Home Care Workers Research Articles

The Home Care Workforce Has Not Kept Pace With Growth In Home And Community-Based Services.

Home and community-based services (HCBS) are the predominant approach to delivering long-term services and supports in the US, but there are growing numbers of reports of worker shortages in this industry. Medicaid, the primary payer for long-term services and supports, has expanded HCBS coverage, resulting in a shift in the services' provision out of institutions and into homes. Yet it is unknown whether home care workforce growth has kept up with the increased use of these services. Using data from the American Community Survey and the Henry J. Kaiser Family Foundation, we compared trends in the size of the home care workforce with data on Medicaid HCBS participation between 2008 and 2020. The home care workforce grew from approximately 840,000 to 1.22million workers between 2008 and 2013. After 2013, growth slowed, ultimately reaching 1.42million workers in 2019. In contrast, the number of Medicaid HCBS participants grew continuously from 2008 to 2020, with accelerated growth between 2013 and 2020. As a consequence, the number of home care workers per 100 HCBS participants declined by 11.6percent between 2013 and 2019, with preliminary estimates suggesting that further declines occurred in 2020. Improving access to HCBS will require not just expanded insurance coverage but also new workforce investments.

Computer-Mediated Sharing Circles for Intersectional Peer Support with Home Care Workers

Home care workers (HCWs) provide essential care in patients' homes but are often underappreciated and work in stressful and isolated environments with diverse and intersecting support needs. This paper describes a computer-mediated peer support program that centers around sharing circles: spaces for personal, narrative storytelling to encourage HCWs to collaboratively reflect on their home care experiences and build rapport and shared identity with their peers. We describe the design of this program and a 12-week deployment that we conducted to evaluate the program with 42 HCWs in New York City. Our findings show that participants engaged in multiple types of peer support including emotional validation, learning how to navigate the workplace and patient care, defining and enabling good home care praxis, and building understanding around purpose and identity as HCWs. We discuss how these findings inform the design of technology and use of holistic pedagogies, such as storytelling, to enable this support in computer-mediated peer support programs. Such programs can help researchers and practitioners interested in addressing diverse needs that occur in intersectional contexts, such as that of HCWs and other marginalized populations.

454 Exploring the views of care home staff on the use of antipsychotics for people with dementia amid the COVID-19 pandemic: A qualitative study

Abstract Introduction There was an increase in antipsychotic prescribing for people with dementia during the COVID-19 pandemic (1). To explain this increase, the current study was conducted to explore the views of staff working in care homes for the elderly during the pandemic on the use of antipsychotics for residents with Behavioural and Psychological Symptoms of Dementia (BPSD). Aim The aim was to explore the use of antipsychotics for people with BPSD during the COVID-19 pandemic by interviewing staff in care homes about their experiences during that time. Methods Semi-structured interviews were conducted online with staff working in ten UK elderly care settings using convenience sampling. Participants mainly onsite care home staff were recruited through online networks, for example, Twitter, and support groups such as CHAIN and NIHR clinical research network. Interviews were conducted between May 2021-March 2022, were audio recorded, transcribed verbatim, and analysed inductively using thematic analysis in NVivo version 12. Results Ten interviews were completed with managers (n=2), care staff (n=6) and nurses (n=2) in nursing homes (n=7) and residential homes (n=3) (all were female). The first theme ‘Challenges experienced in care provision’ entails challenges experienced in the care environment; residents were confined to their rooms, activities were suspended, staff were absent and stressed, and family visits were barred. The reduced human contact affected residents’ sense of self, mental and physical wellbeing, and in turn, their behaviours. The second theme ‘Prescribing process’ refers to doctors prescribing medicines in response to staff raising concerns. The third theme ‘Attitude toward antipsychotics’ denotes participants’ positive and negative beliefs about antipsychotics. The positive beliefs included antipsychotics being the right choice and beneficial, an increased need and continued use of antipsychotics, use of a combination of medications and weighing the risks and benefits of antipsychotics. The negative beliefs included reports of adverse effects and short-term benefits of antipsychotics, antipsychotics not always beneficial, benefits in deprescribing, dislike for antipsychotics and belief antipsychotics are the last resort. Some expressed the need for antipsychotics had not increased but been driven by health professionals involved. The fourth theme ‘Other psychotropic medication’ alluded to other commonly used psychotropic medications and associated risks and benefits. The fifth theme ‘Measures implemented within care settings’ represented strategies implemented to avert the initiation or bolster antipsychotic deprescribing such as non-pharmacological approaches, nurses’ assessment of residents before requesting antipsychotics, multidisciplinary consultation, and medication review. Conclusion This is the first study that reports care home staff views on antipsychotic use for residents with dementia during the pandemic. The limitations include that only views of female respondents were obtained and the limited sample size. Care homes faced enormous challenges in the provision of care services to residents with dementia during the pandemic. The multitude of difficulties experienced in care homes due to lack of preparedness may have influenced staff to have positive views of antipsychotics and their use as an option during the pandemic. It’s important to acknowledge and address these difficulties for example through education and training interventions to help with future preparedness.

Challenges and perspectives of palliative medicine: Awebinar by the Paediatric Virology Study Group.

Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the '8th Workshop of Paediatric Virology' organized by the Institute of Paediatric Virology based on the island of Euboea (Greece).

COMMunity of Practice And Safety Support for Navigating Pain (COMPASS-NP): study protocol for a randomized controlled trial with home care workers

BackgroundChronicpain is a prevalent and costly problem that often has occupational origins. Home care workers (HCWs) are at high risk for work-related injuries, pain, and disability. Current treatments for chronic pain emphasize medications, which are an inadequate stand-alone treatment and can produce significant adverse effects.MethodsIn this translational study, we will adapt an established work-based injury prevention and health promotion program (COMmunity of Practice And Safety Support: COMPASS) to address the needs of HCWs experiencing chronic pain. COMPASS employs peer-led, scripted group meetings that include educational content, activities, goal setting, and structured social support. The translated intervention, named COMPASS for Navigating Pain (COMPASS-NP), will be delivered in an online group format. Safety protections will be strengthened through an ergonomic self-assessment and vouchers for purchasing ergonomic tools. Educational content will integrate a self-management approach to chronic pain using proven cognitive-behavioral therapy (CBT) principles. We will use a mixed-methods hybrid type 2 evaluation approach to assess effectiveness and implementation. A cluster-randomized waitlist control design will involve 14 groups of 10 HCWs (n = 140) recruited from Washington, Oregon, and Idaho. Half of the groups will be randomly selected to complete the intervention during the first 10 weeks, while the waitlist groups serve as controls. During weeks 10–20, the waitlist groups will complete the intervention while the original intervention groups complete a follow-up period without further intervention. Our primary hypothesis is that COMPASS-NP will reduce pain interference with work and life. Secondary outcomes include injury and pain prevention behaviors, pain severity, changes in medication use, risk for opioid misuse, well-being, physical activity, and sleep. Qualitative data, including phone interviews with group facilitators and organizational partners, will evaluate the implementation and guide dissemination.DiscussionThe results will advance the use and knowledge of secondary prevention interventions such as ergonomic tools and cognitive behavior therapy, to reduce injury, pain, and disability and to encourage appropriate uses of analgesic medications among HCWs.Trial registrationClinicalTrials.gov NCT05492903. Registered on 08 August 2022

Live-in migrant home care workers in Germany: Stressors and resilience factors.

Thousands of Eastern Europeans find employment caring for older individuals as transmigrating live-in home care workers in private households in Germany. Studies have shown that the stressors threatening their well-being are multifaceted and include inequalities and a high practical and emotional workload, but research on protective factors is still scarce. This qualitative descriptive study focuses on both the stressors and factors that promote care workers' well-being and contribute to their psychological resilience. In guideline-based interviews, 14 female and one male care workers were asked about their stressors and the factors that help them cope. Identified stressors included separation from their own family, strained relationship with either or both the care recipient (dementia) and their relatives (violation of worker´s rights and devaluation of care work), and permanent availability and lack of free time due to a 24-h care schedule. Resilience factors were both external and internal and included positive social relationships, self-determination, experience in care work, and intrinsic job motivation. Live-ins reside in an ambiguous setting, exposed to both structural and individual strains. However, external and internal resilience factors contribute to a generally positive attitude toward their job and indicate the agency of this precariously employed group. A socially anchored appreciation of their work and an officially controlled expansion of free time are mandatory to improve the working conditions of live-in care workers.

Continuous Change as a Disruptive Force: Exploring Homecare Transitions for Carers of People Living with Dementia in Scotland

Due to an ageing population and strategic moves away from institutional care, the number of informal carers supporting a person living with dementia in Scotland is set to rise. The shift toward community-based care means that informal carers are often in contact with homecare workers during a transitional period between being the primary carer and sharing care with homecare workers. As part of the findings from a larger study that focused on the experiences of co-habiting carers of a person living with dementia when homecare began, this article presents ‘continuous change as a disruptive force’ as a key concept of carers’ experiences of transition. Recognition of continuous change for carers can inform our understanding of transitional processes and ways in which homecare providers’ response to change has considerable impact on carers’ transitional experiences. Interview data were generated remotely with five participants in Scotland. Two participants completed eight interviews over a period of six months. All data was collected between June 2021 and December 2021. Data were collected by telephone, online video meeting (Teams), and in one instance by email and analysed using reflexive thematic analysis. This article focuses on disruption through change caused by dementia – including unpredictability and impermanence, and homecare providers’ lack of responsiveness the closer to crisis participants became. In conclusion, the experiences of transitions to homecare for those caring for a person living with dementia are multiple, complex, and perpetual. I recommend subsequent research into reducing liminal periods for people encountering non-normative transitions and suggest that homecare providers focus resources on providing consistent and reliable services and on training staff specifically in carer support.

Key Factors for Enhancing Home Care Workers’ Intention to Stay by Multiple-Criteria Decision Analysis

The ageing population is increasing rapidly in Taiwan, where the ageing rate exceeds even that of Japan, the United States and France. The increase in the disabled population and the impact of the COVID-19 pandemic have resulted in an increase in the demand for long-term professional care, and the shortage of home care workers is one of the most important issues in the development of such care. This study explores the key factors that promote the retention of home care workers through multiple-criteria decision making (MCDM) to help managers of long-term care institutions retain home care talent. A hybrid model of multiple-criteria decision analysis (MCDA) combining Decision-Making Trial and Evaluation Laboratory (DEMATEL) and the analytic network process (ANP) was employed for relative analysis. Through literature discussion and interviews with experts, all factors that promote the retention and desire of home care workers were collected, and a hierarchical MCDM structure was constructed. Then, the hybrid MCDM model of DEMATEL and the ANP was used to analyze the questionnaire data of seven experts to evaluate the factor weights. According to the study results, the key direct factors are improving job satisfaction, supervisor leadership ability and respect, while salary and benefits are the indirect factor. This study uses the MCDA research method and establishes a framework by analyzing the facets and criteria of different factors to promote the retention of home care workers. The results will enable institutions to formulate relevant approaches to the key factors that promote the retention of domestic service personnel and to strengthen the intention of Taiwan's home care workers to stay in the long-term care industry.

Increased physical workload in home care service is associated with reduced recovery from work

ObjectiveThis study investigated the physical workload of home care service workers and determined whether the different intensities of physical work strain experienced by home care nurses have different impacts on their recovery from work.MethodsPhysical workload and recovery were measured among 95 home care nurses based on heart rate (HR) and heart rate variability (HRV) recordings during one work shift and the following night. Differences in the physical work strain were compared between younger (≤ 44-year-old) and older (≥ 45-year-old) employees and between morning and evening shifts. To determine the effects of occupational physical activity on recovery, HRV at all time points (during the workday, when awake and asleep, and whole measurement) in relation to the amount of occupational physical activity was examined.ResultsThe average physiological strain during the work shift, measured as metabolic equivalent (MET), was 1.8 ± 0.5. Moreover, the occupational physical demands in relation to maximal capacity were higher for the older employees. The results of the study showed that a higher occupational physical workload reduced the HRV of home care workers during the workday, leisure time, and sleep.ConclusionsThese data indicate that increased occupational physical workload is associated with reduced recovery among home care workers. Therefore, decreasing occupational strain and ensuring sufficient recovery is recommended.

Exploring Care Home Workers’ Views on Augmented Reality and Virtual Reality Hand Hygiene Training: A Realist Interview Study

Augmented reality (AR) and virtual reality (VR) hand hygiene training has been developed for healthcare workers, but has not yet been applied to care homes. This qualitative realist study seeks to capture care home workers’ theories concerning how and in what contexts AR or VR training delivered via smartphone apps might work in promoting their hand hygiene practice. Semistructured interviews were conducted with 25 care home workers across three residential and three nursing care homes in Northern England. The interviews explored hand hygiene practices and training in care homes. Participants also provided feedback on an existing programme theory that explains how, for whom, and in which contexts AR/VR might be used to upskill health and care workers. Data were analysed on NVivo using a combined deductive and inductive approach. Participants had varying experiences with hand hygiene training, highlighting an opportunity to refresh skills. Repeated practice, interactive learning, feedback, reminding, and perceived task realism were considered important for hand hygiene and could be trigged by AR/VR. There was less support for other mechanisms including deep immersion, practice in a safe environment, visualisation of personal anatomy (hands) and mistakes, and perceived realism of the imagery and environment. Expected outcomes were effective learning, learner satisfaction, enhanced hand hygiene skills, and infection control. Three themes explained how context matters when implementing AR/VR training: learners (e.g., comfort and preference), care homes (e.g., policies, staffing, and infrastructure), and technology (e.g., cost and using a VR headset). Overall, participants theorised that AR/VR could refresh hand hygiene and trigger repeated practice, interactive learning, feedback and reminding, and task realism. Future work should test the mechanisms and technology in care homes. Hand hygiene training in care homes should consider implementation factors by offering alternative technologies, providing technical support, and working with managers to determine the most appropriate choice of technology.

Quality of life of patients with venous leg ulcers treated by a one-stop clinic

Venous leg ulcers (VLU's) can impair patient quality of life (QoL) and have a significant impact on healthcare costs. Symptoms include pain and pruritis but can also lead to low self-esteem and sleep deprivation, which are often underestimated by physicians. We introduced a system in which patients with a VLU were examined and treated via a one-stop clinic. In this exploratory study, we evaluated the experiences of patients in this new setting using the Skindex-29 and conducting semi-structured interviews. A total of seven patients completed the questionnaires and interviews. The study found that younger patients had an impaired QoL due to symptoms disrupting activities of daily living. The cooperation between healthcare workers, the consistent execution of the treatment plan by different care providers and the close contact between staff and patients were appreciated by patients. Patients were positive about the continuous care provided by homecare workers at the patient's home, and experienced higher levels of attention to their illness. The introduction of a one-stop clinic led to better insight and awareness among staff of patients' symptoms and complaints. More focus and time should be given to patient-oriented symptoms, which was highly appreciated by patients in this study. This could eventually lead to a reduction in the impairing effects of VLUs on patients' lives and healthcare costs due to fewer visits to the hospital.

Normative puzzles for local government: Managing the introduction of single-handed care in England.

A crisis in social care is apparent across the developed world as ageing populations put unprecedented demand on understaffed social care workforces. A recent popular response to this 'care crisis' within the UK involves the 'innovation' of single-handed care (SHC). SHC involves a care package with two or more homecare workers being reduced to one worker using advanced equipment and new moving and handling techniques. In this article, we explore how SHC is rendered in 245 documents from 52 local authorities in England. Using Actor Network Theory as an interpretative lens, we suggest documents attempt to satisfy three 'duties of care': to the individual wellbeing of citizens, morally and fiscally to the collective and to innovation. Each appeal to different stakeholder groups necessary for SHC to work, but the combination of duties can pose problems in enabling coherent stories of SHC. Duties can be kept apart in different documents, but at times they must be brought together in certain textual spaces to enact SHC as a coherent enterprise. Here, the potential tensions that emerge are routinely orientated to as (merely) problems of process that can and should be managed in and through a more refined approach to change management.

Working Conditions Affecting Home Care Workers' Stress and Turnover Intention.

This study explored how working conditions influence the psychological outcomes of paid family and non-family home care workers, focusing on the interaction between institutional and recipient effects. Using data from the 2019 Korean Long-Term Care Survey (N = 998), we performed regression analyses on home care workers' stress and turnover intention. For both types of home care-workers, inadequate working conditions and high occupational hazards influenced stress, while good working conditions and low occupational hazards influenced turnover intention. Overall, the findings suggest that wages, working hours, and work intensity must be reformed in a home care-worker-friendly manner; the wages for home care workers must be raised to a level appropriate to their care work; the services provided by home care workers should be explicitly stipulated; and, to eliminate occupational hazards, environments for fostering cordial relationships between recipients and home care workers must be developed.

Home care workers' views of employment conditions: private for-profit vs public and non-profit providers in Ireland

PurposeThe purpose of this paper is to compare home care workers' views of their employment conditions by provider type – private for-profit vs public and non-profit – using the case study of Ireland.Design/methodology/approachAn online survey was distributed to care workers (n = 350) employed by private for-profit, public and non-profit home care providers in Ireland. Returned questionnaires were analysed statistically in R using chi-squared tests to systematically compare key aspects of employment conditions.FindingsAnalysis shows that conditions are perceived to be significantly worse for those employed by private for-profit providers (and to a lesser extent non-profit organisations) compared to the public provider. There are wide disparities between public and private sector conditions in terms of contracts, pensions, unsocial hours pay and travel time allowances. The main area of convergence is in relation to employer support, where although the public sector performed better, the difference between the three provider types is smaller.Originality/valueRelatively little research compares working conditions in private for-profit providers vs public and non-profit providers in Ireland and other countries. The findings can be understood in the context of marketisation reforms and may partly be explained by a lack of regulation in Ireland's home care sector and low unionisation rates amongst care workers employed by private for-profit providers.

Home care worker-supported exercise program to address falls: a feasibility study.

Falls are a major concern for community-dwelling older adults. The Otago Exercise Program (OEP) is an evidence-based home program that reduces risk of falls. Exercise participation and program adherence can be challenging. Home care workers (HCWs) are well positioned to provide support for older adults. This feasibility study included: HCW training; HCW in-home support of a physiotherapist-tailored OEP; online physiotherapy consultations; older participant questionnaires and functional outcome measures; and HCW and older participant interviews. Twelve older adults, eight HCWs and one physiotherapist participated. A small falls risk reduction, and improvement in falls efficacy, quality of life and functional improvement were noted. Thematic analysis showed formal and informal support was valued by older adults and HCWs. A role-ordered matrix synthesis highlighted variable ongoing independent program participation. By Your Side, a physiotherapist-led and home care worker-supported modified OEP provides a feasible and acceptable option for falls prevention in home care services. Collaborative teamwork, and both formal and informal support, are key aspects to optimising engagement and benefits.

Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool.

The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.

Nursing and end-of-life care at home in a health crisis

The Covid-19 pandemic led healthcare professionals to reconsider their work organization and some of their practices, in order to respond to the health emergency and the importance of care needs. While hospital teams managed the most serious and complex health situations, home care workers also made significant efforts to redeploy their rounds, to take care of and accompany patients at the end oftheir lives and their loved ones while managing hygiene constraints. A nurse looks back on one of these cases and the questions it raised.

Women who care in silence. The impact of covid-19 on home care work in Spain

Resumen En este artículo reflexionamos sobre el impacto de la Covid-19 en los trabajos de cuidados a personas en situación de dependencia realizado en los entornos domésticos en España, concretamente los Servicios de Ayuda a Domicilio (SAD). Mediante una metodología cualitativa, hemos recogido las experiencias y percepciones de gestores, representantes sindicales y trabajadoras del SAD para incidir en las limitaciones y oportunidades de la crisis en la realización de su labor, teniendo en cuenta el ámbito privado donde se desarrolla esta actividad y la falta de valoración social de estos trabajos. Así, aunque la pandemia ha vuelto a subrayar la precariedad y feminización de los trabajos de cuidados, también ha evidenciado su importancia social y económica.

The Financial Risks of Unpaid Caregiving During the COVID-19 Pandemic: Results From a Self-reported Survey in a Canadian Jurisdiction.

As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers' financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the financial risks of unpaid, homebased caregiving throughout the first year of the COVID-19 pandemic. Among 190 caregivers, salient findings include difficulties paying for care expenses after the pandemic was declared than before (P = .002); more caregivers retiring or becoming unemployed during the pandemic than before (P = .013); and a significant relationship between paying out-of-pocket for a home care worker and experiencing a decrease in the availability of such support during the pandemic (P = .029). Overall, the financial stressors of caregiving during the pandemic contributed negatively to caregivers' mental health, with 64.2% noting could be partly offset by greater government and employment-based assistance in managing care expenses and productivity losses. Findings from this study will better inform policies that aim to protect unpaid caregivers from financial risk in pandemic recovery efforts and beyond. Results may also be useful in other welfare states where unpaid caregivers provide the majority of home care services.

Occupational Violence Experienced by Care Workers in the Australian Home Care Sector When Assisting People with Dementia.

People with advancing dementia may be dependent on community services from home care workers and nurses to be supported at home. However, these care workers face difficulty undertaking their roles due to challenging behaviours or occupational violence. This study aimed to explore the challenges faced by home care workers and nurses working with people diagnosed with dementia in the community, to identify job demands contributing to their vulnerability to occupational violence, and to determine ways to help manage occupational violence. A qualitative descriptive study was conducted by interviewing 10 homecare workers and six registered nurses from agencies in South Australia and New South Wales, Australia. Interviews were audiotaped, transcribed and inductive thematic data analysis was conducted. The following themes were identified: (i) sources of threats; (ii) categories of violent, threatening or challenging behaviour; (iii) aggravating factors; (iv) early warning signs; (v) education and training; (vi) managing occupational violence, (vii) resources, (viii) outcomes associated with exposure to occupational violence. Serious issues were identified by participants, yet very little is known about occupational violence for these community care workers. Findings can inform what aspects of work design can be improved to moderate the effects of occupational violence exposure or mitigate rates of exposure, to enable long-term services for people with dementia.