Home Care Workers Research Articles

Uptake and effects of psychological first aid training for healthcare workers' wellbeing in nursing homes: A UK national survey.

Psychological First Aid is a brief intervention based on international guidance from the World Health Organisation. Free to access online training in the intervention was introduced during the COVID-19 pandemic in UK. We aimed to determine the uptake of Psychological First Aid training among healthcare workers in care homes in the UK and to assess its effects on their wellbeing. This was a sequential mixed methods design. Healthcare workers (nurses and carers) working in care homes in the UK were surveyed about their uptake of Psychological First Aid, their stress, coping efficacy and the key concepts of Psychological First Aid (safety, calmness, hopefulness, connectedness, and accomplishment). Those that completed the Psychological First Aid training were asked to share their experiences via qualitative survey. Data collection was conducted between June and October 2021. Analyses included descriptive statistics and regression analysis. A six step thematic analysis was used to interpret the qualitative data. 388 participants responded to the survey. The uptake of Psychological First Aid training was 37 (9.5%). Psychological first aid was a significant predictor for coping efficacy (β = 17.54, p = .001). Participants with a physical or mental health condition experienced higher stress and lower coping regardless of PFA training. Four themes were identified from the qualitative analysis: self-awareness and growth, relationships with others, overcoming stress and accessibility. While this study suggests some benefits to healthcare workers in care home settings undergoing PFA the poor uptake of the training warrants further investigation. Care home staff need psychological support. This gap remains as few completed PFA training. This is the first study in UK and worldwide to look at the effects of psychological first aid on stress and coping in this population and it warrants further investigation.

Care ensembles: examining relational aspects of care in the context of home care

We adapt the concept of the ‘consumption ensemble’ to capture the nuanced collaborations between actors in the provision and receipt of home care. Data were from a ten-year study of home care clients, family carers and workers in selected Canadian provinces. Using the lens of the ‘ensemble’, we analysed interviews with 24 dyads (carers and clients) and reviewed findings of our previously published research. Evidence of agency as collective endeavour supporting client autonomy and of improvisation in the ensemble informed a revision of our previous interactive model of care, emphasising the bidirectional nature of care relationships.

"It Hits Me Right Here at my Heart": Promoting Emotional Health of Home Care Workers.

Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.

"I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic.

Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers’ roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.

The Hidden Script of Work-Related Burdens in Home Care - A Cross Over Mixed Analysis of Audio Diaries.

The lived experiences of work-related burdens in the daily working routines of home care workers are insufficiently investigated. Therefore, the aim of this study is to examine the types, frequencies, and distributions of work-related burdens and to explore their co-occurrence. Qualitative data was collected via audio diaries and analyzed applying a crossover mixed analysis using content as well as network analysis. In all, 23 home care workers (mean age = 46.70 ± 10.40; 91.30% female) produced 242 diary entries. Participants reported work-related burdens 580 times with 77 different types, predominately in relation to work organization (50.5%). Network analysis reveals a complex picture, which shows the strong relation between time pressure and travel between homes, and identifies additional tasks as the central node in the network of burdens. A holistic understanding of setting-specific burdens provides an important starting point for measures of workplace health promotion.

Screen-based home care visits, care work and old age in the Scandinavian welfare state - the case of Denmark

Screen-based home care visits, care work and old age in the Scandinavian welfare state - the case of Denmark

Factors associated with Finnish home care workers job satisfaction

Abstract Background In Finland, home care is seen as a primary form of care for older people. However, rising numbers of clients with increasingly complex conditions have led to deteriorated working conditions and poor job satisfaction among home care staff. In this study, we examined if greater amount of direct care time, higher team autonomy, number of unique clients, and client’s need for care are associated with job satisfaction. Methods Data for the study was collected in October 2021. The amount of direct care and number of unique clients were obtained from a staff time measurement in home care units. The level of team autonomy was obtained from a survey sent to managers of participating organizations. Demographic information and a score for job satisfaction were retrieved from a survey for workers in the participating organizations. Client’s need for care was based on Resident Assessment Instrument (RAI). Data was analyzed using multiple linear regression. Results The number of respondents was 387, of which the majority were practical nurses 307 (79%). Higher team autonomy was associated with better job satisfaction, whereas higher number of unique clients and higher amount of direct care time were associated with poorer job satisfaction. The models were adjusted with clients’ care needs, but these effects will be further examined. Conclusions The results demonstrated that the workers are more satisfied if there is enough time to perform the work, they have adequate number of clients, and teams have autonomy over their work. This seems to be the case despite the level of clients’ need for care, however this needs further analysis. By increasing job satisfaction, better retention of care workers and attraction of care work might be achieved. Key messages • Higher team autonomy is associated with care worker’s job satisfaction. • Enhancing care continuity is important, therefore, when planning home care workers’ workday, it is important to consider that the workers could work with clients they know.

Using Independent Contracting Arrangements in Integrated Care Programs for Older Adults: Implications for Clients and the Home Care Workforce in a Time of Neoliberal Restructuring.

Integrated care programs reshape the processes of health and social care delivery in the home care sector to be more continuous, cooperative, equitable, and efficient. An independent contracting model is one approach being used to overcome issues related to home care fragmentation. To better understand the implications of this model of service delivery for clients and carers, interviews were conducted in 2013 with 22 key informants. Data were analyzed using thematic analysis and interpreted using a feminist political economy framework. This study finds that independent contracting arrangements improve care continuity for clients while simultaneously reinforcing precarious working conditions for home care workers. This research calls for reform to this model of service delivery to better support home care workers as they provide the care necessary for older adults to age in place.

Second-hand Smoke Exposure Among Home Care Workers (HCWs) in Scotland.

Second-hand tobacco smoke (SHS) is a serious cause of ill-health, and concern around SHS exposure at work has driven legislation in public places. In Scotland, most workers are now protected from SHS at work. However, home care workers (HCWs) may still be exposed, as they enter private homes where smoking is unregulated. In this study, we aimed to understand the extent, duration and intensity of that exposure among HCWs in Lanarkshire, Scotland. We surveyed HCWs in four organisations involved in providing care at home: a public healthcare agency (NHS Lanarkshire), two local government entities and a private healthcare company. We also conducted personal exposure monitoring (PEM) of exposure to airborne nicotine and SHS-related fine particulate matter (PM2.5) with 32 HCWs. The vast majority of HCWs surveyed reported being exposed to SHS at work (395/537, 74%), and 50% of those who reported exposure in the home indicated daily exposure. We conducted PEM over 82 home visits, with 21% (17) demonstrating PM2.5 concentrations in excess of the WHO's 2010 air quality guideline limit for 24 h exposure. Duration of exposure to SHS tended to be short and as a result all nicotine samples were below the limit of quantification. Most HCWs are exposed to minimal levels of SHS at work. However, a minority may be exposed to concentrations which affect health. Policies to mitigate this exposure should be considered, such as the use of respiratory protective equipment, improved ventilation during visits, and interventions to reduce smoking in homes.

Addressing the Home Care Shortage: Predictors of Willingness to Provide Paid Home Care in New York

To determine the prevalence and predictors of willingness to consider becoming a paid home care worker. Cross-sectional telephone-based survey study. 800 adult residents of New York State participating in the 2020 Empire State Poll, an annual survey conducted in English and Spanish using random-digit dialing. Willingness to consider working as a paid home care worker was analyzed as the main outcome. Survey questions also involved demographics and unpaid caregiving experience. We used multinomial logistic regression to examine associations between participant characteristics and willingness to be a paid caregiver. Participants had a mean age of 47.7years (95% CI 45.4-50.0). Demographic information included 51.1% female gender, 65.4% White race, 13.4% Black race, 6.4% Asian or Pacific Islander, 14.8% another race, 19.1% Hispanic/Latino ethnicity, and 43.0% household income below $50,000 per year. A weighted 25.4% of participants would consider becoming a paid home care worker. In an adjusted model, willingness to be a paid home care worker was associated with younger age [odds ratio (OR) 0.98, 95% CI 0.96-1.00, P= .032], female gender (OR 2.46, 95% CI 1.35-4.46, P= .003), Black or other race (OR 2.40, 95% CI 1.11-5.17, P= .026, and OR 3.13, 95% CI 1.30-7.54, P= .011, respectively), Hispanic ethnicity (OR 2.26, 95% CI 1.06-4.81, P= .035), household income below $50,000 per year (OR 2.00, 95% CI 1.03-3.88, P= .040), and having provided unpaid family caregiving (OR 2.08, 95% CI 1.15-3.76, P= .016). A quarter of New Yorkers would consider working as a paid home care worker. Willingness to consider this occupation was associated with the demographic characteristics disproportionately represented in the current home care workforce. Improved working conditions and compensation could help attract and retain home care workers, thereby addressing the rising need for home care in the United States.

Research priorities for homecare for older people: A UK multi-stakeholder consultation.

Homecare is generally understood to refer to services that support people to continue living in their own homes. Older people are the primary users and many countries report an increase in the number using homecare services and greater spending on such provision, driven in part by investment in 'ageing in place' policies. Despite this, and reflecting social care more generally, homecare is relatively under-researched. However, in the UK at least, there is growing interest and investment in social care research. In order that this investment is not wasted, it is essential that research addresses what stakeholders identify as research priorities. This study reports work undertaken in the UK during 2021/22 to identify research priorities for homecare for older people, and a broad scoping of existing evidence. A two-stage consultation process was used. First, topic areas for research were identified through consultations with stakeholders. Second, a survey ascertained agreement and differences between groups regarding the relative importance of topic areas as research priorities. Over 50 people participated including older people (n=7), family members (n=11), homecare workers (n=16), homecare providers (n=9) and national policy, evidence and advocacy leads (n=13). Twenty discrete research topic areas were identified. Only one topic area (Joint working between homecare and health services) was a 'Top 5' research priority for all stakeholder groups. Timely engagement with homecare and Workforce: recruitment and retention were 'Top 5' priorities for three stakeholder groups. Scoping of existing research indicates that topic areas receiving the most research attention to date are not among those identified as being of high priority for research. To our knowledge, this is the first time research priorities for homecare have been generated. Findings will be of value to research funders, organisations using research evidence and the research community.

Teaming up to traverse loneliness: a co-creative journey toward a home care work model for supporting social participation among older adults

BackgroundParticipatory research is particularly suitable in adressing know-do gaps in health systems. There is a disparity between what is known about the benefits of social participation and home care’s responsibility to provide conditions amenable to older adults’ social participation, and what is accomplished in home care practice. Home care workers are a large, low-power group, whose competences should be better harnessed. We carried out a participatory action research (PAR) project with the goal of generating an improved structure for identifying and alleviating loneliness. This article aims to explore the co-creative process of designing a work model that guides home care workers in supporting social participation among older care recipients.MethodsMultimodal data from 16 PAR workshops with 14 home care workers were described and explored through the ‘recursive PAR process’ and the ‘framework for occupational enablement for change in community practice”.ResultsThe PAR process is outlined through the objectives, activities, and work model, as well as enablement strategies employed throughout the PAR process; as are its opportunities, challenges and implications. The work model describes how care workers can act as discoverers of care recipients’ unmet social needs, employ intentional communication, and link to relevant professions or community services to alleviate loneliness among older home care recipients.ConclusionsThis research process included opportunities of collaborating with enthusiastic and competent home care workers, but also challenges of moving between theory and practice and maintaining active participation between workshops. The resulting work model is in step with the requirements of elderly care, is unique in its field and could comprise a first step toward a more systematic approach of assessing and addressing loneliness. The vivid delineation of the PAR process provided in this paper can aid other researchers in navigating participatory research in home care contexts.

Improving nutrition and hydration in older people with dementia in care homes.

Dementia can have significant adverse effects on people's ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occur more often in the middle and late stages. It is important that nurses and care staff working in care homes have the appropriate knowledge and skills to provide optimal nutritional care to residents, thereby improving their health, well-being and quality of life. This article provides an overview of nutrition and hydration issues commonly experienced by people with dementia. It explores common causes of suboptimal nutrition and hydration, outlines tools for nutritional screening and assessment and discusses interventions to improve the nutritional care of care home residents with dementia.

A Case for Federal Labor Legislation to Protect Underpaid Home Care Workers.

The National Domestic Worker's Bill of Rights Act aimed to remedy nearly a century of labor and health inequities facing a majority of the home health workforce-including home health workers, personal care aides, and professional caregivers-who are women of color and immigrants. Although the bill did not pass, the National Domestic Workers Alliance and its affiliates continue to organize a new labor movement inclusive of home care workers that supports federal legislation and adequate labor protections for their members, particularly in right-to-work states like Texas and in municipalities where hazardous working conditions and low wages contribute to the perceived disposability and devaluation of care labor. Home care workers require federal labor protections that will hold states accountable for the health and well-being of this essential workforce.

Conceptualizing violence in nursing home policy: A citizenship perspective

Violence is a pervasive, yet often hidden, issue within nursing homes, affecting residents, family members and care workers. Critical exploration of embedded understandings of violence within public policies can provide important insights into how violence is viewed and addressed in nursing home environments as well as the implications of violence for different groups and alternative ways of framing and addressing violence. To this end, this study explored how violence is conceptualized within 45 nursing home policy texts from two Canadian provinces - Manitoba and Nova Scotia. Using a critical policy analysis approach and a citizenship lens, we identified four dominant constructions of policy ‘targets’ associated with specific rights and conceptualizations of violence. Policy documents construct residents as either vulnerable and in need of protection or as challenging and requiring behavior management. Care workers are constructed as either clinical risk managers, responsible for mitigating violence, or as employees with rights and responsibilities. Overall, violence prevention policies governing nursing homes are fragmented and convey conflicting conceptualizations of violence, associated with divergent rights and responsibilities. Our findings highlight the need for comprehensive violence prevention policies that affirm the rights of nursing home residents and care workers alike.

‘It's always a battle against time’. Experiencing and handling temporal conditions in homecare work

AbstractIn most Western countries, the eldercare sector has undergone transformations to obtain cost containment and more efficient service provision, changing the temporal framing of homecare. Time pressure is a salient issue in homecare, but little is known about how homecare workers experience the temporal conditions of their work. Based on 13 group interviews with homecare workers in Sweden, this study examined how the staff experience temporal conditions and handle time pressure in their everyday work in a context of marketisation and increased use of ‘information and communication technology’. The analysis showed that the workers attributed their experiences of time pressure to the compression of time, the control of time and the unpredictability of time. Strategies adopted to handle time pressure included working unpaid hours, maximising efficiency and reallocating time. It is concluded that the homecare workers primarily adopted individual short‐term strategies to deal with structural and organisational temporal issues.

Effects of a dementia virtual reality-based training with peer support for home care workers: A cluster randomized controlled trial.

Home care workers who are the first-line care workers for community-dwelling dementia patients often have limited dementia knowledge, skills, and empathy towards those with dementia. Research is sparse on dementia care training using virtual reality (VR) technology and support network for home care workers. This cluster randomized controlled trial evaluated the effects of a dementia VR-based training with peer support on dementia knowledge, attitude, competence, and empathy of home care workers. Each home care worker team was used as the unit for randomization. Sixteen teams were randomly assigned to either VR group or non-VR control group There was a total of 124 participants completed the study, the VR group (n=61) received a dementia VR-based training consisted of 3-month dementia care e-book modules, dementia VR-based activity and 1-h monthly face-to-face peer support group meetings. The non-VR control group (n=63) only receive the 3-month dementia care e-book modules and 1-h monthly regular staff meetings with no VR activity. Outcome measures were assessed at three time points: baseline, the end of the 3-month intervention, and 1-month post intervention. Generalized estimating equations results indicate that the improvement in dementia knowledge, attitudes, competence, and empathy over time is significant in the VR group compared to the non-VR control group. The effects remained significant 1month after the end of the 3-month intervention. Innovative and accessible dementia training using VR technology with peer support is a promising training approach to improve dementia knowledge, attitudes, competence, and empathy of home care workers.

Spot It, Prevent It: Evaluation of a Rapid Response Algorithm for Managing Workplace Violence Among Home Care Workers.

Workplace violence incidents remain pervasive in health care. Home care workers like personal support workers (PSWs) provide services for clients with dementia, which has been identified as a risk factor for workplace violence. The objective of this study was to evaluate whether the implementation of a rapid response algorithm resolved unsafe working conditions associated with responsive behaviors and decreased perception of risk. A nonexperimental pre- and post-evaluation design was utilized to collect data from PSWs and supervisors. PSWs completed an online survey about their experience with workplace violence and perception of risk. Bi-weekly check-ins were conducted with supervisors to track incidents and their level of resolution in the algorithm. Semi-structured interviews were also conducted to gather in-depth feedback about the algorithm in practice. We found no difference in risk perception among PSWs pre- and post-implementation. However, PSWs who had been employed for less than 1 year had a significantly higher risk perception. Overall, the algorithm was found to be helpful in resolving workplace violence incidents. Opportunity exists to further refine the algorithm and ongoing dissemination, and implementation of the algorithm is recommended to continually address incidents of workplace violence. Newly hired PSWs may require additional supports. Ongoing education and training were identified as key mitigation strategies.

A qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people: Learning from frontline staff experiences.

COVID‐19 had a devastating impact on older people living in care homes. This study explored the clinical trajectory and management of COVID‐19, as well as recovery of older people following infection during the early stages of the pandemic (May to August 2020). A two‐phase exploratory qualitative study was used. Frontline staff with experience of caring for older people with COVID‐19 were recruited to Phase 1, and senior care home operational and quality managers were recruited to Phase 2. During Phase 1 remote semi‐structured interviews (n = 35) were carried out with staff working in care homes, hospital and community settings in England. During Phase 2, a remote consultation event was carried out with senior care home operational and quality managers (n = 11) to share Phase 1 findings and check resonance, relevance and gaps. Data were analysed using Framework Analysis. Older people with COVID‐19 presented with wide ranging symptoms, and an unpredictable illness trajectory. The wide range of COVID‐19 symptoms required timely testing and supportive interventions. Staff used different interventions to manage symptoms and reported uncertainties of how individuals would respond. In care home settings, health and social care staff needed to work together when administering interventions such as subcutaneous fluids or oxygen therapy. Alongside symptom management, supportive care focused on nutrition and hydration, social interaction, and maintaining physical activity to meet both physical and emotional needs. The effects of prolonged periods of social isolation and inactivity on the health and well‐being of older people means rehabilitation is essential to enhance physical and emotional recovery, and to minimise impacts on cognition and function. The pandemic highlighted important areas for care of this population.

Migração, Trabalho Doméstico e Políticas Públicas de Cuidados de Longo Prazo na Espanha

Abstract: This article explores the impact of the Covid-19 pandemic on the labour conditions of migrant workers who provide care to elderly and dependent persons in Spain. Using data from the Active Population Survey, we analyse the effects of the health crisis on the precariousness of this labour sector (measured through unemployment, underemployment and temporary employment). The figures shed light on the degradation of working conditions during the health crisis, the situation of social vulnerability experienced by female workers and the absence of effective policy responses to reverse this inequality during the pandemic. This situation of subordination is structured around the connection between the demand for care workers in private homes and the philosophy behind the public welfare system. Special emphasis is given to the effect of cash transfer programs in the process of the commodification of care.