Home Care Aides Research Articles

Exploring the home healthcare workforce in Alzheimer's disease and related dementias: Utilization and cost outcomes in US community dwelling older adults

ObjectiveThis study assessed home health care use associated with Alzheimer's Disease and related dementias (ADRD) in US community dwelling older adults, including workforce, intensity, and cost outcomes. Materials and methodsMedical Expenditure Panel Survey (2010–2018) household and home care event files were used to identify adults ≥ 65 years with ADRD. Outcomes included home health care provider type, intensity of care use, and annual direct home care cost. All analyses applied person weights for national estimates. ResultsAmong the 20,443 eligible older adults, 4.2% (n = 843) reported ADRD. Among all professional and non-professional health care workers, nurse practitioners (NPs, 38.5%) and home health care aids (35.6%) were most used. Comparing ADRD vs non-ADRD: the annual per-person average number of days in home care was 110 vs. 64 (p<0.001) and home care costs accounted for 30.8% vs. 7.5% of total health care costs. After adjusting for participants' characteristics, those with ADRD were more likely to use home health care (OR = 4.32, 95% CI=3.29 – 5.68) and showed 229% (95% CI = 175% - 297%) higher associated costs than controls (p<0.001). ConclusionThe study provides insight into the home care workforce. Of the professional workforce NPs were most often used and home care aides dominated the non-professional workforce. As expected, ADRD increased the likelihood and intensity of home health care utilization and associated direct home care costs significantly.

Disease-specific nutrition for the elderly and their Caretakers- What was and what could be

Introduction Older adults who suffer from chronic illnesses often employ the help of Home Care Aides (HCAs). These HCAs assist their client’s nutrition and other activities of daily living. However, many HCAs who care for the elderly are themselves unaware of proper nutrition habits that can improve health outcomes. This project proposal centers on a nutrition-training program that focuses on HCAs and their knowledge of proper nutrition. It will challenge participants to eat better using foods are best suited to the chronic illness that their client suffers from. Approach The Nutrition Training Package contains materials that can be used in training sessions conducted over two days. Each day consists of interactive activities, discussions and presentations. These materials were adapted from interventions used by the Healthy Aging Program- an intervention previously hosted by EverThrive IL. Outcomes Although pilot testing is yet to be conducted, the training package is complete and ready for implementation. Conclusion Based on literature review, the contents of the Nutrition Training Package for Home Care Aides will guide participants through stages of the Model of Change, simultaneously creating the self-efficacy to contribute to elongated, healthier living for the elderly.

Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study

BackgroundNumerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides’ involvement in formal communications about resident care.MethodsSustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019–03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention.ResultsWe analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3.ConclusionsTheory-informed feedback provides long-lasting improvement in care aides’ involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study—as does possible post-intervention spread of our intervention to simple feedback homes.

Ulnar Neuropathy at the Wrist

A 51-year-old female homecare aide was referred by her orthopaedic surgeon to a physical therapist for electrodiagnostic and musculoskeletal ultrasound assessments for suspected right carpal tunnel syndrome (CTS). Given its diagnostic accuracy, availability, and cost relative to magnetic resonance imaging for CTS, musculoskeletal ultrasound was selected for evaluation, which revealed enlargement of the median nerve. JOSPT Cases 2021;1(3):148–149. doi:10.2519/josptcases.2021.9793

Reducing the Impact of Client Death on Home Care Aides: The Agency Perspective.

Reducing the Impact of Client Death on Home Care Aides: The Agency Perspective.

Assessment of home care aides’ respiratory exposure to total volatile organic compounds and chlorine during simulated bathroom cleaning: An experimental design with conventional and “green” products

Home care (HC) aide visits to clients’ homes often involve cleaning and disinfecting (C&D) bathrooms. Some ingredients in C&D household products are associated with respiratory illness, including sodium hypochlorite (bleach) and quaternary ammonium compounds (quats). “Green” products may be safer for the environment, however there are limited quantitative evaluations of their respiratory risks. This study assessed airborne concentrations and time profiles of total volatile organic compounds (TVOC) and chlorine generated during typical bathroom cleaning performed by aides using conventional and green products. Aides performed cleaning tasks in a simulated residential bathroom constructed in an environmental air sampling laboratory. A balanced experimental design involved each aide coming to the lab for four visits during which she performed two 20-min cleaning sessions using one of three C&D products (bleach-based, 1–5% sodium hypochlorite by weight; quats-based, 0.1–1% by weight quaternary ammonium compounds; and “green,” 0.05% by weight thymol, a component of botanical thyme oil) or distilled water as a control. TVOC and chlorine direct reading instruments were attached to aides with sample inlets located in the breathing zone. Ten-second averages of TVOC and chlorine gas concentrations and instantaneous peak concentrations were recorded for the sessions’ duration. TVOC concentrations by methods of C&D application (spraying, streaming, wiping) also were evaluated. The study completed 169 air sampling sessions with 22 aides. The quats-based product generated more than twice the average TVOC concentrations (mean = 1,210 ppb) than the bleach-based (mean = 593 ppb) or green (mean = 498 ppb) products. Each product generated TVOC concentrations that rose rapidly within the first few minutes of application. Spraying produced the highest TVOC exposures, wiping the lowest. Thirteen aides (65%) experienced peak chlorine exposures above the OSHA PEL ceiling limit (1 ppm) when using the bleach-based product. HC aides may experience respiratory hazards from use of conventional or green C&D products formulated with bleach or other respiratory irritants and sprayed in small, poorly ventilated spaces typical of bathrooms. Spraying should be avoided.

Home care aides’ attitudes to training on oral health care

This study investigated home care aides’ (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs’ intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the “uninterested” group, whereas 84.8% of the high scorers were classified in the “interested” group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add “disease and oral care-related content” and “safety protection, assessment, and usage of oral care tools during practical oral care process” to the oral healthcare training course content for HCAs in order to improve HCAs’ oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs.

Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home)

Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.

Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives.

For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies' perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.

Home Care Aide Safety Concerns and Job Challenges During the COVID-19 Pandemic.

Home care aides are on the frontlines providing care to vulnerable individuals in their homes during the COVID-19 pandemic yet are often excluded from policies to protect health care workers. The goal of this study was to examine experiences of agency-employed home care aides during the COVID-19 pandemic and to identify ways to mitigate concerns. We used an innovative journaling approach with thirty-seven aides as well as in-depth interviews with fifteen aides and leadership representatives from nine home health agencies in New York and Michigan. Workers described a range of concerns around workplace safety including uncertainty around whether a client had COVID-19, inadequate access to personal protective equipment and safe transportation, as well as fundamental changes to interactions with clients. Agencies also faced challenges acquiring personal protective equipment for their aides. This research points to needed resources to support home care aides and home health agencies both during a public health crisis and in the future.

Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job.

This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job. Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency. The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency. The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.

The Effects of the COVID-19 Pandemic on the Lived Experience of Diverse Older Adults Living Alone With Cognitive Impairment.

Background and ObjectivesEven before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4.3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic.Research Design and MethodsThis is a qualitative study of 24 adults aged 55 and older living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants’ lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts were analyzed to identify codes and themes.ResultsQualitative analysis of transcripts revealed 5 themes: (a) fear generated by the pandemic, (b) distress stemming from feeling extremely isolated, (c) belief in misinformation, (d) strategies for coping during the pandemic, and (e) the importance of access to essential services.Discussion and ImplicationsThis pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment. Findings underscore the need to expand access to home care aides and mental health services for this population.

Are Home Care Aides Interested in Helping Clients Do Physical Activity?

The current home care paradigm dictates home care aides (HCAs) provide prescribed help with activities of daily living, rather than stimulating older adults’ reserves to maintain independence. Little is known about whether HCAs are interested in expanding their role to promote their clients’ health. This study examined HCAs’ interest in helping clients do physical activity among workers who care for their family members or clients assigned by home care agencies in a Medicaid-funded home care program. Data came from brief surveys completed by HCAs at state-mandated in-service training sessions (N=602; 42% caring for non-family clients only, 38% family clients only, 20% both family and non-family clients). Ordered logit analysis was conducted to examine whether HCAs caring for family clients differ from those caring for non-family clients in levels of interest in helping clients do safe physical activity as part of home care work, controlling for HCAs’ age, gender, language (English/Spanish), and years of home care experience. HCAs’ interest levels were high (62% very, 21% somewhat, 8% slightly, 9% not at all interested). Ordered logit analysis indicated that HCAs caring for family members had significantly higher interest levels than those caring for non-family clients only (83% higher among HCAs caring for both family and non-family clients, 30% higher among HCAs caring for family clients only). To reflect HCAs’ interests and to maintain clients’ independence, home care workforce training should direct its attention to empower HCAs to assume health-promoting roles.

Physical Activity, Outcome Expectations, and Social Support in Dyads of Frail Older Adults and Their Home Care Aides

Frail community-dwelling older adults increasingly receive home care and continue to face barriers to participating in physical activity (PA) that could help maintain their function. Home care aides (HCAs) are well-positioned to promoting PA among older home care recipients because of their established relationship and regular interpersonal exchanges; yet, the role of HCAs in promoting and supporting PA in home care settings is seldomly studied. Using the quantitative and qualitative data from a 4-month home-based gentle PA intervention delivered by HCAs to their clients in a Medicaid-funded home care setting, the current study examined whether outcome expectations for exercise (OEE) held by HCAs led to client PA outcomes (i.e. functional limitations and physical performance) through social support for exercise (SSE) provided by HCAs. Longitudinal mediation analysis of 46 HCA-client dyads showed that higher baseline OEE held by HCAs were related to greater SSE reported by clients after the intervention (p<.05; bootstrapped standard errors), controlling for client-level covariates, including baseline OEE, age, gender, comorbidity, and whether HCA was client’s family member. Unexpectedly, SSE did not have significant association with client PA outcomes nor mediated the relationship between OEE held by HCAs and client PA outcomes. Qualitative data suggested alternative factors may explain the results, such as clients’ family beliefs in the intervention and clients’ participation experiences (such as expectation fulfillment). Future research should consider older home care clients’ family contexts to enhance our understanding of HCAs’ roles in preserving the function of growing numbers of older home care recipients.

Effects of COVID-19 Pandemic on the Lived Experience of Diverse Older Adults Living Alone With Cognitive Impairment

Background and Objectives: Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4,3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic. Research Design and Methods: This is a qualitative study of 24 adults aged 55 and over living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants’ lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. Results: Qualitative analysis of transcripts revealed five themes: 1) fear generated by the pandemic; 2) distress stemming from feeling extremely isolated; 3) belief in misinformation, 4) strategies for coping during the pandemic; and 5) the importance of access to essential services. Discussion and Implications: This pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment living. Findings underscore the need to expand access to home care aides and mental health services for this population.

Understanding Nursing Turnover: The Case of Home Health Care

Only a few studies of nursing turnover have examined post-acute home health care. This study examines factors that are associated with home health licensed nurse turnover using linked employee-level and patient-level data from one of the five largest home health companies in the US. The data include variables from human resources and payroll systems, visit logs, discharge records, physical and mental health assessments, care plans, and patient encounters and is organized at the employee-day level. We measured turnover using human resources data, including measures of voluntary and involuntary job separation, and from exit interviews that allow classification of whether turnover was associated with agency-related factors (e.g., pay, schedule, supervisor, coworkers) versus personal factors (e.g., family needs, relocation). In bivariate and multivariate analyses, explanatory variables included nurse demographics, patient population characteristics, and the degree to which nurses can delegate tasks to home care aides. We found a downward trend in turnover for licensed nurses between 2016 and 2019. Attrition in the first year was 34% for full-time nurses and 45% for part-time nurses, most of it occurring in the first 180 days of employment. The rate of voluntary turnover was nearly four times as great as involuntary turnover. We found that agency factors accounted for 26% of monthly turnover on average, while personal factors accounted for 74%. In states in which licensed nurses could delegate more tasks to home care aides, turnover rates were slightly higher than in states with little delegation.

Impacts of the COVID-19 Pandemic on Home Health and Home Care Agency Managers, Clients, and Aides: A Cross-Sectional Survey, March to June, 2020

Home health and home care (HH&amp;HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&amp;HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&amp;HC agencies, clients and aides. A survey of Massachusetts HH&amp;HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&amp;HC agencies, clients, and aides. Specific HH&amp;HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&amp;HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

Characteristics and Work Life Quality of Nursing Home Care Aides in Canada

This cross-sectional study describes care aides’ characteristics and quality of work life in Western Canadian nursing homes.

Financial Vulnerability and Worker Well-Being: A Comparison of Long-Term Services and Supports Workers With Other Health Workers.

Over 1.5 million new jobs need to be filled by 2026 for medical assistants, nursing aides, and home care aides, many of which will work in the long-term services and supports (LTSS) sector. Using 16 years of data from the American Time Use Survey, we examined the financial vulnerability of high-skill and low-skill LTSS workers in comparison with other health care workers, while providing insight into their well-being by measuring time spent on work and nonwork activities. We found that, regardless of skill status, working in LTSS was associated with lower wages and an increased likelihood of experiencing poverty compared with other health care workers. Results from time diary data indicated that the LTSS workforce spent a greater share of their time working and commuting to work. Low-skill LTSS workers were hardest hit, spending more time on paid and unpaid activities, such as household and child care responsibilities.

New Preventative Measures Against Coronavirus Disease 2019 for Home Care Aides in Taiwan.

New Preventative Measures Against Coronavirus Disease 2019 for Home Care Aides in Taiwan.