Home Health Care Aides Research Articles

Applying the Social Ecological Model to Understand Support for Home Healthcare Workers and Covid-19 Vaccine Uptake in N.J.

More than 3.6 M home healthcare aides are key parts of the U.S. healthcare workforce, serving older adults and individuals with disabilities living in the community. This study used a social ecological framework (SEM) to identify facilitators and barriers to Covid-19 vaccination among home healthcare aides and administrators in N.J. Key informant interviews with a purposive sample of home healthcare aides along with federal and state policy review were used to develop a survey of home healthcare administrators (HHA), which was sent to all home healthcare agencies in N.J. Results show that completed vaccination series rates among HHA were the same or higher than statewide and national rates, but there was skepticism about the utility of a booster among both aides and HHA. While organizational policy and information support around Covid-19 from the agencies to the staff was inconsistent, overall agencies acted as a driver for higher vaccination rates. At the intrapersonal level, individual self-assessment of risk was not consistent with actual risk, impeding vaccination. When all levels of the SEM are working in concert it can increase completed vaccinations. Key areas to target addressing the call for yearly boosters include organizational policy and intrapersonal factors aligning perceived and actual risk.

HOME HEALTHCARE WORKFORCE AND NEIGHBORHOOD CHARACTERISTICS

Abstract Despite the rapid increase in the needs for home- and community-based services (HCBS), including home health care which is the most commonly used HCBS, workforce shortage has become a critical challenge to home health agencies in providing quality care to meet the needs of millions of homebound Americans. This study aimed to examine the availability of home health care workforce and its variations by neighborhood characteristics. We linked several national datasets from 2019 and included information from 11,005 HHC agencies in 1,849 counties. The unit for analysis is county. We found that on average county had fulltime equivalent (FTE) 83 (SD=351) home health care nurses, 120 (SD=411) FTE skilled home health providers (e.g., nurses, physical/occupational therapists) and 37 (SD=411) FTE aides. For every 1,000 persons, on average counties had 0.7 (SD=4.6) FTE nurses, 0.9 (SD=4.7) FTE skilled providers, and 0.2 (SD=0.8)) FTE aides. For every 1,000 older adults (>=65), on average counties had 3.6 (SD=23.9)) FTE nurses, 4.8 (SD=24.6) FTE skilled providers and 1.2 (SD=4.4) FTE aides. We also found that counties with moderate (2nd tertile) proportion of Black and Hispanic Americans; counties with highest (3rd title) proportion of Black and Hispanic Americans had the lowest number of FTE home health care aides per every 1,000 persons. Our findings highlight the staff shortage facing home health care and suggest the existence of disparities in availability of home health care workforce.

Constructing What Counts as Human at Work: Enigma, Emotion, and Error in Connective Labor

The rationalization of human life in work, feeling, and relationships is amplified by artificial intelligence (AI), apps and automation, challenging interpersonal workers not only in how and whether they do their work, but also how they understand themselves as human. Given these trends, how do interpersonal workers interpret the humanness of their work? To answer this question, I focus on the interactive service work I call “connective labor,” relying on 80+ in-depth interviews and 300+ hours of ethnographic observations with teachers, therapists and primary care physicians in the San Francisco Bay Area and mid-Atlantic United States, as well as with less advantaged practitioners such as sex workers, hairdressers, and home health care aides. I found that these interpersonal workers differentiated themselves from AI, automated agents, and robots in three ways: (1) by describing and defending their work as not rote, (2) taking pains to prove that they were not robots, and (3) justifying their judgments as safe, unique, and worthwhile. Much of their case rested on the unpredictability of humans, in terms of feelings, secrets, and mistakes. These findings have implications for race, class, and gender inequality, as advantage shaped how people were able to demand, perform, or experience their humanness in the ways that the proliferation of algorithmic technologies made salient.

Challenges and Facilitators to Effective Infection Prevention in Home Health Care: Results From Qualitative Interviews of Home Health Care Services

Background: As the population of older Americans with chronic conditions continues to grow, the role of home health care (HHC) services in improving care transitions between acute care and independent living has become a national priority. Infection prevention and control (IPC) is often a focus of quality improvement initiatives at HHC agencies. In this study, we investigated barriers and facilitators of effective IPC in HHC. Methods: In 2018, we conducted in-depth, telephone interviews with 41 staff from 13 agencies across the United States including administrators, IPC and quality improvement personnel, registered nurses and HHC aides. Interview transcripts were coded in NVivo v 12 software (QSR International), and themes were identified using content analysis. Results: We identified 4 themes: (1) IPC as a priority, (2) uniqueness of home health care, (3) importance of education, and (4) keys to success and innovation. When discussing the top priorities in the agency, participants described IPC as a big part of patient safety and as playing a major role in reducing rates of rehospitalization. Protection of patients and staff was described as a major motivator for compliance with IPC policies and procedures, and agencies placed specific focus on improving hand hygiene, bag technique, and disinfection of equipment. Almost all participants described the uniqueness of providing health care in a patient’s home, which was often talked about as an unpredictable environment due to lack of cleanliness, presence of pets and/or pests, and family dynamics. Furthermore, the intermittent nature of HHC was described as affecting effective implementation of IPC procedures. Education was seen as a tool to improve and overcome patient, caregiver, and families’ lack of compliance with IPC procedures. However, to be effective educators and role models, participants stated that they themselves needed to be properly educated on IPC policies and procedures. Several keys to success and innovation were discussed including (1) agency reputation as a key driver of quality; (2) agency focus on quality and patient satisfaction; (3) using agency infection data to improve the quality of patient care; (4) utilizing all available resources within and outside of the agency, and (5) a coordinated approach to patient care with direct, multimodal communication among all clinical disciplines. Conclusions: This qualitative work identified barriers to effective infection prevention and control in HHC and important facilitators that HHC agencies can use to improve implementation of policies and procedures to improve patient care.Funding: NoneDisclosures: None

New Jersey Home Health Care Aides Survey Results.

The objective of the study was to report on what violence-based training home health care aides received, their participation in health promotion classes, and home health care aides' experience with workplace violence. In 2013, a mail survey was completed by 513 home health care aides in the state of New Jersey. Ninety-four percent of the respondents were female. Respondents whose agency was part of a hospital were more likely to receive violence-based safety training than respondents whose agency was not part of a hospital (p = .0313). When the perpetrator of violence was a patient or family member, the respondents experienced verbal abuse the most (26%), then physical assault (16%) and exposure to bodily fluids (13%). Home health care aides whose agency was part of a hospital were more likely to receive violence-based safety training. Training is an important component of a workplace violence prevention program.

Musculoskeletal Pain and Interest in Meditation and Yoga in Home Health Aides: Evidence From the Home Health Occupations Musculoskeletal Examinations (HHOME) Study.

Home healthcare aides (HHAs) are a growing U.S. workforce highly susceptible to workplace stressors and musculoskeletal pain. In the present study we: 1) examine the association of musculoskeletal pain to life satisfaction and emotional exhaustion; and 2) characterize interest in meditation and yoga in a sample of HHAs. A nonprobabilistic sample of HHAs employed at home healthcare agencies in Florida, Massachusetts, and Oregon (n = 285 total) completed a self-administered questionnaire with standard survey measures on musculoskeletal pain location, duration, and severity; life satisfaction; emotional exhaustion; and interest in meditation techniques and yoga. Among HHAs responding, 48.4% reported pain in the last 7 days and 46.6% reported pain in the last 3 months. Home healthcare aides who reported current pain and chronic pain had a significant (P < .05) decrease in satisfaction with life score and a significant increase in emotional exhaustion score. The majority of HHAs reported an interest in learning about the benefits (65.6%) and practice (66.4%) of meditation and a willingness to participate in a yoga class (59.2%) or stress management meeting (59.1%). The HHAs reported both acute and chronic musculoskeletal pain that was correlated with lower life satisfaction and greater emotional exhaustion. More efforts are needed to reduce the sources of injury and emotional exhaustion.

In Celebration of Home Healthcare Aides.

In Celebration of Home Healthcare Aides.

Complexity of occupational exposures for home health-care workers: nurses vs. home health aides.

To identify occupational exposures for home health-care nurses and aides. Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited. Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test. A majority of the sample was over 40years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke. Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards. Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue.

Home Health Aide Training: An Appeal for Organizational Support.

How home healthcare aides (HHAs) adapt their classroom training to their workplaces is central to their own safety and that of their care recipients. A qualitative approach was adopted for this inquiry, where new workers were interviewed in-depth following their classroom training. Findings suggest a perceived lack of supervisor support for classroom training and lack of follow-up in the workplace. Moreover, the need for more peer support was contended, and more comprehensive written materials in clients' homes may also assist workers' learning and enacting safe manual handling techniques in the workplace. The article concludes with recommendations for supporting HHAs' learning, and includes suggestions for future research.

Developing Culturally Diverse Direct Caregivers for Care Work With Older Adults: Challenges and Potential Strategies

This discussion presents real-world examples of challenges that occur in geriatric training as a contribution to the ongoing conversation about tailored training for direct caregivers. Numerous discussions are available on the need for more geriatric training in nursing, including aspects of care for patients with dementia, but few if any studies have identified a similar need on behalf of direct care workers, including home health care aides,personal care aides, and nursing assistants who are not part of a licensure track or a baccalaureate-based nursing curriculum. This discussion examines three cultural factors that underlie challenges for nursing educators and supervisors in dementia care who oversee direct care workers: (1) the effect of immigrant cultures and languages; (2) the effect of different intergenerational cultural constructs; and (3) the effect of culturally derived attitudes about aging and dementia. Strategies to address these challenges are offered.

New working conditions and consequences on activity of home healthcare workers

Home healthcare is steadily growing in Europe. There are a number of reasons for this development: aging population, rising hospital costs, preference to stay in one's own home. Nevertheless, it has been known that home healthcare workers are frequently exposed to a variety of potentially serious occupational hazards. Furthermore, emotional labor is frequently high in this profession. This paper describes an ergonomic study conducted at a home healthcare service. The research focuses on analyzing working conditions of home healthcare aides and nurses, as well as the impacts of their work in terms of job satisfaction, well-being, emotions at work, relationships with the others and occupational stress. The study show that employee strategies are specifically centered around preserving the relationship between patients and workers and coping with the job demands. This paper also shows that home healthcare workers express emotions and conceal them from others. Finally, recommendations discussed with the manager and workers to improve working conditions in this sector led to practical proposals: for example, implementing certain equipment items better suited to difficult care, encouraging assistance between healthcare workers when operations require this through adequate organizational measures, extending work emotion-focused discussion groups with management involvement.

Risk Factors Associated with Patient Assaults of Home Healthcare Workers

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47-12.67), routinely handling patients (OR = 8.48, 95% CI 1.89-37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75-11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.

Safety Factors Predictive of Job Satisfaction and Job Retention Among Home Healthcare Aides

Although many of the well known work characteristics associated with job satisfaction in home health care have been documented, a unique aspect of the home health care aides' (HHA) work environment that might also affect job satisfaction is the fact that their workplace is a household. To obtain a better understanding of the potential impact of the risks/exposures/hazards within the household environment on job satisfaction and job retention in home care, we recently conducted a risk assessment study. Survey data from a convenience sample of 823 New York City HHAs were obtained and analyzed. Household/job-related risks, environmental exposures, transportation issues, threats/verbal and physical abuse, and potential for violence were significantly correlated with HHA job satisfaction and job retention. Addressing the modifiable risk factors in the home health care household may improve job satisfaction and reduce job turnover in this work population.

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

The Betrayal of Work: How Low-Wage Jobs Fail 30 Million Americans and Their Families (review)

Reviewed by: The Betrayal of Work: How Low-Wage Jobs Fail 30 Million Americans and Their Families Gwendolyn L. Evans and Paula B. Voos The Betrayal of Work: How Low-Wage Jobs Fail 30 Million Americans and Their Families. By Beth Shulman. New York: The New Press, 2003. 240 pp. $25.95 hardback. Beth Shulman captures the essence of low-wage working and living conditions in America by introducing us to workers like Cynthia Porter, an African American nursing assistant in Meridian, Alabama. Ms. Porter earns $350 every two weeks, lives in a shack, and pays others to give her a ride to work since she lacks a car. In this book, we meet call center [End Page 119] workers, child care workers, janitors, poultry-processing workers, home health care aides, guest room attendants, pharmacy assistants, and receptionists. Through a combination of their stories and a review of relevant statistical information, Shulman develops several important themes. First, low-wage workers face daily assaults on their very humanity. Shulman argues that they lack the basic human right of being respected. They are largely invisible, which allows them to be treated with indifference. Furthermore, most low-wage workers are stuck in positions that do not allow them opportunities for upward mobility, contrary to one of our most deeply held myths. Finally, many low-wage workers are minorities, and their ethnic/racial identity furthers the lack of public concern. Research reveals that many low-wage workers do not have the luxury of taking a day off if they are ill or need to care for an ill family member. Nor do they have the right to request an increase in pay. The very request for time off or a pay increase could be used as a reason for termination of employment. And for a worker who is injured on the job, "light duty" does not exist. Shulman urges that we as a society must "bear one another's burdens in more ways than one." She provides a very comprehensive review of public policy options for improving the lot of low-wage workers: raising the minimum wage or providing for living wages, maintaining full employment, strengthening the Earned Income Tax Credit and Child Tax Credit, providing paid family and medical leave, and many others, including once again making it possible for workers to unionize. Shulman argues that the label "low-skill" that is often applied to these jobs in public policy discussions is incorrect and has been a barrier to improving conditions in these socially necessary jobs. Anyone reading this book will be hard pressed to walk down the supermarket aisle, visit a nursing home, hotel, or office with the same myopic vision they had before reading it. It would be a useful text in the classroom or in an adult education context precisely because it combines vivid examples with substantive statistical analysis and relevant policy recommendations. Shulman's book compels each of us to examine where we would be as a nation, were it not for low-wage workers and to think about how we can make their concerns part of the political agenda in the U.S. Gwendolyn L. Evans Brookdale Community College Paula B. Voos Rutgers University Copyright © 2005 the West Virginia University Press, for the United Association for Labor Studies

Home Health Care Aides as Extenders of Therapy Services: A Managed Care Pilot Program

Home Health Care Aides as Extenders of Therapy Services: A Managed Care Pilot Program

Home Health Care Aides as Extenders of Therapy Services: A Managed Care Pilot Program

The purpose of this project was to examine the feasibility of utilizing the home health care aide as extender of therapy services. The pilot was conducted over a one-year period involving four Kaiser home health agencies. A scope of practice analysis was completed. A resource manual and training program for home health care aides were developed. Data were collected using questionnaires, tracking logs, chart audits, and telephone case conferencing. A case study approach was used to evaluate the feasibility and cost-effectiveness of this program in lieu of skilled nursing home rehabilitation. The findings of this study showed that therapists' attitudes, perceptions, and practice patterns are critical to successful implementation of this practice. Furthermore, management buy-in and leadership were also found to have a significant impact on the use of home health care aides. Recommendations included documentation and competency testing procedure redesign. Overall, this study concluded that there is opportunity to increase the therapist to home health care aide skill mix with positive clinical outcomes, but that further study is needed to identify optimum skill mix and appropriate case mix indicators.

Nutritional Management of Diabetes in Home Care

Medical nutrition therapy is a vital component of nutritional management of diabetes in home health care. Many studies document the cost-saving and therapeutic benefit of nutrition intervention in diabetes care. Home health care agencies need to have dietitians on staff for nutrition assessment, counseling, and development of individual patient care plans. Dietitians can help to train nurses and home health care aides in interdisciplinary patient care that incorporates the 1994 nutrition recommendations and principles for people with diabetes mellitus. There are benefits and barriers to home health care nutrition visits, and providing medical nutrition therapy to home health care patients with diabetes can bring about lasting, permanent change.

Professional Development of Home Health Care Aides: The Key to Retention

In the changing health care arena, there are intense demands to provide quality, cost-effective service. Retaining qualified staff is essential for all health care organizations. Home care organizations can maximize the return on dollars spent and clients can receive the maximum benefit from health care dollars spent by promoting the professional development of home health aides. Increased skills and confidence in skills enhances the effectiveness and efficiency of care delivered. Promoting professional development increases job satisfaction, which increases staff retention and saves dollars. A team approach to the professional development of home health aides benefits staff, home care, organizations and, most importantly, clients.