Direct Care Workers Research Articles

African Immigrants in Low-Wage Direct Health Care: Motivations, Job Satisfaction, and Occupational Mobility.

This study explores motivations, job satisfaction, and overall perceived occupational mobility for African immigrants working in low-wage direct health care occupations. The study uses qualitative semi-structured interviews with a sample of thirty African immigrant workers in the greater Pittsburgh metropolitan area. Results show that four major themes captured the motivations of interviewees for doing direct care work: passion for care work, quick money, easily obtained employment, and direct care work as a pathway to other health occupations. The majority of the interviewees were satisfied with their jobs, yet almost all of them saw their occupations as temporary or transitional employment. Most of the interviewees also saw their jobs as lacking occupational mobility. In light of the increased national demand for direct care workers, the growing numbers of immigrants in the direct care labor force, and the high turnover and low retention rates of direct care workers overall, the study suggests that more must be done to make direct care work attractive and rewarding for African immigrant workers.

The experiences of Indian migrant care home staff working with people with dementia: a pilot study exploring cultural perspectives

Purpose – Little is known about migrant Indian care workers working in long-term care facilities for people with dementia in England and the purpose of this paper is to remedy this lack of information in the light of political interest in immigration to the UK and continued staff shortages in parts of the social care sector. Design/methodology/approach – This pilot study investigated the experiences of workplace acculturation among 12 migrant Indian care workers who were employed in English care homes. Qualitative face-to-face interviews were conducted in 2013. Analysis of the interviews was conducted using principles of interpretative phenomenological analysis. Findings – Following analysis five themes emerged along an acculturation timeline. First, during the first six months of their employment, the migrant care workers recalled feeling vulnerable, seemingly marked by a sense of insecurity and an overwhelming state of cognitive burden within an unfamiliar cultural context. Second, simultaneously, the migrants felt perturbed about their new role as direct care workers. Third, few had been able to draw on their networks of friends and relatives to build up knowledge of their new work environments before starting care home employment. Fourth, two years into the work, although they reported feeling better adapted, psychological and socio-cultural adjustments were still thought to be needed. Fifth, most participants retained their ambition to be recognised as a qualified nurse in the UK and to pursue a nursing career outside the social care sector. Research limitations/implications – This is a pilot study in which 12 migrant Indian care home workers were interviewed. Further interviews might provide a greater range of views and experiences. The care homes that participated in this research were in the London region where staff shortages are common in dementia services such as care homes. Practical implications – The findings suggest a need for employers and human resource managers to respond to the specific needs of Indian and other migrants working with older people who are resident in care homes. Such responses should reflect the timeline of their acculturation and employers need also to acknowledge and address aspirations to move on to NHS work. Originality/value – This study is unique to the best of the authors’ knowledge in addressing Indian care workers specifically as a substantial part of the migrant care workforce in the UK. It offers information about their perceptions and suggests practical human response and managerial initiatives.

Does the “Glass Escalator” Compensate for the Devaluation of Care Work Occupations?

Feminized care work occupations have traditionally paid lower wages compared to non–care work occupations when controlling for human capital. However, when men enter feminized occupations, they often experience a “glass escalator,” leading to higher wages and career mobility as compared to their female counterparts. In this study, we examine whether men experience a “wage penalty” for performing care work in today’s economy, or whether the glass escalator helps to mitigate the devaluation of care work occupations. Using data from the Survey of Income and Program Participation for the years 1996-2011, we examine the career patterns of low- and middle-skill men in health care occupations. We found that men in occupations that provide the most hands-on direct care did experience lower earnings compared to men in other occupations after controlling for demographic characteristics. However, men in more technical allied health occupations did not have significantly lower earnings, suggesting that these occupations may be part of the glass escalator for men in the health care sector. Minority men were significantly more likely than white men to be in direct care occupations, but not in frontline allied health occupations. Male direct care workers were less likely to transition to unemployment compared to men in other occupations.

Direct Care Worker Training to Respond to the Behavior of Individuals With Dementia: The CARES® Dementia-Related Behavior™ Online Program.

Only a handful of online training programs are available for direct care workers (DCWs) to acquire the strategic skills needed to improve dementia care in instances of challenging or inappropriate behavior. Utilizing pre- and post-test data from a convenience sample of 40 DCWs, the present study sought to determine (a) whether DCWs’ knowledge of responding to dementia-related behavior increased following participation in the CARES® Dementia-Related Behavior™ Online Training Program (or CARES® Behavior) and (b) if CARES® Behavior was acceptable and useful. The average number of correct scores on a dementia care knowledge measure was significantly higher among DCWs after viewing the online modules when compared with pre-test scores (p < .01). Descriptive empirical and open-ended data also suggested that the interactive, “real-world” content of CARES® Behavior was feasibly delivered online, acceptable, and may influence how DCWs deliver clinical care to individuals with dementia-related behavior.

Work-related musculoskeletal disorders and ergonomic stressors among direct and nondirect contact health care workers from a Nigerian tertiary health facility

Background: Work-related musculoskeletal disorders (WRMDs) among health care workers have increased with little information on ergonomic stressors' exposure. Therefore, the exposure of health care workers to ergonomic stressors and the consequent WRMDs were investigated. Materials and Methods: The descriptive cross-sectional study involved 279 stratified participants from various departments of Olabisi Onabanjo University Teaching Hospital. Standardized Nordic and adapted European Foundation questionnaires were used to obtain data on musculoskeletal pain and ergonomic stressors. The data were analyzed with Statistical Package for the Social Sciences (SPSS) using descriptive and inferential statistics. Results: About 48% of the participants reported WRMDs in at least one part of the body during the 12 months preceding the study while 22.2% reported WRMDs in the last 7days. During the preceding 12 months and the last 7 days, the lower back was the most common site of disorders (29.4% and 9.7%, respectively) while the elbow joint was the least affected site. About 49.7% and 42.7% of the clinical staff and nonclinical staff, respectively, reported WRMDs in the last 12 months while 22.3% versus 22.0% reported WRMDs in the last 7 days. Female participants had a higher prevalence of WRMDs but significant gender difference existed for point prevalence only. A majority of the participants (65.8%) were exposed to 11 or more risk factors. There was a significant association between both 12-month and point prevalences of WRMDs on the one hand and exposure to painful tiring positions on the other. Conclusions: The prevalence of WRMDs was high among health care workers with the lower back being the most frequently affected body region. Work involving painful/tiring positions was the most common ergonomic risk factor associated with WRMDs.

Building the skills of direct care workers: The Alaskan core competencies initiative.

Building the skills of direct care workers: The Alaskan core competencies initiative.

Relationship between system-level characteristics of assisted living facilities and the health and safety of unlicensed staff.

This study examined system-level characteristics of assisted living facilities and the association between these characteristics and the health and safety outcomes of unlicensed staff. Forty-two unlicensed direct care workers completed a survey related to system-level stressors and the individual stress responses of staff. Measurement tools included the Work Stressor Inventory (WSI), General Health Questionnaire (GHQ-12), and Maslach Burnout Inventory (MBI). High levels of emotional exhaustion, psychiatric distress, and work-related injuries were reported by unlicensed staff. Providing care to residents with dementia-related behaviors and supporting families were the most frequently reported work stressors. System-level factors were significantly associated with staff role competence, job commitment, and emotional exhaustion. These results support the need for continued exploration, development, and evaluation of strategies to reduce occupational stressors at multiple levels in assisted living facilities.

The Relationship between Transformational Leadership and Organizational Commitment in Nonprofit Long Term Care Organizations: The Direct Care Worker Perspective

&lt;p&gt;The United States population is rapidly aging, and retaining direct care workers (DCWs) will continue to be a workforce concern for the industry in addressing the demand for long term care services. To date, scant literature exists that addresses the DCW perspective of leadership behaviors and their influence on organizational commitment. To respond to this deficiency, this research studied leadership behaviors of direct importance for DCWs at the immediate supervisor level, and provided empirical insight into organizational commitment among workers closest to patient care. Research on leader behaviors has focused on managerial and executive levels, with scant consideration in long term care at the lower hierarchical levels. Transformational leadership was hypothesized to have a significant positive relationship with organizational commitment, specifically affective and normative commitments, and a significant inverse relationship with continuance commitment. The quantitative correlational study explored the relationship between transformational leadership and organizational commitment among 322 direct care workers employed by nonprofit, multi-level long term care organizations located in the Midwest. Results revealed a statistically significant relationship between overall transformational leadership and organizational commitment as well as affective and normative commitment dimensions, with no significant relationship found between transformational leadership and continuance commitment. The study results are beneficial to industry leaders, researchers, and policymakers for addressing operational policies, leadership training, human resource practices, and workforce policy development. Operational policies should reflect the values of the organization and follow from a compelling, collective vision and mission. Human resources practices warrant review if not aligned with the vision, mission, and values. Leadership development training should considered for continuing education for supervisors at all levels as well as for potential policy alternatives.&lt;/p&gt;&lt;div&gt; &lt;/div&gt;

Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter

ABSTRACTWell-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs’ learning and working environment.

Effects of a psycho-educational intervention on direct care workers’ communicative behaviors with residents with dementia

This study assessed the effects of a person-centered care-based psycho-educational intervention on direct care workers’ communicative behaviors with people with dementia living in aged-care facilities. An experimental study with a pretest–posttest control-group design was conducted in four aged-care facilities. Two experimental facilities received an 8-week psycho-educational intervention aiming to develop workers’ knowledge about dementia, person-centered care competences, and tools for stress management. Control facilities received education only, with no support to deal with stress. In total, 332 morning care sessions, involving 56 direct care workers (female, mean age 44.72 ± 9.02 years), were video-recorded before and 2 weeks after the intervention. The frequency and duration of a list of verbal and nonverbal communicative behaviors were analyzed. Within the experimental group there was a positive change from pre- to posttest on the frequency of all workers’ communicative behaviors. Significant treatment effects in favor of the experimental group were obtained for the frequency of inform (p < .01, η2partial = 0.09) and laugh (p < .01, η2partial = 0.18). Differences between groups emerged mainly in nonverbal communicative behaviors. The findings suggest that a person-centered care-based psycho-educational intervention can positively affect direct care workers’ communicative behaviors with residents with dementia. Further research is required to determine the extent of the benefits of this approach.

Effects of a Psychoeducational Intervention for Direct Care Workers Caring for People With Dementia: Results From a 6-Month Follow-Up Study.

This study aimed to assess the effects of a psychoeducational intervention, designed to improve direct care workers' stress, burnout and job satisfaction, and person-centered communicative behavior in people with dementia. A pretest-posttest control group design was conducted in 4 aged-care facilities. Two experimental facilities received a psychoeducational intervention, and 2 control facilities received an education only. Data were gathered from 53 care workers at baseline, immediately, and 6 months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers' burnout and a significant improvement in several communicative behaviors (e.g., involvement). Stress levels deteriorated at 6 months, and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management, as this might be associated with a reduction in their levels of exhaustion and improved communicative behaviors.

Conceptualizing the Foundation of Inequalities in Care Work

Over the past decade, social science researchers in the area of feminism, labor, immigration, and family have written extensively on the care work crisis and globalized care work. Depending on how broadly care work is conceived, these writings emphasize unique aspects of gender, race, class, and/or citizenship inequalities. Second wave of feminist perspectives, for instance, identify housework and most work culturally defined as “women’s work”—including all paid health occupations dominated by women, such as nurses, direct care workers, and hospital workers but also possibly even health, education, and social service occupations—as central to gender subordination. Another important research stream, focusing on domestic labor as women’s work, but recognizing its traditional outsourcing to slaves, servants, and later employees, highlights the complexities of the inequality generated, not only in terms of gender but race, class, and citizenship as well. Bringing these two bodies of literature together in conversation initially pointed to the inaccurate assumption that care work was valued when it became wage labor. The paid labor of domestics, nannies, and elderly care workers, however, remains deeply devalued, most often with those with limited options entering the profession. This article both assesses contradictions within dominant approaches to care work and highlights the cultural and political foundations of the very inequalities that domestic care workers experience.

Perceptions and employment intentions among aged care nurses and nursing assistants from diverse cultural backgrounds: A qualitative interview study

The residential aged care industry faces shortages and high turnover rates of direct care workers. This situation is further complicated by the increasing cultural diversity of residents and staff. To retain direct care workers, it is crucial to explore their perceptions of the rewards and difficulties of care work, and their employment intentions in multicultural environments. A qualitative descriptive study was used to understand perceptions of the rewards and difficulties of residential aged care work for core direct care workers (i.e. nurses and nursing assistants), how these were related to their intentions to stay or leave, and how these varied between nurses and nursing assistants, and between locally and overseas born workers. Individual interviews were conducted between June and September 2013 with 16 direct care workers in an Australian residential aged care facility with a specific focus on people from culturally and linguistically diverse backgrounds. It was found that direct care workers’ employment intentions were related to their perceptions and management of the rewards and difficulties of care work. Their experiences of care work, the employment characteristics, and the organizational resources that fitted their personality, ability, expectations, and essential needs were viewed as rewards. Evaluating their jobs as meaningful was a shared perception for direct care workers who intended to stay. Individual workers' perceptions of the rewarding aspects of care work served to counterbalance the challenges of care work, and promoted their intentions to stay. Perceptions and employment intentions varied by occupational groups and by cultural backgrounds. Overseas born direct care workers are valuable resources in residential aged care facility rather than a limitation, but they do require organizational support, such as cultural awareness of the management, English language support, a sense of family, and appropriate job responsibility. The findings indicated that aged care policy makers and service providers should understand the range of individual direct care workers’ positive and negative perceptions, and their employment intentions within the context of their roles and their cultural backgrounds.

Dissemination and Implementation of Function Focused Care for Assisted Living.

Assisted living (AL) settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in AL are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and experience more rapid functional decline than their peers in nursing homes. Function Focused Care for Assisted Living (FFC-AL) was developed to prevent decline, improve function, and increase physical activity among residents living in these settings. The purpose of this study was to disseminate and implement the previously established, effective FFC-AL approach to 100 AL settings. Evidence of our ability to successfully disseminate and implement FFC-AL across these settings was established using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance model. Settings were eligible to participate if they had more than eight beds and identified a nurse (i.e., registered nurse, licensed practical nurse, or direct care worker) champion to facilitate the implementation process. Setting recruitment was done via mailed invitations to 300 eligible ALs and e-mails to relevant AL organizations. Evidence of reach was based on our ability to recruit 99 ALs with adoption of the intervention in 78 (78%). There was a significant improvement in policies supporting function-focused care and in establishing environments that supported function-focused care, and there was evidence of enduring changes in settings indicative of maintenance. We were able to implement all aspects of the intervention although challenges were identified. Future work should focus on using more face-to-face interactions with champions along with identified stakeholders, evaluating characteristics of champions to establish those who are most successful, and recruiting residents to obtain resident-specific outcomes.

Shared Decision-Making in Nursing Homes: Factors Associated With the Empowerment of Direct Care Workers.

The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.

Are We Ready for Growing AAC Needs in Group Homes?

Are We Ready for Growing AAC Needs in Group Homes?

Function Focused Care for Assisted Living Residents With Dementia.

Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. A cluster-randomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy.

Perspectives of US Direct Care Workers on the Grief Process of Persons with Intellectual and Developmental Disabilities: Implications for Practice.

The study explored the grief process of persons with intellectual and developmental disabilities (PWIDDs) as perceived by direct care workers (DCWs) and how such workers can guide and support PWIDDs experiencing grief. A thematic analysis approach was used to examine data from nine focus groups with 60 DCWs from five community-based organizations. Findings were supported in the context ofseminal grief and bereavement theories. Three themes(i.e. reactions to loss, processing the loss and incorporating the loss) and related subthemes emerged from the data. PWIDDs are susceptible to traumatic grief, and DCWs are often key witnesses to such experiences. DCWs' perspectives can guide the development of grief and bereavement training which can lead to more tailored support systems.

Development of the Knowledge of Dementia Competencies Self-Assessment Tool.

Competent dementia care requires caregivers with specialized knowledge and skills. The Knowledge of Dementia Competencies Self-Assessment Tool was developed to help direct care workers (DCWs) assess their knowledge of 7 dementia competencies identified by the Michigan Dementia Coalition. Item selection was guided by literature review and expert panel consultation. It was given to 159 DCWs and readministered to 57 DCWs in a range of long-term care settings and revised based on qualitative feedback and statistical item analyses, resulting in 82 items demonstrating good internal consistency and test-retest reliability. Performance on items assessing competencies rated as most important was significantly related to training in these competencies. The DCWs in day care obtained higher scores than those in home care settings, and their sites reported a greater number of hours of dementia training. Validation in a more diverse group of DCWs and assessing its relationship to other measures of knowledge and skill is needed.

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study

BackgroundImplicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. ObjectivesThe purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. DesignCross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). SettingsNursing homes from all three language regions of Switzerland. ParticipantsA random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). MethodsWe utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. ResultsImplicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. ConclusionsImproving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested.