Experiences of Digital Technology for Home Support Workers: The Need for a Human Centered Approach

Home Support Workers (HSWs) care for older people as well as people with disabilities

and long-term conditions by providing personal support with activities of daily living

in their homes. They deliver a range of services that enable people to take part in their

community, to have quality of life, recover from and cope with challenging situations.

This can include the provision of medications, cooking, cleaning, and often intimate

personal care work. For example, an HSW might assist a person to get out of bed in

the morning; perhaps using technology such as a hoist. They might assist with hygiene

and ensure that a person has had their mediciation. HSWs perform specialised tasks for

people with complex conditions. Most importantly, HSWs ensure people can live a life

with dignity.

As in many Western countries, in Aotearoa New Zealand this work has traditionally

been underpaid, classed as un-skilled and continues to be undervalued. However, as

became even more evident during the COVID-19 pandemic, HSWs do essential, highly

skilled work in caring for our most vulnerable and isolated, while putting themselves

at considerable risk. With the onset of serial health crises combined with an ageing

population, it becomes vital that governments take action to ensure the long-term

sustainability of this workforce.

We argue that this is particularly relevant in contexts such as Aotearoa New Zealand,

where services are publicly funded and privately delivered by mainly for-profit providers.

New platform technologies are currently being introduced by providers, both private

and non-profit, to mediate relationships between care recipients (clients) and HSWs.

They have been publicized by actors within the homecare sector as a potential solution

to challenges related to health sector strains associated with an ageing population.

And much like in other sectors, platform technologies such as apps are represented as

offering empowerment for workers and autonomy for clients.

This report critically investigates these claims and the broader impact of the

introduction of platform technologies on the working lives of HSWs and their ability to

provide dignified care for their clients.

Drawing on 16 in-depth Zoom interviews and 1 focus group with Aotearoa-based HSWs,

we argue that platform technologies as currently used are exasperating pre-existing

systemic failures, which have also been severely exposed by the COVID-19 pandemic.

We summarise their experiences through the four themes of Digital Frustration,

Precarity, Health and Safety and Communication Inequality, highlighting a lack of input

for HSWs into the purpose, design, implementation and monitoring of the technology.

We argue that this lack of voice is linked to the publicly funded and privately delivered

system, which often puts private gain before the interests of care workers and their

clients.

Digital Frustration

We found that a lack of input into the design of the technologies and communication

channels being used by HSWs impacts not only worker wellbeing but also the quality

of care that can be provided.

Precarity

We found that the technologies often add to the already significant burden of unpaid

labour, while cementing trends towards de-skilling and loss of professional autonomy.

Health and Safety

We found that during the COVID-19 crisis failures in platform technology and other

communication systems left HSWs and their clients exposed to undue risks, while a

lack of respect and recognition from both providers and the public further cemented a

perception of HSWs being under skilled.

Communication Inequality

We found that the technology renders HSWs as constantly accessible to providers,

but at the same time they lack access to decision-makers and sufficient information on

their clients to do their jobs safely.

Overall, the evidence indicates that platform technology is being used to increase

economic efficiencies for the private providers, rather than increase quality, safety

and effectiveness of services. To ensure that the new technology contributes to a

sustainable workforce and high-quality care going forward, we make the following

recommendations (see Conclusion section for more details):

1. Improve the systemic context surrounding platform technology. Rather than

providing a band aid to a broken system, we argue that for the technology to

improve care and empower workers it must be introduced within a context of

increased funding and stronger accountability mechanisms.

2. Include worker voice in the development of human-centred platform technology.

Rather than economic efficiency as the only driver behind the design and

implementation of platform technology, we argue that the voices of HSWs must

be included through an adoption of the principles of human-centred design,

which are grounded in wellbeing and user satisfaction.