How financial cutbacks affect the quality of jobs and care for the elderly

Based on case studies in 12 nursing homes in the UK, the authors illustrate how financial cutbacks affect job quality and quality of care. The dimensions of job quality that suffered most were those directly related to the ability of workers to provide care – reductions in staffing, longer working hours and work intensification. Cuts to labor costs eroded the quality of workers’ jobs in all 12 homes but with two differential outcomes – in seven homes care quality was maintained and in five homes it deteriorated. Care quality was maintained in homes where a patient-centered care approach and remaining job quality allowed workers to develop workarounds to protect residents from spillover effects. Care quality declined in homes where custodial approaches to care and low job quality did not provide workers the time or resources to protect residents or maintain prior levels of care. A tipping point was reached leading to a spillover into impoverished care.