Experiences of moral distress by privately hired companions in Ontario's long-term care facilities.

PURPOSE: To explore long-term residential care provided by people other than the facilities' employees. Privately hired paid "companions" are effectively invisible in health services research and policy. This research was designed to address this significant gap. There is growing recognition that nursing staff in long-term care (LTC) residential facilities experience moral distress - a phenomenon in which one knows the ethically right action to take, but is systemically constrained from taking it. To date, there has been no discussion of the distressing experiences of companions in LTC facilities. This paper explores companions' moral distress. DESIGN: Data was collected using weeklong rapid ethnographies in seven LTC facilities in Southern Ontario, Canada. A feminist political economy analytic framework was used in the research design and in the analysis of findings. FINDINGS: Despite the differences in their work tasks and employment conditions, structural barriers can cause moral distress for companions. This mirrors the impacts experienced by nurses that are highlighted in the literature. Though companions are hired in order to fill care gaps in the LTC system, they too struggle with the current system's limitations. The hiring of private companions is not a sustainable or equitable solution to under-staffing and under-funding in Canada's LTC facilities. VALUE: Recognizing moral distress and the impact that it has on those providing LTC is critical in terms of supporting and protecting vulnerable and precarious care workers and ensuring high quality care for Canadians in LTC.

Key focal areas for bridging the fields of aging and disability: findings from the growing older with a disability conference.

Based upon research presented at the 2011 Festival of International Conferences on Caregiving, Disability, Aging and Technology (FICCDAT)-and specifically the Growing Older with a Disability (GOWD) conference, this paper identifies areas where bridging building between aging and disability is needed to support older adults aging into or with disabilities. Five focal areas emerged: 1) The Need to Forward Bridging Between Aging and Disability Sectors, 2) Theoretical Frameworks of Individual Aging that Facilitate Bridging, 3) Bridging through Consumer Participation and Involvement, 4) Bridging Through Knowledge Transfer and 5) Bridging Opportunities in Long-Term Supports and Services and Assistive Technologies. Discussion of themes is provided within both international and Canadian contexts, reflecting the interests of FICCDAT and GOWD organizers in discussing how to improve bridging in Canada. Findings from this report form the basis of the Toronto Declaration on Bridging Aging and Disability Policy, Practice, and Research.