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Many older adults with complex care needs live at home due to ageing‐in‐place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care. [ABSTRACT FROM AUTHOR]

This paper examines the intersection between job quality and innovation by exploring policy-led innovation aimed at delivering high-quality adult social care jobs that attract and retain much-needed skilled workers. Through qualitative enquiry, we examine workforce policy's emphasis on training, development and career progression, key elements of job quality, to create higher-skilled, higher-status roles. Drawing on focus groups and interviews with care providers and care workers in Wales (UK), we question the likely success of policy-led innovation given first its ineffective delivery and second its failure to address broader aspects of job quality. Policy thus fails both to institutionalise skilled roles in care work and to raise the status of the care worker occupation. We contribute to emerging HRM and interdisciplinary theory and policy debates about the complex nature of innovation activities and their outcomes for job quality in care work within a sector typified by low-quality jobs. We illustrate the different ways in which job quality and innovation interact and how both can be constrained by one another as a function of environmental antecedents. [ABSTRACT FROM AUTHOR]

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery. [ABSTRACT FROM AUTHOR]

Crisis Resolution and Home Treatment Teams (CRHTTs) provide mental health support for people experiencing crises and its employees are at high risk of occupational stress. Reflective Practice Groups (RPGs) hold promise for reducing staff burnout. However, to date, there have been no evaluations of RPGs delivered in CRHTT settings. This study aimed to explore staff experiences of RPGs delivered in one CRHTT. All CRHTT staff members who had attended at least one RPG were approached to take part. Participants completed two supervision questionnaires and a semistructured interview. Descriptive statistics were calculated to quantify staff experiences and qualitative themes were generated using thematic analysis. Thirteen people participated, all of whom reported positive experiences of RPGs. Three qualitative themes also emerged comprising 'core components of RPGs' 'benefits to staff' and 'challenges of RPG delivery'. Staff value RPGs delivered in CRHTT settings, which may reduce staff burnout and contribute to workforce development. [ABSTRACT FROM AUTHOR]

The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs. [ABSTRACT FROM AUTHOR]

Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p <.001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = −0.002, p =.002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n 216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases. [ABSTRACT FROM AUTHOR]

With the rapid increase of older adults, attracting and retaining home care workers in the long-term care system will be critical to meet demands. This study examined how intrinsic and extrinsic factors of job satisfaction affect home care workers' intention to stay and determined whether ageist attitudes had a mediating effect on the relationship between job satisfaction and intention to stay. The stratified random cluster sampling method was applied in this study and self-administered questionnaires were distributed to 400 home care workers from home service units in one city in southern Taiwan. Overall, 380 participants completed the measures of job satisfaction, ageist attitudes, and intention to stay in their current job. The monthly wages of NT$30,000 to NT$39,999 were significantly related to home care workers' intentions to stay. Both intrinsic and extrinsic factors of job satisfaction were significantly associated with the retention of home care workers. However, the ageist attitudes' separation and affective attitude factors were mainly related to their intention to stay. Ageist attitudes have a significant mediating effect between the intrinsic factors of job satisfaction and intention to stay but have no significance for extrinsic factors. Therefore, we suggested that improving the extrinsic and intrinsic factors of job satisfaction could increase the retention of home care workers. Additionally, providing accurate aging-related knowledge to raise awareness of ageist attitudes may enhance the relationship between the intrinsic factors of job satisfaction and retention. These findings could be valuable for improving the retention of the workforce in long-term care. [ABSTRACT FROM AUTHOR]

There is a scarcity of evidence on the association between shift work, sleeping parameters, heart rate variability (HRV), and chronotype, i.e., morningness and eveningness. The aims of this study were to 1) compare participants with different chronotypes (morning (M), evening (E), or neither (N)) in terms of their total sleep time, sleep efficiency, and HRV parameters, taking their age into account, and 2) examine whether self-reported work-related stress, the length of the working career and years performing shift work affect this association. The participants of the study were home care workers working in two shifts in one municipality in Eastern Finland (N = 395). Of these, 52 females (mean age 42.78 y, SD 12.92 y) completed the study questionnaire and participated in physiological measurements. Several sleep-related parameters were assessed (total sleep time, sleep efficiency, number of awakenings, and length of awakening) and indices of autonomic nervous system based on HRV were calculated. The participants worked in two shifts: a morning shift (7:00–15:00 h) and an evening shift (14:00–21:30 h). All these parameters were assessed during the night before the first work shift (N1), the night before the second work shift (N2), the night before the final work shift (N3), and the night before the first day off work (N4). According to the results, 21.2% of the participants were M-types, 17.3% were E-types, and 61.5% were N-types. On average, the participants had been in working life for 18.8 years and performing shift work for 13.7 years. On night N3, E-types had a significantly shorter total sleep time and spent less time in bed compared to M- and N-types. The total sleep time of M-type and N-type participants was on average 66 minutes and 82 minutes longer, respectively, when compared to E-types on night N3. There were no statistically significant differences in actigraphy-based sleep quality parameters between M-, N-, and E-types on nights N1, N2, and N4. Our results together indicate that M- and N-type individuals may have better sleep quality than E-types, which was also reflected in HRV parameters. Further research with longitudinal study design and workplace interventions is needed to determine how the chronotype can be optimally and individually utilized to improve the health and well-being of morning-type and evening-type people. This is particularly important for both younger and older workers entering the workforce to support healthier and longer working lives. [ABSTRACT FROM AUTHOR]

How may we understand the relationships between public service motivation (PSM), personality traits, and public organizational outcomes? Do organizational outcomes relate to interaction associations between PSM and personality traits? Using a mix of survey data and administrative data from a sample of nursing home care workers in Denmark (n = 427), this article explores the interplay between PSM and the personality trait of conscientiousness in relation to two organizational outcomes: performance and short-run absenteeism. We find that PSM is associated with higher performance and less absenteeism and that conscientiousness is a significant moderator of both relationships—although in distinct ways. The association between PSM and less absenteeism is greater at higher levels of conscientiousness. In contrast, the positive association between PSM and performance attenuates to zero at high levels of conscientiousness. [ABSTRACT FROM AUTHOR]

Little is known about the financial risks of unpaid caregiving. This is, in part, due to challenges in identifying people who are caregivers and limitations in capturing all aspects of spending related to caregiving in existing approaches to public data collection. To fill these gaps, we developed a composite survey informed by validated instruments that assesses the types and magnitude of out-of-pocket expenditures caregivers incur in the provision of homebased care for someone living with a long-term health condition, and their impact across various domains of financial risk. This paper discusses the development of this survey currently in circulation in a Canadian province, and reflects on considerations in the engagement of unpaid caregivers in participatory research. Given its replicability and adaptability, this survey may inform future research in other developed or high-income settings and guide policy attention toward understanding how to protect unpaid caregivers from the financial risks of caring. [ABSTRACT FROM AUTHOR]

Fostered by the free movement of workers agreement in the Schengen area, a new market for live-in care work has emerged. Private for-profit care agencies recruit circular migrant women from Eastern Europe and place them in private households for senior care in Western Europe. This paper looks at the recruitment and placement practices of these agencies. Drawing on concepts on migration infrastructures and a politics of mobility, we argue that these agencies are key drivers in the production of new migration infrastructures tailored to live-in carers' circular mobility patterns. This infrastructure intersects with existing work, gender and care regimes, and works in ways that enclose care workers in the households, ensuring their return home after an assignment. It shapes their migration as a form of movement characterized by repeated short-term and 'just-in-time' jobs. This requires care workers to be mobile, flexible and disposable. Hence, care agencies play an important role in perpetuating an unequal distribution of care along lines of gender and socio-economic inequalities. The findings point to fundamental changes in migration control in the Schengen area with private actors such as care agencies gaining new powers in determining who and under which conditions workers migrate. [ABSTRACT FROM AUTHOR]

The problem addressed in this paper is how to calculate the amount of personnel required to ensure the activity of a home health care (HHC) centre on a tactical horizon. Design of quantitative approaches for this question is challenging. The number of caregivers has to be determined for each profession in order to balance the coverage of patients in a region and the workforce cost over several months. Unknown demand in care and spatial dimensions, combination of skills to cover a care and individual trips visiting patients make the underlaying optimisation problem very hard. Few studies are dedicated to staff dimensioning for HHC compared to patient to nurses assignment/sequencing and centres location problems. We propose an original two-stage approach based on integer linear stochastic programming, which exploits historical medical data. The first stage calculates (near-)optimal levels of resources for possible demand scenarios, while the second stage computes the optimal number of caregiver for each profession to meet a target coverage indicator. For decision-makers, our algorithm gives the number of employees for each category required to satisfy the demand without any recourse (overtime, external resources) with fixed probability and confidence interval. The approach has been tested on various instances built from data of the French agency of hospitalisation data (ATIH). [ABSTRACT FROM PUBLISHER]

This paper examines how home care workers in Oregon, a predominantly female, geographically dispersed, and economically undervalued workforce, were brought together to engage in collective action and extend their reach beyond the local union to civil society. Drawing on qualitative interviews with union staff and member activists, along with archival data, it documents how home care workers used social movement unionism to improve their working conditions in the early 2000s. The lessons from this case are especially relevant today given the growing demand for in-home care as a means to avoid being placed in institutionalized settings and the shortage of workers to meet the rising demand. [ABSTRACT FROM AUTHOR]

Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions. A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO. HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported. More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home. [ABSTRACT FROM AUTHOR]

Home care workers (HCWs) are at high risk for musculoskeletal pain and injury, and they are an important population for pain management research and intervention. The purpose of this study was to gather novel data on HCWs' work characteristics, pain experiences, pain management strategies, and risk for opioid misuse. A survey invitation was e-mailed to a random sub-sample of HCWs in Washington State, and 421 responded. Over half (54.2%) reported chronic or currently elevated pain. Pharmacological pain management strategies were used by 67.3% of all respondents with 4.8% reporting prescription opioid use. Biopsychosocial factors like injuries, interpersonal conflict, financial strain, and anxiety were associated with increased opioid misuse risk. Multimodal primary and secondary interventions are recommended to improve HCWs' pain management. [ABSTRACT FROM AUTHOR]

There has been a steady growth in the population of adults with intellectual and developmental disabilities, some of whom are known to age prematurely; aging is also associated with increased rates of disability and chronic conditions that can lead to frailty. Supports provided by social and health sectors are crucial to supporting those identified as frail. A case study design was used to investigate the implementation of inter-sectoral collaboration between providers of services from specific social and health sectors; namely, developmental services (aka disability services) and home care services, in the context of supporting those identified as frail. Twenty-three participants (including individuals with intellectual and developmental disabilities, family members, and providers from both sectors) were interviewed using an open-ended format targeting known conditions for effective inter-sectoral collaboration: necessity, opportunity, capacity, relationships, planned action, and sustained outcomes. Interviews were recorded, transcribed verbatim, and coded by two independent researchers. All participants touched on key facilitators and barriers for successful inter-sectoral collaboration across the six conditions. A single exception occurred in that individuals and families did not discuss sustained outcomes. Each of the six conditions for effective inter-sectoral collaboration is relevant to planning required to support adults with intellectual and developmental disabilities who are frail. When it comes to collaborative ventures between social and healthcare teams, the use of resources and tools that both facilitate and promote these conditions should be prioritised. [ABSTRACT FROM AUTHOR]

While there is a growing literature on home care workers, less is known about how home care companies market their services. Through a content analysis of the 19 largest U.S. home care and home health providers' websites, we examined how companies describe services, desired outcomes of care, and job responsibilities and qualifications. Companies actively market family-like relationships as central to "good care". However, companies' emphasis on unmeasurable skills such as compassion and warmth may also create exploitative work environments. Supporting "good care" requires improved data collection, industry oversight, and policy change to recognize socio-emotional care and protect a marginalized workforce. [ABSTRACT FROM AUTHOR]

This article reviews findings from a recent ethnographic study of the workforce in a residential treatment center for children. Major threats to workers' physical safety and psychosocial well-being were documented, including client violence and intensive and threatening regulatory oversight of practice. I show how, in this setting, the effects of client violence against workers and attempts to comply with the regulatory policy appear to have had unintended negative consequences for the safety of youth in care, as well as their caregivers. I argue that attempts to improve safety and the perception of safety for youth in care require a systemic understanding of how violence and its regulation affect the milieu as a whole, with attention to the well-being of both children and workers. I conclude with suggestions for how organizations can maximize safety for all. [ABSTRACT FROM AUTHOR]

Orphans in Sub-Saharan Africa are often raised by relatives. Many end up in residential homes due to financial burdens on extended families. As a result, the socio-emotional development of orphans may be adversely affected. This paper explores care workers' perspectives on the socio-emotional adjustment of orphans in residential homes. Qualitative methods were employed in which eleven male and female care workers from three residential homes for orphans were interviewed. The data was analysed using Thematic Analysis.Results suggest that non-care related duties in the home interfere with care workers' responsivity to children. Relationships between care workers and children were positive; based on emotional support, listening, responsiveness, and trust. However, orphans tended to have difficulties adjusting to the residential home, expressing emotions, and making friends. Results also showed that orphans continue to deal with the loss of their parents and may, as a result, act in aggressive ways. Recommendations include improved access to psychosocial support and easing care workers' workload to enable them to effectively aid orphans in navigating their socio-emotional challenges. The paper illustrates key insights into the socio-emotional adjustment of orphans from the perspectives of care workers caring for them. [ABSTRACT FROM AUTHOR]

As our population ages and people overwhelmingly prefer to age in place, the need for home care workers is steadily increasing. Unfortunately, due to the low value society places on caring work, filling these positions and retaining workers is a challenge. Drawing on a pilot study involving in-depth interviews with eight female home care aides, this brief report profiles three categories of worker perceptions of their jobs: "satisfied" (n = 3), "need more support" (n = 3), and "on my way out" (n = 2). Study participants liked their work but believed their jobs needed to be improved. Policy implications based on study findings are explored. [ABSTRACT FROM AUTHOR]

The treatment burden inherent in self-managing multiple chronic conditions (multimorbidity) is recognized, but there has been little examination of the care burden experienced by paid home health-care assistants (HCAs) who support older people with multimorbidity. Focus groups were conducted with HCAs in Ireland and data were coded using a thematic analysis approach. Care burden of HCAs was linked with lack of knowledge and information, poor communication, insufficient time and resources, gaps in medication support and work-related stress. Strategies are required to reduce the care burden of HCAs, who are essential stakeholders supporting growing numbers of older people with multimorbidity. [ABSTRACT FROM AUTHOR]

The purpose of the study was to obtain exploratory, descriptive information that would provide insights into the barriers to and facilitators of the implementation of fall prevention programs in home care settings. The study employed a qualitative approach through a series of focus groups with home care providers who work with patients with diabetes (N = 29). The study identified teamwork, resistance to change, and patient's readiness as major factors in fall prevention practice at home care. Understanding health-care providers' experiences with fall prevention in home care settings has the potential to facilitate better translation of evidence to practice for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Most older people experiencing chronic health problems, physical disabilities, and memory losses are still able to age in place in their own homes. However, they often need help from others to enjoy healthy, active, and independent lives. They turn mostly to family members, mainly women and usually their daughters, daughters-in-law or wives. But caring for frail elders has become more demanding and complex, and these family members often feel physically and emotionally overwhelmed and burnt out. They concede that they cannot do it alone. Others find it more difficult to hold full-or even part-time jobs. Hiring home (direct) care workers to assist their loved ones can be an effective solution to ease their caregiving responsibilities. However, these personal care aides, home health aides, and nursing assistants are already in short supply. Moreover, going forward the aging of the baby boomer population will result in an even greater demand for their services even as these jobs are often unattractive to American-born workers and turnover is high. This country's immigration policies will make it even more difficult for women caring for older persons to hire these workers. Over 25 percent of home care workers are low-skilled immigrants or foreign-born. However, the Trump administration's policies reduce the number of immigrants entering the U.S. and specifically choke off the various pathways that enable low-skilled persons to be hirable in the home care sector. Female caregivers seeking relief from their caregiving responsibilities will lose out unless we remove these immigration barriers. [ABSTRACT FROM AUTHOR]

The rapidly expanding Australian home care workforce represents an untapped resource for improving health literacy (HL) and health outcomes of their clients. Nine home care workers (HCWs) were interviewed for this study to gain data around their experiences of providing HL support to their clients, key HL needs and priorities, and training that would best these needs. Findings indicate that HCWs are providing HL support, and identify a number of enablers and barriers to providing this support. Core inclusions for a HL training checklist are suggested. Implications for future research are considered. [ABSTRACT FROM AUTHOR]

A 2018 ballot initiative in Maine proposed universal home care and improved work conditions for home care workers.Although ultimately defeated, the innovative proposal received considerable support and laid the groundwork for an upcoming legislative campaign.It offers a framework for increasing access to home care and creating quality jobs for home care aides. This commentary reviews the problems addressed by the Homecare for All initiative, what was proposed, the campaign process and anticipated next steps, and implications for gerontological social workers. [ABSTRACT FROM AUTHOR]

Objective: To examine perceived control among live-in and live-out home care workers and to identify factors that contribute to perceived control among both types of caregiving. Method: 338 migrant live-in home care workers and 185 local live-out home care workers were asked to report their perceived control. Burnout, satisfaction with the relationship with the care recipient and the care recipient's family, and satisfaction with social relationship were also gathered. Results: Both types of caregivers reported high levels of perceived control, although live-in home care workers expressed more perceived control. Higher age, higher levels of satisfaction with the relationship with the care recipient and the care recipient's family and lower levels of burnout, predicted perceived control. Satisfaction with social relationship was a stronger predictor of one's perceived control among live-in home care workers. Conclusions: Promoting social relationships outside the home care context by allowing migrant live-in home care workers to take part in social gatherings is recommended as this can strengthen their sense of perceived control. [ABSTRACT FROM AUTHOR]

We describe a community-engaged approach to develop and pilot a home care aide (HCA) administered health interview with Medicaid Home and Community-based Services clients. Stakeholders identified five priority health topics and selected a card sorting methodology for interviews. A barrier to interviewing clients was decreased communication skills among HCAs, and we modified health interview training to include communication training. Stakeholders reported the interview methodology was feasible within usual care, acceptable to clients, and contributed to increased knowledge on providing person-centered care. Stakeholder engagement resulted in valuable insights regarding the health interview methodology and relevant training needs. [ABSTRACT FROM AUTHOR]

This study investigated Home Health Aides' (HHAs) experiences in the immediate aftermath of client death. Semi-structured in-person interviews with 80 HHAs explored how notification of death and reassignment to a new client were handled. Only 42.5% of HHAs were notified of the death; 40% had to notify the agency; 17.5% were not notified at all and had a negative experience. Reassignment preferences varied, but HHAs had a better experience when their preferences were taken into consideration. Study findings suggest that more mindful approaches to transitions following client death would be valued by HHAs and could improve their work experience. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the effectiveness of a rehabilitation training program for community health workers in a resource-limited setting over a 5-year period. This is a retrospective cross-sectional study. Participants were home-based palliative care community health workers at St. Gabriel's Hospital in rural Malawi (2013: n = 20, 2014: n = 20, 2015: n = 20, 2016: n = 60, 2017: n = 60). Data were collected from knowledge tests, skill competency tests, observations of skills in the home setting and surveys of the community health workers. Descriptive and comparison statistical methods were used to analyze the results. Over the 5 years of trainings, attendance was 99%. Participants showed significantly greater knowledge on the post-test than on the pre-test in four of the 5 years of annual training (2013: p < 0.001, 2014: p < 0.001, 2015: p = 0.007, 2016: p < 0.001). 100% of the participants demonstrated competency in all rehabilitation skills in all 5 years of training (20 skills in the first 3 years, 32 skills in the fourth year, and 20 skills in the fifth year). 100% of participants demonstrated the ability to apply some aspect of training in the home setting. The community health workers reported that the rehabilitation skills learned helped the patient, the caregiver, and themselves (> 85% 'some' or 'a lot'). Community health workers participating in the rehabilitation training program in a resource-limited setting over the past 5 years have improved their knowledge, skill competency and the ability to implement what they have learned for patient care in the village. [ABSTRACT FROM AUTHOR]

Background: Aides are increasingly providing services to children with cerebral palsy to promote better functioning and participation; these aides work under the direction and supervision of physiotherapists. Objectives: In this qualitative study, we explored how aides in pre-school settings apply professional knowledge to their daily routines. Methods: Based on 65 h of observations, including sequential video recordings and seven interviews, we conducted a theme based content analysis connecting to enactive theory of participatory sense-making. Results: The aides highlighted that time management is challenging due to the temporality of their work, which requires flexibility to provide services as situations occurred. They also requested more supervised interactive involvement to learn and make sense of their own experiences while interacting with the child. Therapeutic handling was highlighted as particularly challenging. Conclusions: The application of physiotherapy knowledge is not merely knowledge transfer between settings but involves a transformation of knowledge on many levels, including personal, social, and contextual levels. [ABSTRACT FROM AUTHOR]

As the US population ages, there is an expected increase in demand for home health aides (HHAs); therefore, it is important to ensure their occupational well-being. Previous studies have demonstrated associations between negative emotions and musculoskeletal pain. Using survey data collected from 285 HHAs, we characterize the association between affect and musculoskeletal pain. Affect was measured using the Positive and Negative Affect Schedule, while musculoskeletal pain was measured using the Brief Pain Inventory. We found that as positive affect composite score increased, musculoskeletal pain decreased [β = -0.57, t(124) = -7.01, p <.001]. There was no significant association between the negative affect composite score and musculoskeletal pain. However, several individual moods were associated with decreased or increased pain. These data suggest that some moods may buffer against musculoskeletal pain, while others may predispose HHAs to musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Among medical professionals, the role of home care workers is crucial in the care of patients in their homes. In Japan, however, research on the difficulties home care workers face while working in rural zones is limited. Using thematic analysis, a qualitative study was conducted with 57 home care workers in a rural area of Japan. Findings revealed the difficulties they experienced regarding the medical problems of their patients and in their relationships with other professionals. The old customs of rural medicine and the system of long-term care insurance strongly influence relationships among multiprofessionals, leading to conflict and hierarchy. [ABSTRACT FROM AUTHOR]

The Community of Practice and Safety Support (COMPASS) program is a peer-led group intervention for home care workers. In a randomized controlled trial, COMPASS significantly improved workers’ professional support networks and safety and health behaviors. However, quantitative findings failed to capture workers’ complex emotional, physical, and social experiences with job demands, resource limitations, and the intervention itself. Therefore, we conducted qualitative follow-up interviews with a sample of participants (n = 28) in the program. Results provided examples of unique physical and psychological demands, revealed stressful resource limitations (e.g., safety equipment access), and elucidated COMPASS’s role as a valuable resource. [ABSTRACT FROM AUTHOR]

Home care aides risk musculoskeletal injury because they lift and move clients; the body weight of most adults exceeds the NIOSH recommended limit for lifting. Methods to reduce manual patient lifting in institutional settings are often technically or economically infeasible in home care. Our goal was to identify suitable, safe, low-technology transfer devices for home care use. Sixteen experienced home care aides performed client transfers from wheelchair to bed (upward) and bed to wheelchair (downward) in a simulated home care environment (laboratory), using four different slide boards and by hand without a device. Aides’ hand forces were measured during client transfers; aides also evaluated usability of each board. Hand forces exerted while using slide boards were mostly lower than in manual transfer, and forces were lower in downward versus upward transfers. Aides judged a board with a sliding mechanism easier to use than boards without a sliding mechanism. Practitioner Summary: This paper provides quantitative biomechanical measurements showing that slide boards reduced the hand forces needed by home care aides to transfer clients from bed to wheel chair and vice versa, compared to manual lifting. Using a semi-quantitative usability survey, aides identified boards with a sliding mechanism easiest to use. [ABSTRACT FROM AUTHOR]

The progress in Australia towards the full industrial recognition of home care work as ‘work’ has stalled. This paper draws on International Labour Organization (ILO) Convention 189 on Decent Work for Domestic Workers 2011 to argue for a re-imaging of decent minimum standards for home care workers in Australia. While to date Australia has not ratified ILO 189, home care workers, who are employed to work in the homes of the aged or with people with disabilities, fall within the scope of this Convention. Drawing on the scholarship and activism that has emerged around ILO 189 we argue that with the slow but steady shift to more fragmented, individualised and informal employment relationships in home care services re-imagining employment protections for home care workers in Australia is crucial. Recasting minimum labour standards for work described as both ‘work like all other’ and ‘work like no other work’ could well provide a basis for a more substantial re-imagining of Australian employment regulation for all workers. [ABSTRACT FROM AUTHOR]

In Singapore, the responsibility of caring for persons with dementia falls on family members who cope with a long-term caregiver burden, depending on available support resources. Hiring foreign domestic workers to alleviate caregiver burden becomes a prevalent coping strategy that caregivers adopt. This strategy allows caregivers to provide home care as part of fulfilling family obligations while managing the caregiver burden. This study aimed to investigate primary caregivers’ relationship with hired support and its impact on coping with caregiver burden. Twenty in-depth interviews were conducted with primary caregivers who hired live-in domestic helpers to take care of their family members with dementia. The findings revealed that caregivers perceived the normative obligations to provide home care to family members with dementia. They sought support from domestic helpers to cope with physical and mental burnout, disruption of normal routines, and avoidance of financial strain. A mutual-support relationship was built between caregivers and domestic helpers through trust and interdependence. The presence of domestic helpers as a coping resource reveals the positive outcomes of problem-, emotional-, and diversion-focused coping. This study illustrates that coping strategies are employed in different ways depending on the needs of caregivers, access to infrastructure, cultural expectations, and available resources. [ABSTRACT FROM PUBLISHER]

Classroom training sessions for new home care workers (HCWs) are often brief and ad hoc, varying in format and content. Yet the application of this training may be central to worker and client safety. A qualitative approach was adopted for this inquiry, comprising two separate but related practical studies. In the first, exploratory study, classroom training was observed, and HCWs were interviewed following their classroom training. Based on these findings, a set of interventions was implemented and evaluated in the second study. Findings from the overall inquiry suggest that brief classroom sessions are effective, however, a format which encourages the development of dispositional and procedural knowledge is most important. Learning in the classroom may also be enhanced with the provision of a range of written materials to trainees. The paper concludes with a set of recommendations for enhancing the effectiveness of brief classroom training sessions, and suggestions for future research. [ABSTRACT FROM AUTHOR]

We describe a community-engaged approach with Medicaid home and community-based services (HCBS), home care aide (HCA), client, and physical therapist stakeholders to develop a mobile application (app) exercise intervention through focus groups and interviews. Participants desired a short exercise program with modification capabilities, goal setting, and mechanisms to track progress. Concerns regarding participation were training needs and feasibility within usual care services. Technological preferences were for simple, easy-to-use, and engaging content. The app was piloted with HCA-client dyads (n = 5) to refine the intervention and evaluate content. Engaging stakeholders in intervention development provides valuable user-feedback on both desired exercise program contents and mobile technology preferences for HCBS recipients. [ABSTRACT FROM PUBLISHER]

To accommodate the increasing demand for home care in Ontario, Canada, some care tasks traditionally performed by regulated health professionals are being transferred to personal support workers (PSW). However, this expansion of PSW roles is not uniform across the province. Between December 2014 and April 2015, barriers and facilitators to expansion of PSW roles in home care were explored in a series of 13 focus groups. Home care staff identified seven categories of factors affecting the expansion of PSW roles in home care including: communication and documentation; organization and structures of care; attitudes and perceptions of the expanding PSW role; adequate staffing; education, training and support; PSW role clarity and variation in practices, policies, and procedures. Addressing barriers and promoting facilitators at the funder and employer levels will enable the provision of safe, effective, and equitable care by PSWs. [ABSTRACT FROM PUBLISHER]

How home care workers (HCWs) adapt their classroom training to their workplaces is central to their own safety and that of their care recipients. A case study approach was adopted for this inquiry into HCW training in Australia, where new workers were directly observed and interviewed in their workplaces following classroom training. Findings from the study advance four contributions: (a) learning is person-dependent, (b) artefacts in the form of written materials afford a valuable form of learning support; (c) opportunities for these workers to meet, share and refresh their knowledge are important for further development of occupational capacities; and (d) more organisational support for such socially isolated workers' learning is needed. [ABSTRACT FROM AUTHOR]

We examined the effects of provider characteristics on home health agency performance on patient experience of care (Home Health CAHPS) and process (OASIS) measures. Descriptive, multivariate, and factor analyses were used. While agencies score high on both domains, factor analyses showed that the underlying items represent separate constructs. Freestanding and Visiting Nurse Association agencies, higher number of home health aides per 100 episodes, and urban location were statistically significant predictors of lower performance. Lack of variation in composite measures potentially led to counterintuitive results for effects of organizational characteristics. This exploratory study showed the value of having separate quality domains. [ABSTRACT FROM AUTHOR]

Applying a theory-based conceptual model of organizational diversity, climate of inclusion, and beneficial/detrimental outcomes, this study analyzes 30 qualified studies (N= 496,740 workers) published during the past 2 decades. Results indicate that although diversity is associated with both beneficial and detrimental outcomes, diversity management efforts that promote a climate of inclusion are consistently associated with positive outcomes (? = .42, 95% CI = .29, .54) (N= 290,854). Findings suggest that human service organizations should move beyond a sole focus on increasing diversity representation to developing policies and practices that engender a climate of inclusion. [ABSTRACT FROM AUTHOR]

Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery formats of dementia-specific continuing education (CE) programs, and challenges and catalysts to attending CE on any topic. From January through March, 2014, 82 of 111 eligible home care staff in one Saskatchewan health region completed a cross-sectional postal survey (73.9% response rate). The survey included 41 nurses/case managers (client care coordinators, assessors, and team managers) and 41 continuing care aides (home health aides). Nurses/case managers and aides were equally likely to report moderate to high interest in locally delivered CE and low interest in Internet-based and computer-based CE. Compared with nurses/case managers, aides were more likely to report challenges to CE attendance due to CE not being a requirement of their position or relevant to their work. Low staffing levels were the top challenge regardless of professional role. Nurses/case managers and aides were equally likely to identify locally offered programs and paid time off as the top two catalysts of CE attendance. Given the growing number of individuals with dementia receiving home care services, the current study suggests that continuing education should be offered locally and included in rural staff’s paid time in order to encourage attendance. [ABSTRACT FROM AUTHOR]

Objectives: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities. Methods: Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts. Results: Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work. Conclusion: This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides. [ABSTRACT FROM AUTHOR]

The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)--many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients' language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults' perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities--either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners' comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-- relative to the Mexican guise--was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups. [ABSTRACT FROM AUTHOR]

Article 19 of the UN Convention on the Rights of Persons with Disabilities requires states to provide personal assistance services. This article is based on qualitative research in Iceland, Norway and Sweden, carried out between 2012 and 2013. The overall study focused broadly on the implementation of Article 19. This article, however, reports findings based on a particular group of participants within the larger study: non-disabled parents who coordinate personal assistance schemes for their adult son or daughter. The article examines the various ways in which the parents, the majority of whom were mothers, negotiate principles of independence, choice and autonomy for their adult son or daughter who requires intensive support, including assistance with communicating. The aim is to explore, in the context of the Convention and the principles of the independent living movement, how to acknowledge and conceptualise personal assistance schemes that require another person to manage on behalf of the user. [ABSTRACT FROM PUBLISHER]

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world. [ABSTRACT FROM PUBLISHER]

An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study’s objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey of all home care staff in a primarily rural health region was used to gather data. Of 111 eligible staff, 82 participated (41 nursing aides, 41 nurses/case managers). To explore the relationship between activity frequency (F) and competence (C), the proportion of nurses and aides in four quadrants for each activity was examined: (1) low F-low C, (2) low F-high C, (3) high F-low C, and (4) high F-high C. Nurses/case managers were significantly more likely than aides to regularly perform 11 activities and to report high competence in 9 activities (p< .05); aides were more likely to assist with two activities (personal care and daily living activities). Thus, nurses/case managers performed a broader range of activities and reported higher competence overall. The top CE topic for both groups was recognizing differences between dementia subtypes, but rankings for most activities varied by group. Aides’ CE priorities indicated a desire to develop competence in low frequency-low competence activities, suggesting an expanded role in supporting dementia patients and their families. Nurses’ CE priority topics were in the high F-high C quadrant, indicating a need to further develop competence in these activities. Findings have implications for planning CE programming for home care providers. [ABSTRACT FROM PUBLISHER]

This paper describes an action research study which asked “what happens when home carers are trained to use contact reflections.” Pre-Therapy contact reflections aim to facilitate psychological contact with people who are contact-impaired. Home carers offer care and support in people’s own homes and social care is increasingly offered in this community setting. Training home carers to use contact reflections may have some impact on the quality of care offered. Three home carers from a home care agency participated in training and subsequent group meetings. For the study they all chose to work with clients who had dementia. Home carers developed a different way of communicating with their clients, including some use of contact reflections, but mostly used more direct language and became more attuned to their clients. This way of relating helped carers to achieve the care tasks more easily and without causing distress to clients. This was a small sample of three home carers from one agency and the findings cannot be generalized but the study did identify possibilities for further research. [ABSTRACT FROM AUTHOR]

This article examines associations between home care workers' health, and non-standard hours and insecurity. Health refers to symptoms of stress and musculoskeletal disorders (MSDs), non-standard hours refer to part-time and casual hours, and insecurity refers to job and employability insecurity. Data come from our 2002 survey of 532 home care workers (nurses, therapists and personal support workers) in a medium-sized city in Ontario, Canada. Path analysis regression results for the conceptual model show that (1) part-time and casual hours and job insecurity are positively and significantly associated with symptoms of stress, (2) the associations between part-time and casual hours and MSDs are mediated by symptoms of stress, and (3) job and employability insecurity are directly associated with MSDs. Results provide evidence that non-standard hours and insecurity must be addressed in order to improve home care workers' health. We show the detrimental effects of non-standard hours and insecurity on workers' health, and the results have implications for employers, human resource managers, trade unionists and government policy-makers. [ABSTRACT FROM PUBLISHER]