Dirty Is Fine, Degrading Is Not: Healthcare Assistants in Long-Term Care Facilities Facing Low Wages and Unsafe Staffing Levels
The study draws on five months of fieldwork in the Turin area (Italy; July – December 2024), involving: over thirty semi-structured recorded interviews to healthcare assistants and trade unionists; participant observation as a volunteer in a LTCF; shadowing of an healthcare assistant during her shifts; and observation of two national strike actions related to the renewal of national collective bargaining agreements.
Our findings show, first, that healthcare assistants do not find their work inherently degrading, despite such work involving contact with human waste and making them exposed to verbal and physical violence by patients. Instead, most workers stress how it is low wages and the organization of labor, and particularly its intensity, that makes it degrading. More specifically, they point to staffing shortages and to the regional regulation allocating insufficient care time to each elderly person residing in LTCFs.
Second, our findings show the tension emerging, in this context, from the stratification and hierarchization of healthcare occupations. More specifically, a conflict often emerges between healthcare assistants – charged with the most physically demanding, lowest-paid and least socially recognized job within healthcare occupations – and nurses, whose professional trajectory in the last thirty years involved a progressive shift from physically demanding manual labor to more clinical work. Interestingly, we notice how, in this conflict, healthcare assistants do not attempt to hide the “dirty” aspect of their work to gain social recognition. Rather, they insist on this aspect so as to make it visible and demand their work to be better organized, paid and socially recognized.