Time to care: How a homecare model harnesses nurses' professional ethic and cultivates caring.

Abstract

Background: A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes.

Objectives: Using Tronto's caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits.

Design: A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1-2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online.

Ethical considerations: While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities.

Findings: 63 interviews and 185 h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses' professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values.

Conclusions: As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring.