Home Care Organizations Research Articles

“Let’s stick together”: toward a serial mediation model about the impact of relational leadership on workers’ employability

PurposeThis paper explores whether relational leadership enhances nurses’ employability. An empirical study was conducted to investigate associations between relational leadership, perceived supervisory support, perceived opportunities for competence development and employability.Design/methodology/approachA serial mediation model was constructed to investigate our hypothesized relationships. We applied a two-wave panel design and collected self-reported survey data from 109 nurses who worked in a Dutch homecare organization. Relationships were tested using PLS-SEM.FindingsOur findings suggest no direct association between relational leadership and employability. However, we found support for a serial mediation model, in which perceived supervisory support and perceived opportunities for competence development fully mediated the relationship between relational leadership and employability.Research limitations/implicationsThis scholarly work contributes to the employability literature; a supervisor who fosters high-quality relationships with nurses communicates a willingness to support their development and provides them competence development opportunities, which, in turn, fosters nurses’ employability.Practical implicationsHR managers and supervisors in homecare organizations should create leadership development policies and practices that encourage relational leadership, particularly empowering leadership.Originality/valueTo the best of our knowledge, up until now, this study is the first to use supervisors’ relational leadership to predict employees’ employability.

Time to care: How a homecare model harnesses nurses' professional ethic and cultivates caring.

A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes. Using Tronto's caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits. A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1-2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online. While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities. 63 interviews and 185h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses' professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values. As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring.

Elder abuse in Flanders, Belgium: perspectives from home care nurses

ABSTRACT The present study focuses on elder abuse in the home care setting. The aim of this study was to explore home care nurses’ definition, general perspectives and experiences of elder abuse, and the barriers they experience to avoid elder abuse. Individual qualitative interviews were held with Flemish home care nurses (N = 17), employed by a Dutch home nursing organization. Data analysis was performed using reflexive thematic analysis. Results showed that (1) participants’ understanding of elder abuse was based on intuition and daily practice. (2) Participants highlighted several institutional barriers to avoid elder abuse. (3) The participating home care organizations did not have a standard protocol to report or handle elder abuse. Institutional structures, procedures and decisions should be critically reviewed as to how they lead to staff abusing older adults.

Feasibility of a new transmural care pathway for advance care planning for older persons: A qualitative study into community care registered nurses’ perspectives

BackgroundTransmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. ObjectiveTo examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. DesignA qualitative study design using semi-structured interviews. Setting(s)Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants19 community nurses. MethodsA topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. ResultsFour themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. ConclusionsWe highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstractCommunity nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.

Analysis of the national structure of care provided to older people in Slovenia

Ageing in place has for many years been at the forefront of political goals for care provision for older people in Europe. The organization of care in terms of the national governing structure must therefore be continually observed to better understand the care actually offered and then used by older people. In this study, we examined the organization of social home care and institutional care across municipalities and administrative units in terms of what is offered to older people as formal care. Variation across municipalities and administrative units is observed with explorative cluster analysis and analysis of means of key dependent variables across clusters to better understand the variability in the care offered to older people in those municipalities and administrative units. The results show that while social home care is temporally available across several clusters of municipalities, and the affordability of social home care is also stable across clusters of municipalities, there are still municipalities where social home care has a limited time availability and municipalities where the out-of-pocket contribution to social home care delivery is nearly the twice the average of such contributions. In terms of institutional care, one can find administrative units with either a deficit or a surplus of placements of such care available.

Adaptive budget allocation in simheuristics applied to stochastic home healthcare routing and scheduling

The organization of home care is of pivotal importance in response to the trend of delivering more care directly to clients’ residences. With more vulnerable clients residing at home, variability in care durations needs careful consideration. This paper addresses the operational home healthcare routing and scheduling problem (HHCRSP) with uncertainty in travel and service times. The quality of the routes is evaluated based on the expected objective function, incorporating travel time, waiting time, and shift overtime. Due to the complexity of the problem, a simheuristic approach is applied that carefully integrates the optimization of the deterministic HHCRSP with simulation. This study proposes a new framework, based on optimal computing budget allocation and the expected opportunity costs, to dynamically determine when to employ optimization and when to use simulation. A practical case study demonstrates the effectiveness of the approach and reveals the substantial impact of accounting for randomness in the HHCRSP.

Reducing work-related stress among health professionals by using a training-based intervention programme for leaders in a cluster randomised controlled trial.

Healthcare organisations worldwide are affected by the shortage of health professionals due to work-related stress and health professional leaders play an important role by implementing effective strategies. Therefore, this study aims to investigate whether the STRAIN intervention program (using evidence-based training for health professional leaders) can reduce work-related stress among health professionals. This study is based on a cluster randomised controlled trial, consists of three measurements and includes 165 participating hospitals, nursing homes and home care organisations. A total of 206 health professional leaders took part in the intervention programme and 19,340 health professionals participated in the study. Results showed no significant differences (p > 0.05) between the intervention and control group regarding the effort-reward imbalance ratio, quantitative demands, opportunities for development, bond with the organisation, quality of leadership, social community, role clarity, rewards, difficulties with demarcation and work-private life conflict. Pre-/post-test analysis revealed a tendency for significant positive results (p < 0.05) for stressors, stress symptoms and long-term consequences for organisations with a leaders' participation rate of ≥ 75%. Leaders' awareness, commitment and readiness is essential to implement effective strategies reducing work-related stress.

Barriers and facilitators for reducing low-value home-based nursing care: A qualitative exploratory study among homecare professionals.

To explore barriers and facilitators for reducing low-value home-based nursing care. Qualitative exploratory study. Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist. Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator. Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care. Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists. Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care. The Consolidated Criteria for Reporting Qualitative Research checklist was used. No patient or public contribution.

Burnout and occupational stress of home care rehabilitation professionals transitioning out of the COVID-19 pandemic in Ontario, Canada.

The COVID-19 pandemic has significantly impacted the home healthcare industry, with increased rates of burnout and stress among homecare rehabilitation professionals (hcRPs). This study aimed to (1) examine the nature of burnout and occupational stress among homecare rehabilitation professionals at a large home care organization in Ontario, Canada, transitioning out of the pandemic, and (2) assess its impact on work participation and engagement. We conducted a cross-sectional survey using the National Institute for Occupational Safety and Health Generic Job Stress Questionnaire and Copenhagen Burnout Inventory to examine burnout and job stress. One hundred thirty-nine participants identified that work stress and burnout are more likely to occur when one struggles to cope, experiences unexpected circumstances, and feels a lack of control, which can lead to anger and emotional exhaustion. The adjusted odds ratio for emotional exhaustion was 5.46, indicating that the probability of experiencing work stress among homecare rehabilitation professionals increases as emotional exhaustion increases. Significant associations were found between coping with daily tasks and levels of burnout. Work stress and burnout influence coping, unexpected circumstances in homecare rehabilitation professionals work-life. Furthermore, highlighting the need to provide organizational support and policies that specifically address these issues in the home care sector.

Onco@home: comparing the costs and reimbursement of cancer treatment at home with the standard of care

BackgroundOncological home hospitalization (HH) was implemented in a Belgian context to evaluate the feasibility of oncological HH. In a first HH model (HH1), implemented by three Belgian hospitals, two home nursing organizations and a grouping of independent nurses, the blood draw and monitoring prior to intravenous therapy was performed by a trained home nurse at the patient’s home the day before the visit to the day hospital. In a second HH model (HH2), implemented in one hospital, the administration of two subcutaneous treatments (Azacitidine and Bortezomib) for myelodysplastic syndrome and multiple myeloma were provided at home instead of in the hospital. A previous study on this pilot showed that oncological HH is feasible and safe and improves the Quality of Life. The aim of this study is to investigate the cost and reimbursement of cancer treatment in these two HH models compared to the Standard of Care (SOC).MethodsA bottom-up micro-costing study was conducted to compare the costs and revenues for the providers (hospitals and home care organizations) of the SOC and the HH models.ResultsCosts associated to HH were higher than the SOC in the hospital. Comparing revenues with costs, the research revealed that the reimbursement from the National Health Insurance of HH for oncological patients is insufficient. In HH1, costs were higher than in the SOC (+ €50.4). There was a reduction in costs in the hospital by moving the blood draw to the home setting (-€23.9), but the costs in home care were higher (+ €74.3). The extra revenues in home care (+ €33.6) were insufficient to cover the costs. The cost difference between the SOC and HH2 (+ €9.5 for Azacetidine) was smaller than in HH1. But, there was almost no funding for subcutaneous administration in home care. If the product is administered in a day hospital, the hospital receives a revenue of €124 per administration, while in home care the funding is €5 per visit.ConclusionCosts of HH are higher and the reimbursement from Belgian NHI is insufficient to organize HH. As a result, HH for oncology patient is still limited in Belgium.

The logic of ‘home care time’

The study investigates temporal aspects of home care in Sweden, as experienced and interpreted by older care users. Data consists of 34 interviews with 36 care users and 15 participant observations during home visits by care staff. By focusing on care users’ recalibration of time and events, the analysis identifies a form of interpreted experience – here termed ‘home care time’ – that comprises two governing sublogics – care users’ understanding of themselves as part of the home care organisation, and care users’ empathetic understanding for care staff – where each sublogic evolved from several approaches where care users expressed time empathy, tried to increase time efficiency, or adapted to other care users. Some care users described attempts to take control and influence temporal aspects. Such attempts resulted in adjustments to services at the individual care user's request, but they were also associated with the risk of conflict between care users and care workers. The study addresses the gap in the literature, which mostly studies and theorises care from a care provider perspective. The logic of home care time identified in the study can explain why older people may say they are satisfied with services though poorly performed due to time shortages. This explanation is a corrective to stereotypes that portray older care users as docile and grateful.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study.

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Improved Wound Healing by Direct Cold Atmospheric Plasma Once or Twice a Week: A Randomized Controlled Trial on Chronic Venous Leg Ulcers.

Objective: This study compared the effect of two frequencies of direct cold atmospheric plasma (direct-CAP) treatment with standard of care (SOC) alone on healing of venous leg ulcers (VLUs). Approach: Open-label, randomized controlled trial (ClinicalTrials.gov NCT04922463) on chronic VLUs at two home care organizations in the Netherlands. All three groups received SOC for 12 weeks or until healing. In addition, treatment groups received direct-CAP once (1× direct-CAP) or twice (2× direct-CAP) a week, at specialized wound care facilities and the patients' residences. Primary outcome was percentage of wounds healed. Secondary outcomes included wound area reduction and adverse events. Results: In total, 46 patients were randomly allocated to receive SOC only (n = 15), SOC + direct-CAP once a week (n = 17), or SOC + direct-CAP twice a week (n = 14). A higher percentage of wounds healed within 12 weeks in the treatment groups 53.3% (1× direct-CAP, p = 0.16) and 61.5% (2× direct-CAP, p = 0.08) versus 25.0% (control). The largest wound area reduction was obtained with 2× direct-CAP (95.2%, p = 0.07), followed by 1× direct-CAP (63.9%, p = 0.58), versus control (52.8%). Absolute wound area reduced significantly compared with baseline in both treatment groups (p ≤ 0.001), not in control (p = 0.11). No device-related serious adverse events occurred. Innovation: Direct-CAP applied once or twice a week could substantially improve wound healing of VLUs in primary care. Conclusion: Together with other clinical safety and efficacy data, these results support the integration of direct-CAP as a valuable therapy for complex wounds.

Homecare workers - an untapped resource in preventing emergency department visits among older individuals? A qualitative interview study from Sweden

BackgroundOlder individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study explores if and how HCWs perceive they may contribute to the prevention of ED visits among their clients.MethodsIn this qualitative study, 12 semi-structured interviews were conducted with HCWs from Sweden between July and November 2022. Inductive thematic analysis was used to identify barriers and facilitators to prevent ED visits in older home-dwelling individuals.ResultsHCWs want to actively contribute to the prevention of ED visits among clients but observe many barriers that hinder them from doing so. Barriers refer to care organisation such as availability to primary care staff and information transfer; perceived attitudes towards HCWs as co-workers; and client-related factors. Participants suggest that improved communication and collaboration with primary care and discharge information from the ED to homecare services could overcome barriers. Furthermore, they ask for support and geriatric education from primary care nurses which may result in increased respect towards them as competent staff members.ConclusionsHCWs feel that they have an important role in the health management of older individuals living at home. Still, they feel as an untapped resource in the prevention of ED visits. They deem that improved coordination and communication between primary care, ED, and homecare organisations as well as proactive care would enable them to add significantly to the prevention of ED visits.

The Paradox of Choice in Palliative Care Decision-Making in Managed Long-Term Care: A Qualitative Study

Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers’ communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers’ communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden.

Evaluating the introduction of positive health on the amount of received home care among older patients: A pre-post study

BackgroundThe increasing demand for home care services can be attributed to demographic shifts. Positive Health can be defined as the capacity to adapt and promote self-reliance in social, physical, and emotional challenges. PurposeThis study aimed to explore the influence of introducing Positive Health on the amount of home care nursing for older patients, measured in minutes per week over a six-week period. MethodA pretest-posttest study involving 176 randomly selected patients in each group. Data was extracted from the Electronic Health Record of a large home care organization in the Netherlands. FindingsPost-introduction of Positive Health, the median weekly home care amount significantly decreased (176.25 minutes, IQR=111.7–287.9) compared to pre-introduction (180.67 minutes, IQR=83.8–248.7, p=0.005). Significant differences in nursing diagnoses per patient group were observed (p<0.001). DiscussionFurther research is needed to observe the long-term impact of working with Positive Health concept on patient outcomes in home care setting.

Influence of Capacity of Caregivers in Support of Children with Disabilities

This study aimed to triangulate the critical variable of caregiver support that influences social service accessibility by understanding the roles of caregivers in supporting children with disabilities within the informal settlements of Kenya’s sub-county of Kasarani. The primary target population includes caregivers, often parents, of children with disabilities, and the secondary target is stakeholders, funding agencies, and community-based humanitarian organizations within Kasarani. A questionnaire was provided to 200 prospective participants, with 157 responding. The resulting data was encoded and analyzed using SPSS to reveal descriptive statistics and a regression analysis model to determine relationships between the dependent and independent variables. The results show that social service accessibility in Kasarani is influenced by the four identified targets of this study. Specifically, a one-unit increase in caregiver participation provides a 0.231-unit increase in accessibility of social services. The findings suggest that increasing home care for children with disabilities is vital; therefore, it is recommended that the government use policies to establish additional homes for disabled children and expand funding for home care and local-based community organizations to improve the lives of those with disabilities.

Factors associated with health professionals’ stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations.BackgroundHealth professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations).MethodsThis study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals’ stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep.ResultsThe main findings reveal that the incompatibility of health professionals’ work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor’s good leadership qualities were also associated with health professionals’ job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes.

Developing and Retaining Homecare Nurses Through Employer-Based Tuition Assistance Programs: A Mixed Methods Study

ABSTRACT Purpose This study describes how an employer-based tuition-assistance program for homecare workers at one Canadian homecare organization enabled nursing career advancement and retention. Design A convergent parallel mixed-methods design. Methods We reviewed existing administrative data and concurrently conducted semi-structured interviews. Descriptive statistics were used on quantitative data and qualitative data was analyzed using thematic analysis. A joint data display was developed to integrate findings from both quantitative and qualitative data together. Findings Tuition assistance reduced financial barriers to career advancement; 83% of recipients remained with their employer for at least 1-year post-studies but only 29% experienced career advancement. Psychosocial supports, career navigation and coaching to ease the licensing and role transition processes were identified as opportunities to support learners. Conclusion Employer-based tuition assistance programs are impactful in helping to develop skilled employees. Practical enhancements to further support career transitions may maximize retention to address urgent homecare staffing challenges. Clinical Evidence Employer-based tuition assistance can be a useful strategy to support nursing career growth and staff retention.

From Restricted Resources to Ethical Burden-Former Home Care Workers' Reasons for Leaving Their Jobs.

The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.