630635 research-article2016
JAGXXX10.1177/0733464816630635Journal of Applied GerontologyBurgess et al.
Article
“That Is So Common Everyday . . . Everywhere You Go”: Sexual Harassment of Workers in Assisted Living
Journal of Applied Gerontology 1–22 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464816630635 jag.sagepub.com
Elisabeth O. Burgess1, Christina Barmon1, James R. Moorhead Jr.2, Molly M. Perkins3, and Alexis A. Bender4
Abstract In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage
Manuscript received: August 14, 2015; final revision received: December 16, 2015; accepted: December 26, 2015. 1Georgia
State University, Atlanta, USA Department of Human Services, Atlanta, GA, USA 3Emory University, Atlanta, GA, USA 4Army Public Health Center (Provisional), Aberdeen Proving Ground, MD, USA 2Georgia
Corresponding Author: Elisabeth O. Burgess, Gerontology Institute, Georgia State University, P.O. Box 3984, Atlanta, GA 30302-3984, USA. Email: [email protected]
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
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Journal of Applied Gerontology
residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research. Keywords assisted living, direct care workers, qualitative methods, sexual harassment Prior to the 1970s, navigating a sexually charged workplace was an expected but little discussed part of the workday for many workers. In the 1970s and 1980s, scholars such as MacKinnon (1979) reframed the discussion about sexual behavior in the workplace. In the ensuing decades, academic research, legal scholarship, and social policy problematized sexual power dynamics in the workplace. Today, sexual harassment is considered a form of workplace discrimination by the U.S. Equal Employment Opportunity Commission (US EEOC, 2015), which defines it as “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature” that interferes with one’s employment or work performance or creates a “hostile or offensive work environment.” In spite of increased attention and legislation, sexual harassment remains a serious problem. The majority of women and a significant minority of men report experiencing sexual harassment in the workplace at least once (Uggen & Blackstone, 2004; Welsh, 1999).Yet the experience of sexual harassment remains subjective based on individual experience and organizational context (Welsh, 1999). Furthermore, many workers who experience sexual harassment do not have legal or institutional resources to stop it (Huebner, 2008). Workers who experience sexualized behavior in the workplace do not always label it as sexual harassment. Sexual interactions in the workplace can range from flirting and teasing to physical encounters and have varied and contradictory significance (Williams, Giuffre, & Dellinger, 1999). Individual and structural factors shape how and whether workers define this as harassment (Welsh, 1999; Williams et al., 1999). Workers are more likely to define non-consensual, persistent, or abusive sexual behaviors as harassment (Giuffre & Williams, 1994; Welsh, Carr, MacQuarrie, & Huntley, 2006). Moreover, race, class, age, gender, job status, and organizational culture contextualize sexual harassment (Blackstone, Houle, & Uggen, 2014; Welsh et al., 2006; Williams et al., 1999). In this article, we examine an often invisible form of harassment: the sexual harassment of workers in assisted living (AL) facilities by residents. AL provides a unique environment for studying sexual harassment because the
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
3
Burgess et al.
AL industry advertises a home-like environment that emphasizes residents’ choice and control. But it is also a workplace for staff, the vast majority of whom are female, who can develop long-term nurturing relationships with residents. Using data from a qualitative study of six AL facilities in metropolitan Atlanta, we examine how AL workers and administrators manage sexual harassment or inappropriate behavior.
Sexualized Behavior and Harassment in Health Care Although many health care workers encounter sexual behavior in the workplace (Deery, Walsh, & Guest, 2011; deMayo, 1997), existing research has focused primarily on nurses. Spector, Zhou, and Che (2014) found that 25% of nurses were exposed to sexual harassment. Patients are the most common perpetrators of sexual harassment, and both male and female nurses are victims (Bronner, Peretz, & Ehrenfeld, 2003). However, patient behavior is not regulated by employment guidelines and depends largely on the culture of the institution. Furthermore, sexual behavior is not always perceived as problematic. Although nurses report inappropriate sexual behavior from patients, they are hesitant to define it as sexual harassment (Huebner, 2008). Because incidents are often isolated and patients are vulnerable, nurses do not perceive this as a problem but part of the job for which they are prepared and trained. In addition, the context of the sexual behavior, such as the severity of the incident and the identity of the perpetrator, influences whether it is perceived as sexual harassment by health care workers (Daly, Banerjee, Armstrong, Armstrong, & Szebehely, 2011; deMayo, 1997). Sexual harassment becomes invisible in nursing for numerous reasons. In hospital settings, nurses balance the emotional and physical needs of patients through a set of intimate exchanges (Ruchti, 2012). According to Ruchti (2012), these nurses asserted that successfully negotiating these interactions was a result of their professional approach to medical and health care work. Despite a lack of training on managing sexual harassment from patients, nurses prided themselves in handling challenging situations (Ruchti, 2012). When patients are perceived as vulnerable, confused, or in pain, their actions are minimized or excused (Huebner, 2008; Ruchti, 2012). It is only when nurses perceive the behavior as intentional and likely to reoccur, that it is defined as sexual harassment (Deery et al., 2011; Huebner, 2008; Ruchti, 2012). The burden for managing these sexually charged interactions falls on individual nurses (Madison & Minichiello, 2004). As a result, the collective exposure to sexual harassment is minimized.
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
4
Journal of Applied Gerontology
While patients, mostly male, act in sexually charged or inappropriate ways, nurses frequently dismiss the behavior labeling patients as confused or harmless (Blackstone et al., 2014). Moreover, nurses and supervisors naturalize behavior claiming that “men are just like that” and believe nurses should be responsible for policing inappropriate behavior. Without training on managing intimate conflict, nurses were responsible for negotiating these interactions on their own. Thus, the burden and stress of sexual harassment is perceived as a personal problem, not a structural one. Over time, nurses develop strategies for managing sexual harassment (Blackstone et al., 2014). Ethnic minority nurses (or health care workers) may be more likely to define these issues as problematic (Barling, Rogers, & Kelloway, 2001; Deery et al., 2011). Cultural stereotypes of nurses as sexy, flirtatious, or promiscuous reinforce the belief that nurses are sexually available (Madison & Minichiello, 2004; Ruchti, 2012). In unsupportive workplaces, these stereotypes reinforce a culture of silence around sexual harassment (Madison & Minichiello, 2004). These stereotypes and sexualized behavior of patients negatively influence the ability to get work done. These disruptions may be momentary or require more significant emotional and temporal attention. Ultimately, sexual harassment may contribute to burnout or poor job retention (Deery et al., 2011).
Gaps in Research on Sexual Harassment in Health Care Although there is a growing body of research on sexual harassment in health care, it has focused on nurses in hospital settings. There is little research about sexual harassment in long-term care (LTC) or geriatric settings. Within health care, workers have differential access to resources depending on where they work and what they do. Fear of workplace violence and sexual harassment can influence job performance and mood (Barling et al., 2001). Direct care workers (DCWs) in LTC have on-going relationships of caregiving, which may be one of the most salient aspects of the job (Ball, Lepore, Perkins, Hollingsworth, & Sweatman, 2009). Strong interpersonal ties to residents may offset some of these negative aspects of these low status, difficult jobs with high turnover and low pay (Berdes & Eckert, 2007; Stone, 2004). Conversely, negative interactions and poor relationship quality may impact job satisfaction, turnover, and sick days (Clausen, Hogh, & Borg, 2012; Stone, 2004). At worst, DCWs deal with both verbal and physical abuse on the job (Ball et al., 2009; Berdes & Eckert, 2007). Lower status workers such as DCWs may be more vulnerable to issues of sexual harassment. Building on existing research, this article examines how AL staff and administrators define, understand, and negotiate sexual and intimate comments, joking, and physical touch. Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
5
Burgess et al.
Method This analysis is part of a larger National Institute on Aging (NIA)-funded qualitative study investigating how residents negotiate sexuality in AL facilities. The data collection was cross-sectional and spanned 2 years from 2009 to 2011. The data were collected from six AL facilities in the metropolitan Atlanta area. The data we use in this analysis focus on administrators and staff. The institutional review board at Georgia State University approved all of the procedures (#H08476). The names of the facilities and individuals are all pseudonyms.
Setting and Participants We purposively sampled six AL facilities in the metro Atlanta area for maximum variation, selecting homes that varied in location type (urban, suburban, and exurban), size, price range, ownership type, and resident demographics. Three of our homes were medium sized and had less than 50 residents: Rosewood Hills (43), Somerset Manor (48), and White Sands Plantation (40). The remaining homes had more than 50 residents: Forest Glen (90), Aster Gardens (65), and Sycamore Estates (58). Four were corporately owned, one was family owned, and one was a non-profit. The homes ranged in size from 50 to 109 beds. Fees ranged from $1200 to $5545 per month depending on the level of care provided. Although there was variation in terms of location, size, and cost, the homes were similar in terms of resident demographics (age, sex ratio, level of support needed). And although we aimed for maximum variation in sampling, AL residents are more likely to be female, middle class, and White (Caffrey et al., 2012) and our sample reflects that. All residents required some assistance with activities of daily living. The majority of residents and administrators were White, and the majority of staff in this study were minorities and women. This is consistent with national trends (Institute of Medicine [IOM], 2008). We primarily interviewed DCWs, but because many other staff interact with residents, we also included activity directors, kitchen and dining staff, clerical workers, a maintenance employee, and direct care managers. See Table 1 for a comparison of respondents.
Data Collection Data collection involved observations, interviews with administrators, staff, family members, residents, and focus groups with staff in each home. The primary investigator (PI) and a team of trained graduate students collected
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
6
Journal of Applied Gerontology
Table 1. Socio-Demographic Characteristics of Staff and Administrators.
Age 0–34 35–44 45–54 55 and above Gender Female Male Race Black/African American (non-Hispanic) White/Caucasian (non-Hispanic) Other Education
JAGXXX10.1177/0733464816630635Journal of Applied GerontologyBurgess et al.
Article
“That Is So Common Everyday . . . Everywhere You Go”: Sexual Harassment of Workers in Assisted Living
Journal of Applied Gerontology 1–22 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464816630635 jag.sagepub.com
Elisabeth O. Burgess1, Christina Barmon1, James R. Moorhead Jr.2, Molly M. Perkins3, and Alexis A. Bender4
Abstract In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage
Manuscript received: August 14, 2015; final revision received: December 16, 2015; accepted: December 26, 2015. 1Georgia
State University, Atlanta, USA Department of Human Services, Atlanta, GA, USA 3Emory University, Atlanta, GA, USA 4Army Public Health Center (Provisional), Aberdeen Proving Ground, MD, USA 2Georgia
Corresponding Author: Elisabeth O. Burgess, Gerontology Institute, Georgia State University, P.O. Box 3984, Atlanta, GA 30302-3984, USA. Email: [email protected]
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
2
Journal of Applied Gerontology
residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research. Keywords assisted living, direct care workers, qualitative methods, sexual harassment Prior to the 1970s, navigating a sexually charged workplace was an expected but little discussed part of the workday for many workers. In the 1970s and 1980s, scholars such as MacKinnon (1979) reframed the discussion about sexual behavior in the workplace. In the ensuing decades, academic research, legal scholarship, and social policy problematized sexual power dynamics in the workplace. Today, sexual harassment is considered a form of workplace discrimination by the U.S. Equal Employment Opportunity Commission (US EEOC, 2015), which defines it as “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature” that interferes with one’s employment or work performance or creates a “hostile or offensive work environment.” In spite of increased attention and legislation, sexual harassment remains a serious problem. The majority of women and a significant minority of men report experiencing sexual harassment in the workplace at least once (Uggen & Blackstone, 2004; Welsh, 1999).Yet the experience of sexual harassment remains subjective based on individual experience and organizational context (Welsh, 1999). Furthermore, many workers who experience sexual harassment do not have legal or institutional resources to stop it (Huebner, 2008). Workers who experience sexualized behavior in the workplace do not always label it as sexual harassment. Sexual interactions in the workplace can range from flirting and teasing to physical encounters and have varied and contradictory significance (Williams, Giuffre, & Dellinger, 1999). Individual and structural factors shape how and whether workers define this as harassment (Welsh, 1999; Williams et al., 1999). Workers are more likely to define non-consensual, persistent, or abusive sexual behaviors as harassment (Giuffre & Williams, 1994; Welsh, Carr, MacQuarrie, & Huntley, 2006). Moreover, race, class, age, gender, job status, and organizational culture contextualize sexual harassment (Blackstone, Houle, & Uggen, 2014; Welsh et al., 2006; Williams et al., 1999). In this article, we examine an often invisible form of harassment: the sexual harassment of workers in assisted living (AL) facilities by residents. AL provides a unique environment for studying sexual harassment because the
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
3
Burgess et al.
AL industry advertises a home-like environment that emphasizes residents’ choice and control. But it is also a workplace for staff, the vast majority of whom are female, who can develop long-term nurturing relationships with residents. Using data from a qualitative study of six AL facilities in metropolitan Atlanta, we examine how AL workers and administrators manage sexual harassment or inappropriate behavior.
Sexualized Behavior and Harassment in Health Care Although many health care workers encounter sexual behavior in the workplace (Deery, Walsh, & Guest, 2011; deMayo, 1997), existing research has focused primarily on nurses. Spector, Zhou, and Che (2014) found that 25% of nurses were exposed to sexual harassment. Patients are the most common perpetrators of sexual harassment, and both male and female nurses are victims (Bronner, Peretz, & Ehrenfeld, 2003). However, patient behavior is not regulated by employment guidelines and depends largely on the culture of the institution. Furthermore, sexual behavior is not always perceived as problematic. Although nurses report inappropriate sexual behavior from patients, they are hesitant to define it as sexual harassment (Huebner, 2008). Because incidents are often isolated and patients are vulnerable, nurses do not perceive this as a problem but part of the job for which they are prepared and trained. In addition, the context of the sexual behavior, such as the severity of the incident and the identity of the perpetrator, influences whether it is perceived as sexual harassment by health care workers (Daly, Banerjee, Armstrong, Armstrong, & Szebehely, 2011; deMayo, 1997). Sexual harassment becomes invisible in nursing for numerous reasons. In hospital settings, nurses balance the emotional and physical needs of patients through a set of intimate exchanges (Ruchti, 2012). According to Ruchti (2012), these nurses asserted that successfully negotiating these interactions was a result of their professional approach to medical and health care work. Despite a lack of training on managing sexual harassment from patients, nurses prided themselves in handling challenging situations (Ruchti, 2012). When patients are perceived as vulnerable, confused, or in pain, their actions are minimized or excused (Huebner, 2008; Ruchti, 2012). It is only when nurses perceive the behavior as intentional and likely to reoccur, that it is defined as sexual harassment (Deery et al., 2011; Huebner, 2008; Ruchti, 2012). The burden for managing these sexually charged interactions falls on individual nurses (Madison & Minichiello, 2004). As a result, the collective exposure to sexual harassment is minimized.
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
4
Journal of Applied Gerontology
While patients, mostly male, act in sexually charged or inappropriate ways, nurses frequently dismiss the behavior labeling patients as confused or harmless (Blackstone et al., 2014). Moreover, nurses and supervisors naturalize behavior claiming that “men are just like that” and believe nurses should be responsible for policing inappropriate behavior. Without training on managing intimate conflict, nurses were responsible for negotiating these interactions on their own. Thus, the burden and stress of sexual harassment is perceived as a personal problem, not a structural one. Over time, nurses develop strategies for managing sexual harassment (Blackstone et al., 2014). Ethnic minority nurses (or health care workers) may be more likely to define these issues as problematic (Barling, Rogers, & Kelloway, 2001; Deery et al., 2011). Cultural stereotypes of nurses as sexy, flirtatious, or promiscuous reinforce the belief that nurses are sexually available (Madison & Minichiello, 2004; Ruchti, 2012). In unsupportive workplaces, these stereotypes reinforce a culture of silence around sexual harassment (Madison & Minichiello, 2004). These stereotypes and sexualized behavior of patients negatively influence the ability to get work done. These disruptions may be momentary or require more significant emotional and temporal attention. Ultimately, sexual harassment may contribute to burnout or poor job retention (Deery et al., 2011).
Gaps in Research on Sexual Harassment in Health Care Although there is a growing body of research on sexual harassment in health care, it has focused on nurses in hospital settings. There is little research about sexual harassment in long-term care (LTC) or geriatric settings. Within health care, workers have differential access to resources depending on where they work and what they do. Fear of workplace violence and sexual harassment can influence job performance and mood (Barling et al., 2001). Direct care workers (DCWs) in LTC have on-going relationships of caregiving, which may be one of the most salient aspects of the job (Ball, Lepore, Perkins, Hollingsworth, & Sweatman, 2009). Strong interpersonal ties to residents may offset some of these negative aspects of these low status, difficult jobs with high turnover and low pay (Berdes & Eckert, 2007; Stone, 2004). Conversely, negative interactions and poor relationship quality may impact job satisfaction, turnover, and sick days (Clausen, Hogh, & Borg, 2012; Stone, 2004). At worst, DCWs deal with both verbal and physical abuse on the job (Ball et al., 2009; Berdes & Eckert, 2007). Lower status workers such as DCWs may be more vulnerable to issues of sexual harassment. Building on existing research, this article examines how AL staff and administrators define, understand, and negotiate sexual and intimate comments, joking, and physical touch. Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
5
Burgess et al.
Method This analysis is part of a larger National Institute on Aging (NIA)-funded qualitative study investigating how residents negotiate sexuality in AL facilities. The data collection was cross-sectional and spanned 2 years from 2009 to 2011. The data were collected from six AL facilities in the metropolitan Atlanta area. The data we use in this analysis focus on administrators and staff. The institutional review board at Georgia State University approved all of the procedures (#H08476). The names of the facilities and individuals are all pseudonyms.
Setting and Participants We purposively sampled six AL facilities in the metro Atlanta area for maximum variation, selecting homes that varied in location type (urban, suburban, and exurban), size, price range, ownership type, and resident demographics. Three of our homes were medium sized and had less than 50 residents: Rosewood Hills (43), Somerset Manor (48), and White Sands Plantation (40). The remaining homes had more than 50 residents: Forest Glen (90), Aster Gardens (65), and Sycamore Estates (58). Four were corporately owned, one was family owned, and one was a non-profit. The homes ranged in size from 50 to 109 beds. Fees ranged from $1200 to $5545 per month depending on the level of care provided. Although there was variation in terms of location, size, and cost, the homes were similar in terms of resident demographics (age, sex ratio, level of support needed). And although we aimed for maximum variation in sampling, AL residents are more likely to be female, middle class, and White (Caffrey et al., 2012) and our sample reflects that. All residents required some assistance with activities of daily living. The majority of residents and administrators were White, and the majority of staff in this study were minorities and women. This is consistent with national trends (Institute of Medicine [IOM], 2008). We primarily interviewed DCWs, but because many other staff interact with residents, we also included activity directors, kitchen and dining staff, clerical workers, a maintenance employee, and direct care managers. See Table 1 for a comparison of respondents.
Data Collection Data collection involved observations, interviews with administrators, staff, family members, residents, and focus groups with staff in each home. The primary investigator (PI) and a team of trained graduate students collected
Downloaded from jag.sagepub.com at University of Wollongong on May 17, 2016
6
Journal of Applied Gerontology
Table 1. Socio-Demographic Characteristics of Staff and Administrators.
Age 0–34 35–44 45–54 55 and above Gender Female Male Race Black/African American (non-Hispanic) White/Caucasian (non-Hispanic) Other Education
