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This study aims to explore the financial status of Medicaid Home Care Aides (HCAs) working in Washington State (WA). This study importantly covers both economic and psychological components of financial insecurity, a comprehensive approach that may help advance policy development for HCAs' financial security. An online survey was conducted from April to May 2019 among employed WA HCAs. The descriptive analyses were conducted using Stata. About two-thirds earned less than $30,000 annually (62%) from all their jobs combined, including non-caregiving work. Over 1 in 4 reported having over $40 k in long-term debt (28%). More than 3 in 4 reported they could only cover housing and basic living expenses using savings for less than 2 months (76%), showing likely unreadiness for sudden financial shocks (financial vulnerability). Nearly 3 in 4 HCAs (73%) experienced at least one material hardship that include housing hardship, utilities hardship, medical hardship, and food insecurity. One in 4 expressed their financial stress was severe. More WA HCAs experienced material hardships (73%) than U.S. low-income families (64.2%). In 2021, the median annual wage for WA HCAs was about 20% higher than the national one; however, their wages still remain below the living wage. In conclusion, although WA HCAs' wages are comparable to national averages, they still experience financial vulnerability and material hardships. Therefore, achieving living wages is necessary for WA HCAs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Personal care assistance (PCA) provides vital support so rural disabled people and older adults can live in their communities. Currently, the state of home and community-based services in the United States is dire, with major shortfalls in access and utilization of these services. Moreover, little is known about the experiences of people living in rural areas who need paid, in-home assistance with activities of daily living. Because rural areas are often underserved and under-resourced, this study aimed to understand the experiences of rural users of personal care assistance services to inform the development of a training for rural people. Between February and November of 2021, 38 semi-structured qualitative interviews were conducted with 40 self-identified rural-dwelling people across the United States who use paid PCAs. Interview topics included finding, hiring, and training workers; worker qualities; and how living in a rural place impacted PCA services. Using thematic coding, results highlight how rurality intersected with participants’ daily experiences. Respondents identified 3 barriers to getting PCA services: (1) lack of transportation and travel distance, (2) worker shortages, and (3) fewer local community services; and one facilitator of obtaining PCA services: strong community connection. Additionally, some aspects of rural culture—such as valuing a slower pace of life, independence, and rugged individualism—presented both barriers and opportunities for rural PCA recipients. As the home care worker shortage crisis in the United States is expected to worsen in coming decades, rural people needing PCA services face unique circumstances related to place and culture. [ABSTRACT FROM AUTHOR]

Previous studies have shown delirium is common in the home setting and can indicate a medical emergency. Many older adults come into the hospital or ER with delirium. However, little is known about the recognition of delirium by home health workers and community nurses. The purpose of this study is to explore the experience of home health (HH) staff caring for an older adult with delirium or delirium superimposed on dementia (DSD), with a focus on capturing rich details of these experiences and their knowledge of recognition and management of delirium. Utilizing story circle methodology, this qualitative study recruited 18 home health care workers from rural Pennsylvania to share their personal experiences in caring for older adults with delirium or DSD. Participants highlighted six key themes: (i) Noticing delirium as a sudden change in behaviors, (ii) Knowing the person with dementia, (iii) Potential causes of delirium, (iv) Fear of delirium and lack of protection for HH staff, (v) Lack of specific protocol and barriers, and (vi) Managing delirium collaboratively with HH staff and family. The findings emphasize the critical role of HH staff in early delirium detection and the necessity of family involvement in patient care. However, the study also highlights the need for improved training and standardized protocols to enhance HH staff’s ability to manage delirium effectively. Addressing these gaps is essential to improve patient outcomes and the quality of care provided in home health settings. [ABSTRACT FROM AUTHOR]

Home-based health care can be physically and emotionally demanding, resulting in injury or illness. Washington State's workers' compensation compensable claims between 2006 and 2016 were analyzed to describe the characteristics of injured home-based health care (HBHC) providers and the burden created by these injuries. Comparisons were made with clinical health care (CHC) providers, as well as between all compensable claims and work-related musculoskeletal disorder (WMSD) claims. Over 90% of claimants for both HBHC and CHC were female. The mean age of all compensable HBHC claimants (45.7 years) was significantly older than for CHC, with the majority (54.5%) between the ages of 40 and 59. However, HBHC claimants with WMSDs were younger, overall. Across health care type and claim type, the majority of injured care providers were overweight or obese (BMI ≥ 25). The highest mean age occurred among claimants injured from falls, either on the same level or to a lower level (HBHC: 48.3-48.6 years, CHC: 46.1-48.1 years). This same group also had the highest BMIs. WMSDs accounted for 47.3% of HBHC compensable claims and 50.3% for CHC. Falls on the same level were the second most common injury event among HBHC claims. For both HBHC and CHC, back injuries were the most common body part for both claim types (all compensable claims: 28.8% HBHC and 23.9% CHC, WMSD claims: 60.8% HBHC and 47.5% CHC). Overexertion was the injury event most attributed to WMSDs (HBHC: 82.6%, CHC: 71.6), overexertion during lifting being the most prevalent overexertion type (HBHC: 27.8%, CHC: 19.6%). [ABSTRACT FROM AUTHOR]

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

There has been a 75% decline in home health aide visits between 2000 and 2016, the only Medicare home health nonskilled service. A literature review indicates no studies addressing reasons for the decrease. This study summarizes interviews of nine executives from three for-profit chain-owned Medicare-certified home health agencies. Results indicate agreement on three themes: Medicare home health uses a medical model, focusing on intermittent skilled care; the Medicare home health prospective payment system exacerbated the focus on skilled care by rewarding higher reimbursement for skilled care–based episodes; and a "less is better" synergy has evolved regarding utilization of home health aide services and reimbursement. Policymakers are urged to use the forthcoming Medicare home health Patient-Driven Groupings Model Reform and recent Medicare Advantage changes covering nonmedical services to encourage greater utilization of home health aides and other nonmedical services addressing patient and caregiver social needs affecting care. [ABSTRACT FROM AUTHOR]

Although the work of home health aides is very demanding physically and emotionally, they rarely receive support from peers or from the organizations for which they work. This study is aimed at examining the influence of organizational values and work-related compensation on job satisfaction of home health aides. A total of 3,377 home health aides and 1,036 home health agencies were selected from the nationally representative sample. The number of work-related fringe benefits was highly associated with job satisfaction of home health aides. Household income was found to be negatively associated with job satisfaction. Significant cross-level interaction effects revealed that hourly wage had a stronger relationship with job satisfaction when individual home health aides worked for agencies that were perceived to recognize the value of home health aides. We conclude that organizational values significantly moderate the relationship between work-related factors and job satisfaction. The findings suggest that home health care facility leaders need to recognize explicitly the value of home health workers, to provide them with additional fringe benefits so that workers feel valued and to adopt a patient assignment system that allows strengthening of patient-worker bonds for enhancing home health aides' job satisfaction. [ABSTRACT FROM AUTHOR]

This article reports on the use of an innovative reflective diary method with paid home care workers caring for people with dementia. It examines the key features of the diary design, recruitment and training of participants, diarists' approaches and responses to diary-keeping, and evaluates the use of diaries in this context. Following training, 11 volunteers (all female) employed by a U.K.-based home care organization kept diaries of their experiences of caring for those with dementia. Using specially designed diaries, they wrote about their visits to clients for a period of approximately 4 months and were remunerated for up to 16 extra hours at their usual hourly rate of pay. Overall, home care workers engaged well with the process, keeping regular, lengthy, timely, and reflective diary entries. Diary-keeping provided a means for these workers to express their emotions about their work, while enhancing their self-insight and care practices. We demonstrate the feasibility of diaries for research with this occupational group and conclude that the written reflexivity employed in diaries can document, enrich, and improve the work of these caregivers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe personal, job, agency, environmental, and ergonomic factors that affect job satisfaction among home health workers (HHWs). A cross-sectional design was conducted, and data from the National Home and Hospice Care Survey (N = 3,274) were analyzed using a multilevel structural equation model (generalized structural equation model). HHWs with excellent training knowledge were about 1.5 times more likely to report a higher degree of job satisfaction compared with those with poor training knowledge, and those who reported a work-related injury were 66% more likely to report lower job satisfaction score. Job satisfaction is associated with work environment, leadership support, and work-related training. Future research and a follow-up survey are needed to understand HHWs' workforce and be better positioned to meet their need so that they may meet the need of the aging population. [ABSTRACT FROM AUTHOR]

The present qualitative study aims to shed light on the job satisfaction of home-visit care workers in Japan. A total of 19 participants were recruited from two rural, three suburban, and one urban area in and around Nagoya city. The qualitative data were collected through individual or group interviews from May to August of 2017. The interviews were conducted using an open-ended questionnaire concerning job satisfaction. Qualitative content analysis was used to systematically identify ideas and patterns emerging from the interview data. Three main themes emerged from the analysis: client–worker conflict, public opinion about the profession, and changing but rewarding work. Home-visit care workers enjoy working in an environment where communication is highly valued, and appreciate the diversity of their clients' personalities. [ABSTRACT FROM AUTHOR]

Workers exposed to wet work are at an increased risk for occupational contact dermatitis and may benefit from screening to detect early disease. The objective of this study was to assess the prevalence of hand dermatitis in home care workers, identify factors that influence presence of disease, and explore feasibility and importance of workplace screening in the home care sector. Following institutional ethics approval, nurses, personal support workers, and rehab therapists at one large home care provider in Ontario, Canada, self-screened for hand dermatitis using the Hand Dermatitis Screening Tool and accompanying photo guide and completed a short feasibility evaluation. Of the 220 participants, 18% had a positive screen for hand dermatitis and 77% reported exposure to wet work. In all, 93% of participants reported using the tool took less than 2 minutes and 84% reported screening for hand dermatitis is important. In conclusion, prevalence of hand dermatitis in home care workers is higher than reported in the general population. Workplace screening for hand dermatitis was deemed important, and the tool was feasible to use in the home care sector. [ABSTRACT FROM AUTHOR]

As the population ages, and more people are living at home with chronic conditions, there is an increasing need for home support workers (HSWs). Safety is a central concern for HSWs, and contributes to the recruitment and retention of HSWs and ultimately to a sustainable home care sector. This article reports on a scoping review that was conducted to assess the state of the literature related to the safety of HSWs. Studies were selected that address the central phenomenon and that were conducted from 2000 to 2015. One hundred twenty-six studies were included in the synthesis of findings. This article outlines two of the four major findings, those related to safety factors associated with home care organizations: (1) injury prevention initiatives and (2) human resource planning. The findings have important implications for developing strategies to address safety concerns for HSWs. [ABSTRACT FROM AUTHOR]

Given the increased prevalence of chronic disease and health care costs, more individuals are treated in the home, which has augmented the demand for more Home Healthcare Workers (HHCWs) in the field. HHCWs face multiple hazards with injury rates being more than double the national average; however, current studies on HHCWs have provided limited understanding of their occupational safety & health experiences and exposures. The aim of this study was to assess the frequency and risk of exposures through perceptions of HHCWs. The results of this study provide an initial picture of the different risks that HHCWs face daily. These findings show that studies involving HHCWs occupational safety need to be job-specific, and the proposed interventions will also likely need to be tailored by HHCWs type. [ABSTRACT FROM AUTHOR]

This article highlights findings from a mixed-method evaluation of two pilot programs that utilized Home Health Aides (HHAs) as health coaches for home care patients with chronic illness, including (1) a dedicated health coaching program for patients with heart failure and (2) an integrated program for HHAs working with chronically ill patients. Interviews were conducted with HHAs and staff to understand their experiences implementing program activities. Data from clinical assessments and surveys were employed to examine the characteristics and outcomes of patients. HHAs viewed health coaching positively and described it as an informative process that is dependent on patient motivation and willingness to change. Patients in both programs reported improvement in self-care maintenance. Patients in the chronic illness program also reported improved quality-of-life. [ABSTRACT FROM AUTHOR]

The study explored the role of work/family conflict and workplace social support in predicting home health workers' mental distress using a sample of home health workers in Central Texas (n = 150). The result of multivariate analysis showed that work/family conflict increased mental distress, while client support and organizational support decreased mental distress. In addition to the direct effects, client support was found to buffer the negative impact of work/family conflict. Findings call attention to the ways to reduce work/family conflict and increase workplace social support in efforts to promote home health workers' mental well-being. [ABSTRACT FROM AUTHOR]

Home health care agencies provide services to some of the most vulnerable patients and must encourage influenza vaccinations of their employees. The current study assessed the impact of increasing employee compliance with vaccinations and aimed to determine why certain employees refuse vaccinations. This was an observational study that looked at employee vaccination rates, employee sick days, and responses to an employee survey of those who refused vaccinations. Data were collected at a large not-for-profit home health care agency in the northeast that provides services primarily to Medicare patients. Vaccination compliance and sick days information were collected on all employees of the home care agency over three flu seasons (2012-2015). Survey data were collected on employees (n = 240) who refused the influenza vaccination during the 2014-2015 flu season. The agency more than doubled vaccination rates from 38% to 88% and found a corresponding reduction in staff sick time. By surveying the “refusers,” it was found that the common reasons for avoiding vaccinations were beliefs of not being in a high-risk group, not needing vaccine, being healthy and never getting the flu, and not liking injections. It is clear that a concerted effort to increase employee influenza vaccination rates can be successful and possibly decrease staff sick days. However, there seems to be a small group of employees who refuse vaccination. Better education of these employees should help eliminate the common reasons people decline vaccination. [ABSTRACT FROM AUTHOR]

Using a pre-training and post-training survey research design, 683 participants completed a personal/home care aide (P/HCA) training program. After training, participants chose a career goal and were placed in one of the following groups: (1) only goal to be a P/HCA, (2) become a certified nurse aide/assistant or home health aide, (3) become a licensed vocational nurse, or (4) go to college to earn a degree in a health-related area. Factor analysis of home care commitment items indicated two measures: home care intent and stepping stone. Group 2 trainees had a significantly higher home care intent than trainees in Groups 1 and 4. However, Groups 2, 3, and 4 were each more likely to view P/HCA training as a “stepping stone to higher level jobs” than Group 1. [ABSTRACT FROM AUTHOR]

To examine the predictors of job satisfaction by home health aides, we conducted structural equation modeling to identify how the predicting variables directly and indirectly influence job satisfaction by home health aides. A total of 3,274 female home health aides working in home health care industry were selected for this study from the nationally representative sample. Support from organizations and supervisors, and personal support have positive direct effects on the job satisfaction of home health aides. Organizational support and supervisor support have important roles in weakening the negative relationship between job-related stressors and job satisfaction. We conclude that support from organizations and supervisors might improve job satisfaction by home health aides through reducing stress. [ABSTRACT FROM AUTHOR]

With an aging population and provider shortages, personal care aides (PCAs) hold potential for providing low-cost, high-quality in-home supports and services. They comprise an unprecedented workforce in terms of size and rapid growth. However, this workforce is also characterized by costly high-turnover rates that threaten quality of care and outcomes. It is imperative that measures be taken to improve PCA skills and stabilize their employment. In 2010, a PCA training program was developed titled “Building Training . . . Building Quality” as part of a national demonstration. Key findings were that learners’ skills, employability, and job satisfaction significantly improved, and “intent to stay” was associated with increased confidence in ability to do the job. This report details findings of value to those interested in retaining high-quality PCAs. [ABSTRACT FROM AUTHOR]

Personal care aides (PCAs) are critical to meeting the need for low-cost, high-quality care for frail older adults at home. Developing this workforce entails not only increasing its size but also ensuring that PCAs possess the skills necessary to deliver competent, safe, and respectful care. Yet, no federal PCA competencies or training requirements exist, and state requirements vary widely. In 2010, a 77-hour PCA model training program was developed as part of a national demonstration. However, a key finding of this study was that many enrollees faced serious socio-economic challenges that prevented them from graduating. This report details findings from a survey sent to all non-completers to ascertain reasons for attrition and improve program success. It offers recommendations for future program planners. [ABSTRACT FROM AUTHOR]

With the growth of the older adult population increasing at an exponential rate, caring for this population has become increasingly difficult. As many choose to age in place (i.e., in the home environment), both the public and private sectors are being forced to respond. The emergence of home health care and the employment of home care aides is one of the ways that the industry has evolved to meet this crisis. However, retention of home care aides has proven problematic. This study explores factors affecting home care aide retention in agencies that employ home care aides. A sample of 116 home care aides employed by three agencies was surveyed to identify retention issues relative to the home care aide. A hypothetical model of home care aid job retention was tested with a hierarchical regression analysis, where 11 variables were entered in five steps, using a time-sequenced order. The results indicated that the hypothetical model was able to explain 41% of the variance in months employed as home care aides, with age, education, wages earned, and intrinsic satisfaction as the most significant contributors to the model. Being able to predict retention of home care aides allows employing agencies to realign themselves to retain workers and improve quality of care. However, it is important to realize that the same traits that predict retention among home care aides may also leave these workers vulnerable to exploitation. [ABSTRACT FROM AUTHOR]

This article describes the approach taken in implementing a major organization change in a large home nursing service. Rather than prescribing a model for change, five key issues are outlined: establishing a mandate for change, project management methodology, staff engagement, using data and evaluation, and ensuring sustainability. Professional development was provided to middle managers across the organization to ensure that the capacity for managing change was available. A project identity was established and a detailed project plan identified roles, initiatives, deliverables, timelines, and accountabilities. Staff support for changes was improved through their involvement in creating solutions and developing new processes. Project indicators and reports were produced to monitor the impact of initiatives. The project evaluation showed that there had been considerable improvements in organization performance. Staff were positive about their involvement in the project and the opportunities that were created for them to address the identified issues. [ABSTRACT FROM AUTHOR]

When a professor leaves a long-time teaching position in baccalaureate nursing to work in a nursing staff position in home health care, this change engenders certain, perhaps conflicting, expectations from the professor and the agency. Tension may exist because of differences between the two roles in the level of independent functioning, the level of authority, communicating with physicians, professional competence, and time constraints. Supportive agency staff helps to minimize the conflicts through a tailored orientation. This article reviews role change theory as it pertains to this transition, discusses differences between academia and home health practice roles as they affect employment, makes recommendations for agencies and faculty to help with this role transition, and relates one nursing professor's experiences during her orientation to a new home health staff position. [ABSTRACT FROM AUTHOR]

The article offers information on the certification programs available to health care professionals and paraprofessionals in the United States. The American College of Health Executives and the National Association for Home Care and Hospice (NAHC) are two of many professional organizations that services certification for health care, home care, as well as hospice executives. The organization focuses on skill, knowledge and experience of professionals working in specialty practice. Most certifications have time frame for completion and recertification process.

The article profiles Julie A. Nelson and Rebecca B. Skrine, two new editorial board members for the periodical "Home Health Care Management and Practice." Julie A. Nelson serves as the Director of Gritman Medical Center's Home Health and Hospice in Moscow, Idaho. Rebecca B. Skrine is the Rehabilitation Services Manager for Baptist Hospital East Home Health Agency in Louisville, Kentucky. The two serves as contributors, reviewers, and article writers for the journal before being accepted to the editorial board.

The article offers information the technological competency of health care providers. Technological competency is defined as having suitable or sufficient skill, knowledge, experience for some purpose to assure quality in process and services. It is argued that assessing technological competency is becoming increasingly important as home care system is moving into a highly technological environment. It is mentioned that it is impossible to attain a proficient and productive performance in a low-technology home care center.