or the employer. Employees need to be well trained for their occupation (Shaddock et al. 1998). People who are satisfied in their job are less likely to experience burnout. A person whose personality is a good fit to the characteristics of the job will be less likely to experience burnout (Fernet et al. 2004). People who work in positive and fulfilling occupations are less likely to experience burnout. The likelihood of burnout is reduced when an individual is energized, dedicated and willing to invest and take pride in the work performed (Gonzálex-Romé et al. 2006).
The employer has a responsibility to minimize the likelihood of burnout in the job. Employees need to be rewarded, have autonomy in their job, and have the ability to build and develop skills (Stacey 2005). Employers need to provide stable and supportive relationships for their employees (Shaddock et al. 1998). Staff should not be overloaded or burdened with too many tasks and responsibilities. Employers must educate their staff about the signs of burnout and provide support to staff when they start to experience burnout (Innstrand et al. 2002; Shaddock et al. 1998).
Methods
A qualitative approach was appropriate for this research. Qualitative research is useful in “understanding how individuals subjectively see the world and how they make sense of their lives” (Novak and Campbell 2006: 247). Grounded theory was used as a theoretical framework for this research. Corbin and Strauss (1990) state that grounded theory is “designed to develop a well integrated set of concepts that provide a thorough theoretical explanation of social phenomena under study” (5). Grounded theory allows the researcher a way to explain the phenomena that is being studied. The first principle of grounded theory is that the phenomena being studied are constantly changing and never static. The second principle is that actors have the ability to make their own destiny. Grounded theory is applicable when researching the work requirements and attributes of DSWs. The responsibilities and skills needed for the job are constantly changing and staff often have to respond quickly to the changes that occur.
Initially in this study, fifteen (15) hours of field observation at a developmental services agency were completed to better understand the type of work completed by DSWs. The field observations were useful in providing an idea of what it means to support people with developmental disabilities and the skills required to perform the job. Dorothy, the Executive Director of this agency and one of the interviewees, allowed me to complete field observations at several locations where DSWs provide support. The DSWs were observed completing their jobs either in a group home or at a coffee shop that was run by people with developmental disabilities. The coffee shop was an interesting location as most of the customers were also people who worked for the same agency as the DSWs providing the assistance. Two group home locations were also observed for approximately three hours at each location. These were the locations where most of the in-depth conversations occurred. Marissa and Sharon shared some of their experiences of being a DSW while providing support for the women living in the homes. Although there were some male employees as customers at the coffee shop, all of the DSWs who were observed were female. Interactions with both the DSWs and the people with developmental disabilities were completed during the fieldwork.
A snowball and purposive sampling approach was used to find DSWs to interview for this project. Palys (1997) notes that a “purposive, or theoretical, sampling merely extends the admonition that researchers should be guided by the objectives of the study” (139). There were certain criteria that were used when selecting people to participate in this research. It was important to include people who had worked in the developmental services field for several years because they would be able to talk about the changes they have experienced over time and also explain why they are still involved in the field when retention has been widely noted in the literature as a problem.
Participants were asked to assist in recruiting other participants, unfortunately no one recommended a male DSW. It was challenging, in general, to find more DSWs to interview. Several of the participants included in this research mentioned that they did not think people would want to talk about the problems in their jobs for fear of reprisal from supervisors or management. One of the participants, the Executive Director of an agency, was interested in having some of her staff speak to me, but this could not be arranged as people did not seem interested in participating. The lack of interest could be related to the issues raised by other participants, that is, people would not want to talk about their experiences for fear that their dissatisfaction in their jobs would somehow be disclosed to management.
Five DSWs participated in the in-depth unstructured interviews and, with the exception of one participant, all interviews were performed during non-work hours and in a public area. All participants were female and had been working in the field for more than five years. Three of the five women interviewed provided care for people with developmental disabilities in a group home setting. One of the five women provided relief support and worked both in a home setting and in the community. Another participant was a supervisor and worked in the main office of a developmental services organization. The final participant was the Executive Director of a Developmental Services Organization. Her interview was completed during office hours and she was the gatekeeper for the field observation work. In total there were three different developmental services organizations involved in this research.
The field observations were one to two and a half hours in duration. The interviews were semi-structured and lasted between twenty minutes to an hour and a half. Although the interviews were not audio recorded, hand written notes were taken during the interviews and field observations. Hand written notes were used as a way to make the interview feel more relaxed and to help participants feel more comfortable sharing sensitive information about their work. The notes taken during the interviews and field observations were expanded immediately following the interview/observations. The notes were typed into a Word document. N-Vivo was used to assist with data management and the content from the interviews and field observations were coded into specific themes.
The participants are all referred to by pseudonyms to ensure anonymity. Victoria, Sophia and Maria are DSWs who have been in the field for more than eight years. Karen is a supervisor and has been working in the field for over 20 years. Dorothy is an Executive Director. Sophia works part-time and does relief work in the community. The interviews with Victoria, Sophia, Maria and Karen focused in-depth on their experiences of burnout and working in front-line positions. Dorothy’s interview focused primarily on her experience with worker satisfaction. Interviewing Dorothy was an important component of the study as her responses added a different context and perspective related to burnout rates and the information provided by developmental services workers. Dorothy was aware of high burnout rates within developmental services and was actively involved in trying to reduce burnout rates in her organization.
Results and Discussion
Burnout
Interestingly, none of the participants reported feeling burned out, although some reported incidences when they felt more pressure and questioned their choice of occupation. Even though they had not experienced burnout they recognized that it is a common experience in developmental services. Most of them spoke about coworkers who have experienced burnout. There were several factors that the participants associated to burnout and these include: low wages, part-time employment, and lack of support and recognition from management.
With regard to low wages, not all of the participants believed that DSWs are paid too low. When I asked Sophia what keeps people motivated in the field she laughingly replied, “besides the money?”. I questioned her response as I had heard that DSWs were not well paid. However, she was genuinely satisfied with her income and reported that DSWs earn on average between $15-$20 per hour depending on the service organization. Pay was also not an issue for one of the women, Marissa, I met during the field observations. Marissa was working in a group home setting and told me how much she loved her job. She said the money is helpful for supporting her family. Previous to working at the agency she cleaned hotel rooms and was grateful for this new opportunity. Marissa told me that her husband is jealous because she loves going to work and cannot imagine a better place to work. However, Marissa’s experiences seem unique compared to most of the other participants. Her self-expressed high degree of satisfaction in her current position may be the result of having worked previously in a less rewarding job, making this one seem better, by comparison.
The other participants felt that low wages were a cause of burnout. Karen, who has a supervisory position, told me “I think a lot of it is money. […]I guess I can’t really complain because I am at the highest rate in my category but some of the other workers want more money.” When asked about burnout, Dorothy, the Executive Director, said: “I think a lot of it comes down to wages. People are not paid much in this industry. When you compare this to other sectors, for example, education, it is much lower.” Another participant, Maria, had switched organizations recently and although she is currently making less money, the atmosphere is better and she is more satisfied with her job.
It appears that part-time employment and shift work are common working conditions faced by DSWs. Dorothy believes that shift work often leads to burnout and, as a result, reduced retention rates for the employees in her organization. She also said that “people who are working part-time are more likely to be dissatisfied or leave the workplace.” When asked if there were more people working full-time than part-time at her agency she replied:
Well actually, there are more part-time. They work between 24-40 hours in a week. This works well because of our setup in the homes. The only people working full-time hours are those in supervisory roles and the team leaders. So a lot of people use this job as a second income for the family. What is nice about working 24 hours is that you are eligible for benefits and this makes a big difference.
Karen’s comments about part-time employment were similar to Dorothy’s comments. Karen mentioned that having benefits helps people but many will still leave because they are able to get a different job with full-time hours.
Although part-time hours can lead to burnout, Karen and Sophia talked about the fact that some people actually prefer part-time work. Both these women are older and have children. Perhaps, although not probed on this question, they had partners who were also working which did not require them to work as many hours. Karen said: “some people prefer to work part-time. They want to spend time with their families or do other things.” Sophia, who is working part-time, stated that “right now I am happy where I am. I don’t want to work full-time either. I like working part-time. I am just really busy.” The other two women are working full-time hours, which may explain why they did not make any comments about part-time work.
Most of the participants believe that part-time employment leads to burnout. Part-time employment is a characteristic of carework or body work (Twigg 2000, 2004) and ancillary workers (Armstrong et al. 2008). This is also a main characteristic of precarious work environments (McDonald 1997). Precarious jobs are characterized as being low pay, part-time, short-term, temporary, and offering little or no benefits and pension plans (McDonald 1997; Townson 2000a; 2000b). People working in these types of jobs have a difficult time surviving on a daily basis, let alone planning for the future (Townson 2000b). Perhaps the lack of control over the work environment, being part-time, leads to burnout. Most part-time employees lack high wages and benefits which can also create financial tension for the employees.
Lack of support and recognition from management was voiced by several of the participants. Karen, the supervisor, said: “I also think people feel as though they aren’t heard by the management. There are a lot of disgruntled workers and we don’t listen to them enough. When someone says they are in a crisis mode then we need to act on this and not brush past it.” Karen also explained that “people [management] listen but they don’t do anything about it. […]The management needs to do more and listen to the problems experienced by the staff.” Not listening was a major problem identified by Karen because there are times when DSWs are placed in vulnerable situations and require support from management.
Maria commented about the lack of praise and recognition: “it’s a tough job because you don’t get a lot of praise and it is not really rewarding. You have to find rewards in the small things you do. You often only get negative feedback when you do something wrong. You very rarely hear when you do something right.” Maria also commented on the fact that there is a lack of job security. Although she recognizes that some DSWs are unionized, she still felt a concern that people seemed to get fired for “stupid reasons”. She recommends that people be careful because they are vulnerable.
Dorothy recognized that many DSWs may feel as though they do not receive enough praise. She explained that “you might hear people say that they don’t get enough praise in the job. But they probably get it more than they realize.” Dorothy’s comment could be related to the fact that she has been in the developmental services field for many years and has heard many comments from her co-workers and employees. Dorothy emphasized the difference that age makes for people working as DSWs. She thought that younger workers were more vocal about not receiving recognition and often expected more recognition than older staff members. Maria also made a comment about age, saying that younger workers are less likely than older workers to stay in the field for a long period of time. Victoria also commented on the impact of age and explained why she thought younger workers might be more vulnerable at work. She said that older staff and those who have been there longer may put more pressure on the new staff and make it more challenging for them. Victoria handles these staffing problems by working the night shift so she does not have to deal with other staff members.
Similar to the comments from these participants about age, Hall and Hall (2002) found that younger workers were more likely than older workers to leave the field of developmental services. Additionally, younger and more educated workers are more likely to leave the job because they are more mobile and may have more opportunities available to them (Hall and Hall 2002). Ford and Honnor (2000) also found that older workers were generally more satisfied with the support they received.
Most of the participants recognized that burnout is common in their occupation, which is congruent with other research findings (Mitchell and Hastings 2001; Shaddock et al. 1998). The participants’ perceptions as to what can lead to burnout are supported by the literature. The most commonly cited causes of burnout identified in the literature include: low wages; lack of training; lack of support from management; complex job duties and responsibilities that require specialized knowledge, skill and attitudes; physical tasks of the job; lack of job security; lack of paid leaves; and, lack of opportunities for job advancement (Ford and Honnor 2000; Hewitt and Larson 2007; Larson and Lakin 1999; MCSS 2006; Robertson et al. 2005).
The Ontario Ministry of Community and Social Services is aware of the problems of burnout and retention of DSWs. Although most of the participants were aware that burnout rates are high and it is becoming difficult to retain DSWs, Dorothy was the only participant actively involved in trying to make changes. Dorothy is currently involved in a task force that is discussing ways to recruit and retain developmental services workers. She said:
The ministry [Ontario Ministry of Community and Social Services] is looking at this right now and has done a project with some ‘experts’ in the field to understand what would help keep people in the field. There are not as many people interested in working in this field. They have created a few core groups of people. There is one that looks at the core competencies that are needed to work in this field. This is the area that I am working in.
Challenges and Dirty Work
Most of the challenges described by the participants, such as bathing, toileting, and dressing people with developmental disabilities, can be linked to notions of dirty work. In addition to dirty work, some DSWs reported being in situations that were dangerous. Most of the DSWs reported that their job was challenging at times because the people they provide support to could become angry and aggressive. Despite the dirty work and possible elements of risk or danger, the DSWs enjoy providing support and are, overall, happy with their jobs.
Most of the participants spoke about elements of their job that are considered undesirable, somewhat disgusting and risky. Maria provided an example of when it was difficult to support people with developmental disabilities. She said: “I worked in a home where there was a woman and she would take off her clothes and run around naked for a bit. There was a guy in the house that would get aggressive after. […]It would just make it difficult.”
A few of the participants spoke about difficult behaviours they are required to manage. Sophia had the experience of supporting a man with the “super-male syndrome.” She explained that this man “can be very frightening…it took nine people to control him when he was moved from the institution.” Maria talked about a man she supported who was a pedophile and how difficult this behaviour was for her personally: “I think I learned the most from him. It was challenging because you obviously don’t approve of his behaviour but you can’t judge him on that, he has the right to all the services that others receive. It was interesting working with him.” A difficult behaviour was described by Victoria related to a man she provided support to who enjoyed screaming. She reported that “in the summer when the windows are open, you can hear him down the street. He’s really loud. Some people ask how I deal with it on a regular basis but I don’t notice anymore.”
Sometimes the unpredictability of the work can make it dangerous and challenging for DSWs. Sophia’s job requires her to fill-in for other workers when they take breaks. Consequently, she spends approximately an hour per day in each of several different homes. She said that it can be dangerous because you often do not know what to expect and you might not be familiar enough with the people you are supporting. Although the other DSWs who work in a group home setting might experience more continuity than Sophia because they always work in the same location, there is still some unpredictability in their work. Both the worker and the person being supported might have a bad day which can lead to challenging situations.
Karen spoke about difficult experiences she had at an early point in her career. She said: “I was in counseling and there were lots of supports from the Ministry and the organization but I just had a really hard time with some of the behaviours.” She still remembers her dad’s advice and uses it today when she comes across a difficult situation. He told her, “hate the sin but love the sinner. […]There are so many times when you just have to overlook what they have done.”
Providing support for people with developmental disabilities is not always easy. Dorothy talked about what keeps the DSWs at her agency interested in their work. She agreed with what others have said that it takes a special person to work in the field of developmental services. She believes that the work of DSWs is not valued in society.
Dorothy’s comments support the research by Twigg (2000; 2004) on carework and the lack of value these jobs hold in society. Many of the tasks that DSWs do on a regular basis might be considered dirty work by others in society. Most of study participants spoke about elements of their occupation that are considered ‘dirty work’. The personal care, especially toileting and bathing, provided to the people they support can be deemed dirty work. Interestingly, however, when voicing complaints or dissatisfaction about their occupation the participants did not focus as much attention on the personal care aspects of their work as one might expect. What they did talk about were the problems in the structure of the organization, such as low wages, low autonomy, lack of training opportunities, and lack of support from management.
There are many risks and dangers when working in the field of developmental services, similar to those that could be found in many other occupations that involve carework or bodywork. Unfortunately, for the study participants, most of the risks and dangers are unknown and unpredictable, as the people they support may have a ‘bad’ day that may result in challenging behaviours. Proper training and support from management would contribute to reducing risks and protecting both the employee and the person with a developmental disability. It was these two areas - training and support - that were specifically identified by participants as factors that contribute to burnout. Overall, the experiences of the participants and the findings in the existing literature converge on the need for more training and support from management.
Hochschild’s (1979; 1983) work on the effect of emotional labour can be used to help understand why the DSWs in this research feel strong connections to their work and to the people they support, and how DSWs experience stress caused by hiding emotions. Deep acting, how people modify their feelings in order to express the desired emotion, can provide insight into why the DSWs were able to hide their initial reactions, such as discomfort, when listening to someone scream or having to provide care for someone who is a pedophile. Deep acting might come more ‘naturally’ to DSWs who have training opportunities to prepare them for difficult situations or supportive supervisors and management. Unfortunately, participating in deep acting can cause emotional strain. Having supportive management and access to training opportunities will help to reduce this strain.
Personal Characteristics of DSWs
There appears to be certain personality traits the participants feel are important for DSWs. These characteristics may provide DSWs with a better foundation to do their job and make them less vulnerable to burnout. Dorothy wants employees who are team members, work well in a group situation, and are passionate about their jobs. One way to find people who are passionate about the job is to hire people who have personal connections to a vulnerable person. Dorothy looks for this characteristic when she is interviewing at her agency. Dorothy and the other four participants discussed their personal connections to people with developmental disabilities and how that connection influenced their interest in this type of work. Most of them had a family member who has a developmental disability. One of the participants involved in the field observations, Sharon, told me that most of her family members are working in the field of developmental services. It seems natural for Sharon to be in this field and she has long standing relationships with most of the women she is currently supporting.
The participants identified several personal characteristics they believe they possess, which have helped them do well in their jobs and reduced their likelihood of becoming burned out. These traits include being: patient, caring and nurturing, open-minded, emotionally and physically strong, and not squeamish. As Sophia said: “I don’t think you should do this job if you don’t have patience. Also, you need to be thoughtful. You need to listen to the person and take time to learn their needs.”
Maria identified several of these characteristics when she talked about why DSWs cannot be squeamish. She said: “I mean you deal with a bunch of yucky stuff on a daily basis. You can’t have a weak stomach. You also have to be patient and nurturing. You have to be able to deal with structure but also adapt to change. I mean, there is a lot of structure in the job but also there can be chaos.” Victoria also talked about not being squeamish. She said:
People have to be able to deal with poop, literally, poop because you will encounter this in your job, on a regular basis. So if you are scared of poop then this isn’t the job for you. People also need to be able to deal well in any situation and especially the unexpected. You also need to be strong. Not physically but emotionally, you need to deal with a lot of challenging behaviours and problems….you need to be able to deal with a crisis and not get overwhelmed. You never know what to expect each day.
Karen talked about her experience with a difficult client that almost resulted in her looking for another job. She spoke about having to seek counseling to help her through this difficult period at work. Karen offered a coping strategy for other DSWs who might face difficulties when caring for a person with developmental disabilities. She said that it is necessary to look past the behaviours of the person you support and remember that, despite their behaviours, the person deserves the same type and quality of care as anyone. This was useful to her during difficult times at work.
Dorothy spoke about the need for autonomy and control over the work environment. She described how her organization is structured to provide employees with as much autonomy and control as possible over their jobs. The emphasis at her agency is on teamwork. Workshops and team building exercises are offered on a regular basis, which Dorothy thinks make a big difference. Ongoing communication is encouraged and weekly and monthly meetings are scheduled to facilitate information sharing. Dorothy takes pride in her agency which has low burnout rates even though it had a reputation for having low wages compared to other agencies. Even though her organization values autonomy, Dorothy worries about having too much autonomy in the workplace. She told me that DSWs are encouraged to take the people they are providing care for into the community, to go shopping, go for lunch or even on organized out-of-community trips to places such as trip to Niagara Falls. Although Dorothy is concerned that there might be too much flexibility she recognizes that this is an important part of the job.
There are certain characteristics, such as patience, caring, nurturing, open-mindedness, strength and not being squeamish, that the participants believe are important to ensure success for those working in developmental services. People who have these characteristics will likely be happier and more satisfied in their job. These characteristics match the requirements of some of the job descriptions, such as those providing respite care and supporting people with developmental services participate in the community, described by Parsons (2006). Fernet and associates (2004) argue that employees who are satisfied in their jobs and have a good fit to the characteristics of the job will be less likely to experience burnout. Each of the participants had characteristics that matched the characteristics required in their job descriptions, which may explain why none of the participants have experienced burnout, to date. The participants seemed to be energized and dedicated to their jobs and took pride in the work they preformed. These match the characteristics that Gonzálex-Romé and associates (2006) state are required to reduce the likelihood of burnout.
Stacey’s (2005) findings on providing rewards and autonomy to staff members as a way to reduce the likelihood of burnout are working at Dorothy’s agency. Dorothy’s staff benefit from workshops and flexibility in their jobs. She notices that there is a lower turnover rate at her agency compared to other agencies.
Dirty work and carework are also issues that came up in the discussions by the participants. The comments about not being squeamish because you need to deal with body functions would easily fall under the label of dirty work. But, as predicted by Hughes (1958: 1962), Twigg (2000; 2004)and Stacey (2005), even though these workers are dealing with dirty or undesirable jobs during their workday, they are still happy to be at work and do not dwell on these undesirable characteristics. Most were even able to find humour in these situations and spoke about the people they cared for in a kind and nurturing manner.
Perks and what keeps them motivated in the job
There are certain aspects of the job that keep the participants motivated to continue supporting people with developmental disabilities. All of the participants said they enjoyed their jobs and caring for the people they support. Sophia thinks that people should not be DSWs if they do not love what they are doing. She said: “you have to love the people you support. It can be very rewarding. I am passionate about my job. I am happy doing this job.” She thinks it is important to have affection when doing the job. Maria agrees that people need to love what they are doing or they should not be working in the field. Victoria also said on more than one occasion that she really enjoys working with the people she supports. Dorothy observed that her employees are generally happy in their homes. She said: “people in the field become attached to the house that they work in. Not in a bad way but just that they feel pride in the house and feel a part of it. They are motherly, again not in a bad way but they want to nourish and see the people they are supporting do well.” She thinks that it is important to feel invested in the work and feel a connection with the people you are providing care for and the people you work with at the agency and in the home.
The participants enjoy the ability to care for people with developmental disabilities and watch them grow and develop. Most of the DSWs have known the people they support for more than five years. Karen expressed feeling a sense of pride: “it’s really great to see people blossom in this area. It’s nice [to] see people do things that they couldn’t do before. I knew a lot of the people from the institution and I have seen what they can do now.” Sophia also explained why she enjoys her job:
You make connections with the people you support. You see them do something on their own and it is so rewarding. I mean, some of these people I helped support when they were residents at the institution. At the institution they could not do anything on their own. They could not cook, clean, do their own laundry. We did everything for them. Now, in the community living, they are doing lots of things on their own. They are able to do their own banking, grocery shopping, cleaning, and cooking. I am just there to support them.
Job satisfaction needs to be nurtured by the organization. Organizations that offer training opportunities and autonomy appear to have a higher percentage of DSWs who enjoy their job. Training opportunities varied depending on the agency where the participants were employed. Not all of the organizations where the participants work offer training opportunities; however, most participants believed training would help in keeping more people satisfied in their jobs. Maria, who participated in workshops at her previous employment, misses the opportunity to participate in workshops unavailable at her current employment. Dorothy, in her role as an Executive Director, said, “we also offer a lot of workshops and team building exercises.” She believes that the training opportunities and team building exercises contribute to her agency having low levels of staff turnover. Marissa, one of the DSWs who shared her experiences in the field observation talked about workshops. Marissa said she enjoys participating in the workshops because it provides her with an opportunity to learn more about her job and providing care. Her job brings her a lot of satisfaction, as evidenced by her comment “I am so happy to get up in the morning and come to work. I really love my job.” Sharon, one of the DSWs who was interviewed during the field observations was not as happy about the workshops offered at this same agency. She said that “only a select few” are available to go to the workshops each year.
Although burnout is common among DSWs, as described in the literature and confirmed by most of the study participants, there are certain aspects of the occupation that keep people interested and motivated enough to continue working in such a challenging field. There appears to be a need for people to be passionate about their job and the people they support. The DSWs in this research enjoy their work and some even commented that they love their job and/or the people they support. Having a sense of pride and work engagement was discussed by Gonzálex-Romé et al. (2006) as a way to reduce the likelihood of burnout. This sense of pride in their work was evident through the comments made by several participants, who, themselves, had not experience burnout in their occupation.
Access to training may help DSWs learn how to manage emotional labour so it is less exhausting, mentally. Learning how to deal with difficult situations or what the expectations are for DSWs would help DSWs manage their emotions while working in the field. Workshops might assist DSWs to learn how to manage their feelings towards the people they are caring for to avoid becoming over-invested or not being invested enough. Hochschild’s (1983) concepts of deep and surface acting may be indirectly discussed during workshops and team meetings. These may be the places where DSWs can learn what emotions are expected of them. DSWs may also be able to showcase their true emotions to others who are experiencing similar situations. Participating in workshops and the related networking with other DSWs may provide a way for DSWs to maintain the value in their jobs and reinforce their importance in society.
Conclusions
Developmental Services Workers (DSWs), including front line staff, a supervisor and an Executive Director, spoke in this study about their experiences and the skills and personality needed to enjoy working in the field of developmental services. Interestingly, the participants, both in the interviews and in the field observations, have not experienced burnout but have seen it in the field. Their experiences may be unique, or perhaps they have certain personal characteristics that keep them satisfied in the job.
Research cited in this paper identifies some of the factors that contribute to job satisfaction as well as those factors that promote burnout. The participants in this research acknowledge that burnout is a problem in developmental support services and identified some factors that they believe contribute to burnout. In most cases, the factors identified by the participants are congruent with the research cited. Even though the participants in this study have not experience burnout, the literature indicates burnout is a serious concern in the broader field of personal services (Brotheridge and Grandey 2002; Ford and Honnor 2000; Hewitt and Larson 2007; Larson and Lakin 1999; Robertson et al. 2005; Shaddock et al. 1998; Skirrow and Hatton 2007). The literature’s assessment of the impact of this issue is supported by the current interest of the Ministry of Community and Social Services in addressing job satisfaction, burnout and retention rates experienced by workers in this field.
Despite the small and unrepresentative sample, the results support work done by other researchers in this area. The types of problems faced by DSWs articulated by the study participants are comparable to those identified in the literature on the topic of burnout and retention. The intended ‘uniqueness’ of this sample was to include DSWs at different organizational levels in developmental services to see how their experiences compare. Including an Executive Director, who has been involved in developing and implementing strategies to recruit and retain DSWs, was beneficial as she had a top-level view of what was working and not working in similar sized organizations. This high level perspective has allowed her to successfully implement strategies to reduce burnout levels in her agency. The other participants in this research provided a critical perspective of their work environment and the characteristics that have impacted the burnout levels for their co-workers.
A few of the participants made comments about their work colleagues not wanting to talk about their work because they were not overly happy in their role and did not want their dissatisfaction to get back to their supervisors. If possible, another research study that is able to interview workers who are less happy with their work situation and looking for alternative work, would provide an interesting comparison to those workers who seem to have found coping mechanisms that keep them mostly happy in their work.
Hughes’ concept of dirty work and Twigg’s concept of carework and bodywork can be used to explore and analyze the type of work required of DSWs and why burnout might occur. Twigg’s carework or bodywork provide a better approach to studying DSWs than using dirty work because it removes the stigma associated with the word ‘dirty’. It is necessary to acknowledge the less desirable aspects of developmental service occupations, but identifying the job satisfaction experienced by DSWs is important to the recruitment and retention of workers. Fortunately, many of the less desirable tasks of DSWs can be improved. The daily tasks that may be described by some as “dirty work” are not the least desirable tasks for the DSWs included in my research.
Hochschild’s work on the effects of emotional labour can be applied to the work performed by DSWs and help to explain the level of burnout in this field. Developmental service workers are constantly engaging in emotional labour when providing care for people with developmental disabilities. As many of the participants discussed, DSWs have strong emotional attachments to the people they support. This strong attachment may help or hinder workers who have to engage in deep or surface acting. Perhaps having a strong attachment to the person makes it easier to hide emotions when bathing or dealing with difficult behaviours, because the DSWs know that it is only one small part of the person.
Other changes, such as higher wages, more full-time positions, more training opportunities, and support from management are necessary to recruit new workers to the field and keep DSWs engaged in their occupation. Management must become more involved with staff by listening and taking action when staff present problems related to the people they support. More research is needed in this area, especially more Canadian data which appears to be lacking. Unfortunately, policy changes have been slow to implement and, even though there is an awareness about retention and burnout concerns with DSWs, there has been little implementation (Hall and Hall 2002). Perhaps, the changes that are occurring within the Ontario Ministry of Community and Social Services are a strong indication of progress in managing the dual challenges of increasing recruitment and retention. Successful implementation of changes will encourage more people to apply to become DSWs and retention levels will increase because workers will be happier and more satisfied in their roles.
Rebecca Casey is currently pursuing her PhD degree in Sociology at McMaster University under the supervision of Drs. Lori Campbell (supervisor), Margaret Denton and Peri Ballantyne. Her research interests are on disability, aging and policy development. Rebecca’s dissertation will focus on injured workers to better understand their health and economic experiences. This dissertation work is affiliated with the Research Action Alliance on the Consequences of Work Injury (RAACWI).
Please forward all comments and inquiries to:
Rebecca Casey
McMaster University
Department of Sociology
1280 Main St. West
Hamilton, ON L8S 4L8
905-525-9140
Acknowledgments
I thank the anonymous reviewers of an earlier version of this manuscript, who offered useful comments and suggestions.
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