Professional and regulatory logics of care: Unraveling the institutional contexts of personal care workers’ well-being failure

Attracting and maintaining a sustainable care workforce is a persistent global challenge for the long-term care (LTC) sector. Personal care workers account for the largest proportion of the LTC workforce and provide the most frequent daily assistance to older adults with complex care needs. Yet, their caring labour has been poorly recognized and valued by the society. Keating et al. (2021) suggested that because of chronic system failures in the LTC sector, personal care workers experience substantial “well-being failure” characterized by adverse well-being outcomes in multiple dimensions, including material, relational, and subjective well-being. The concept of “well-being failure” highlights how the care crisis imposes collective well-being challenges on the personal care workforce, calling for a systemic understanding of workers’ hardships at a structural level. Drawing from the theory of institutional logics from the organization studies literature, in this study we examine the institutional logics that shape the well-being failure of personal care workers in residential care homes. Using the residual-productivist welfare regime of Hong Kong as a critical case example, together with in-depth interviews with 52 personal care workers and stakeholders in the LTC sector, we argue that the professional logics of professional hierarchy and the regulatory logics of compliance and risk containment have systematically translated into dysfunctional care culture and organizational arrangements that demoralize personal care workers at the frontline of care. Practical implications for team communication and collaboration between regulator and private service-providers are discussed.