Work conditions and occupational health of female personal aides in wards of Taiwan's hospitals

Background: In Taiwan, it is a custom that hospitalized patients have to be accompanied by their family members during their stay in hospital. With the growing predominance of nuclear families, personal aides (PAs) temporarily hired by the needed families have become important substitutes for the families to carry out care work in hospital. These outsourcing workers, mostly women, are also considered by hospital management as a means to reduce nursing cost of the organization. Objectives: To investigate work conditions and occupational health problems among hospital PAs, and to understand the social context, including labor legislations, power dynamics at work, and management policies, which shaped their work experiences. Methods: Multiple qualitative methods were adopted, including policy analysis and in-depth interviews with 20 PAs and 15 managing staffs, including head nurses, brokers, and union leaders. Results: Being excluded from the coverage of the Labor Standard Act, these PAs lacked basic labor protections. Long working hours, lack of control over work, and difficulties in resisting unsafe work conditions were commonly cited. Their work was closely supervised by many players, including the patients, their families, nurses, and managers from brokering companies. Being flexibly employed and lacking in collective power, these PAs were highly individualized and burned with high risks of musculoskeletal discomforts, infectious diseases, and psychological distress from interpersonal conflicts. Conclusion: Our findings highlight the disadvantageous work and health conditions among PAs and suggest more support for these peripheral healthcare workers because their health and well-being will be a prerequisite for health care quality.