Why I Became a Home Support Worker: Recruitment in the Home Health Sector

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57 home support workers in three Canadian provinces, to examine the factors that attract individuals to employment in this sector. These factors include: previous experience, financial considerations, and enjoying working with people. Understanding these overlapping factors can aide in the recruitment of future workers.     

Why doctors choose small towns: A developmental model of rural physician recruitment and retention

Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. The strongest known influence on rural physician recruitment is a “rural upbringing,” but little is known about how this childhood experience promotes a return to rural areas, or how non-rural physicians choose rural practice without such an upbringing. Less is known about how rural upbringing affects retention. Through twenty-two in-depth, semi-structured interviews with both rural- and urban-raised physicians in northeastern California and northwestern Nevada, this study investigates practice location choice over the life course, describing a progression of events and experiences important to rural practice choice and retention in both groups.     

Level of empowerment and health knowledge of home support workers providing care for frail elderly

The purpose of this study was to assess the profile of home support workers (HSWs) caring for the frail elderly and to determine the perceived empowerment levels and general health knowledge of these support workers. Background, work-profile, empowerment level and health knowledge related to seniors of 64 HSWs were assessed using questionnaires. Findings revealed the majority of workers to be middleaged women, and their health knowledge scores were low. Empowerment levels were moderate as was formal power. Findings demonstrate the need to revise the curriculum of HSWs to include health topics, as well as the need for continued education and strategies to enhance empowerment levels.     

Keeping women doctors in the country

Women are disproportionately poorly represented in the rural Australian medical workforce and appropriate retention policies should recognise the factors contributing to a positive rural experience for female doctors. This study describes the professional, social and family experiences of 10 female general practitioners (GPs) working in rural South Australia. Variety of work, the opportunity to provide continuity of care and being valued by the community were important factors in rural recruitment and retention. Successful retention of a female rural medical workforce also required flexible on-call and after-hours arrangements, provision of additional support and employment opportunities for non-medical spouses and partners; and provision of appropriate child care services to rural medical families. To date, there have been few initiatives specifically addressing the concerns of female rural medical practitioners. An advisory body of rural women doctors and community representatives can provide practical guidance regarding the opportunities available for rural communities to effectively support their women doctors.     

A Description of the Southern Rural Access Program's Practice Management Strategies

ABSTRACT: Context: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers. Purpose: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers. Methods: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected. Findings: The survey results showed that almost half (46%) of all practices assisted were private stand-alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organizational home for the technical assistance services varied by state, overall states employed an average of 1.67 full-time equivalent practice managers (0.81 full-time equivalent supported by RVF) and received an average of $136 055 per state from the RWJF for the 2–year period beginning April 2002 for practice management support. Conclusions: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of organizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time.     

Community involvement in medical practitioner recruitment and retention: reflections on experience

The provision of health services to rural and remote communities has been the source of much concern and debate in recent times. One aspect of this is the universal problem of insufficient medical practitioners in rural areas and the associated issues of recruitment and retention. Rural communities can play an important role in the recruitment and retention of health professionals, particularly in terms of aiding the integration of health professionals and their families into the community. Community 'involvement' is not community 'development' in the usual sense of that term. Community involvement is about engaging and facilitating active community participation and leadership in the process at hand. This article reflects on experience gained through working with rural and remote communities in Queensland, Australia, with the key purpose of facilitating active community involvement in the recruitment and retention of medical practitioners. This article raises and discusses a number of issues arising from these experiences, with particular focus on barriers and opportunities to community involvement, and working with other agencies. Communities and agencies that attempt to increase rural community involvement in health service planning, provision, recruitment and retention should consider the following. For communities: Involvement must be real--active participation; Expectations need to be achievable (short and long term); Outcomes should be sustainable; Resources and capacity should remain in the community. For agencies: Avoid creating unrealistic community expectations; Be aware of time and resource requirements and constraints; Be consistent, forthright and honest in all dealings with communities; Keep communities informed of pending policy changes; See the process through to whatever conclusion.     

Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push

Background/aim: Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method: Thirty‐eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results: Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ‘bored’ or ‘stale’, organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions: The results supported the development of a ‘push and pull’ conceptualisation of recruitment and retention issues, including job‐related (intrinsic) and non‐job‐related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.     

Factors in Recruiting and Retaining Health Professionals for Rural Practice

CONTEXT: Rural communities, often with complex health care issues, have difficulty creating and sustaining an adequate health professional workforce. PURPOSE: To identify factors associated with rural recruitment and retention of graduates from a variety of health professional programs in the southwestern United States. METHODS: A survey collecting longitudinal data was mailed to graduates from 12 health professional programs in New Mexico. First rural and any rural employment since graduation were outcomes for univariate analyses. Multivariate analysis that controlled for extraneous variables explored factors important to those who took a first rural position, stayed rural, or changed practice locations. FINDINGS: Of 1,396 surveys delivered, response rate was 59%. Size of childhood town, rural practicum completion, discipline, and age at graduation were associated with rural practice choice (P < .05). Those who first practiced in rural versus urban areas were more likely to view the following factors as important to their practice decision: community need, financial aid, community size, return to hometown, and rural training program participation (P < .05). Those remaining rural versus moving away were more likely to consider community size and return to hometown as important (P < .05). Having enough work available, income potential, professional opportunity, and serving community health needs were important to all groups. CONCLUSION: Rural background and preference for smaller sized communities are associated with both recruitment and retention. Loan forgiveness and rural training programs appear to support recruitment. Retention efforts must focus on financial incentives, professional opportunity, and desirability of rural locations.     

Physiotherapy in rural and regional Australia

OBJECTIVE: To inform rural physiotherapy recruitment and retention strategies by describing physiotherapists in the Shepparton region: reasons for career choice, education and physiotherapy professional issues. DESIGN: Survey. SETTING: Health service providers. PARTICIPANTS: Practising and non-practising physiotherapists. MAIN OUTCOME MEASURE: Survey responses. RESULTS: Survey response rate 79%. Eighty four physiotherapists (79 practicing and 5 non-practicing; 80% female) clustered in main regional centres responded. Two-thirds worked part-time with most in the public sector (70%), with one third holding more than one position. One-third considered themselves generalists and one-third specialists. Physiotherapy was first career choice for 83% who made this decision between 14 and 19 years old (16.8-2.5 years) because of contact with a physiotherapist. Professional issues challenging physiotherapists in a rural location are compounded by lack of career path, professional support, access to professional development and postgraduate education. Additional issues are the costs and time to attend courses and conferences, travel/distance, and inadequate resources. Positive elements of rural practice were part-time employment opportunities, independence as primary health providers, practice variety and community recognition. CONCLUSION: Rural physiotherapy recruitment and retention strategies must address resource shortcomings by developing career paths, access to postgraduate education and support. Enhancing workforce capacity could enable more students to have meaningful rural experience to assist recruitment. Strategies highlighting existing positive features of rural practice, reinforced with tangible rewards and recognition of physiotherapists' contribution to the health care of Australians are recommended.     

“It's a nice country but it's not mine”: Exploring the meanings attached to home,rurality and place for older lesbian,gay and bisexual adults

An ageing population across European nations, including the United Kingdom, brings with it new challenges for health and social care services and precipitates social policy initiatives targeted at meeting the care and support needs of a rapidly expanding number of older people. Ageing in place is one such policy driver—policy efforts that seek to promote the maintenance of older citizens residing in their own homes for as long as possible with minimal state intervention. Current generations of older lesbian, gay and bisexual (LGB) people have endured homophobia throughout their life histories, and sexual identity can shape perceptions and experiences of ageing, including experiences of home life, community and place. Our objective is to examine the meanings attached to home and place for older LGB adults living independently across three dimensions: rural places as “home,” connections to LGB communities, and social care provision in the home. We present interview findings from a mixed‐methods study on the social inclusion of older LGB adults in Wales. Twenty‐nine LGB‐identifying adults (50–76 years) self‐selected to participate in semistructured interviews between 2012 and 2013. Thematic findings from interviews indicate varying and contradictory meanings attached to home life in rural places, the importance of connection to communities of identity across geographical and online localities, and a high degree of ambivalence towards the prospect of receiving social care services in the home. We argue that a more nuanced understanding of the subjective meanings attached to home, rurality and community for older LGB people is needed to fully support LGB citizens to continue to live independently in their homes.     

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

Background  

The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions.     

Personal-professional boundary issues in the satisfaction of rural clinicians recruited from within the community: findings from an exploratory study

Objective: The objective of this paper is to highlight, from within a broad study of recruitment/retention, findings that identify personal–professional boundaries as key challenges for rural child and youth mental health clinicians recruited from within the community. Design: Two mixed methods online questionnaires followed by semistructured telephone interviews with a small subset of respondents were administered to clinicians, team leaders, supervisors and managers whose practice responsibilities encompass rural settings in three regions of British Columbia, Canada. Participants: Forty‐four clinicians and 27 team leaders/managers participated in the survey while eight clinicians and one team leader/manager participated in the semistructured interviews. Half the clinician respondents were recruited from within the community. Of those recruited from outside the community, half had prior experience living or working in a rural community. Main outcome measures: Levels of satisfaction with lifestyle, practice and preparation for practice were compared across categories of respondents identified earlier. Open‐ended comments were coded by theme and also compared across categories of respondents. Results: While expressing their higher levels of satisfaction with rural lifestyle and professional practice, clinicians recruited from within rural communities report significant initial and ongoing stress related to personal–professional boundaries and dual relationships. They also report lower levels of satisfaction with orientation and preparation for practice relevant to dealing with these stressors. Conclusion: Prior attachment to rural communities, increasingly viewed as an effective recruitment and retention strategy, requires better preparation and ongoing supports to enable practitioners to deal with dual relationships and the personal–professional boundary issues that are a direct consequence of their attachments.     

Recruitment and retention of rural physicians: issues for the 1990s.

This paper briefly describes a number of structural and economic changes in the profession of medicine and in the rural medical care delivery system that have occurred since about 1970. Changes in the national physician supply; in the training, work, and practice characteristics of physicians; in the demographic characteristics of physicians; in the medical resources available in rural communities; and in federal and state support for the provision of medical services are noted. Four conceptual models that underlie physician recruitment and retention programs for small towns and rural communities are described. These include affinity models, which attempt to recruit rural persons into training or foster interest in rural practice among trainees; economic incentive models, which address reimbursement or payment mechanisms to increase economic rewards for rural practice; practice characteristics models, which address technical, collegial, referral, and other structural barriers to rural practice; and indenture models, which recruit temporary providers in exchange for scholarship support, loan forgiveness, or licensure. Examples of applications of each model are provided and the effects of changes in the medical care system on the effectiveness of each model are assessed. Finally, it is argued that elements of an optimal model for the recruitment of physicians to rural practice include the promotion of medical careers among rural high school students, the provision of financial and cultural support for their training, the development of technical and collegial support systems, and the limited use of indenture mechanisms to meet the needs of the most impoverished or isolated rural settings.     

Systematic Review of Rural and Urban Differences in Care Provided by Home Health Agencies in the United States

ObjectiveHome health care agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges from their urban counterparts in delivering care (eg, longer distances to travel to patient homes leading to higher fuel/travel costs and fewer number of visits in a day, impacting the quality of home health care for rural beneficiaries). We review evidence on differences in care outcomes provided by urban and rural HHAs.DesignSystematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the Newcastle-Ottawa Scale (NOS) for quality appraisal.SettingCare provided by urban and rural HHAs.MethodsWe conducted a systematic search for English-language peer-reviewed articles after 2010 on differences in urban and rural care provided by U.S. HHAs. We screened 876 studies, conducted full-text abstraction and NOS quality review on 36 articles and excluded 2 for poor study quality.ResultsTwelve studies were included; 7 focused on patient-level analyses and 5 were HHA-level. Nine studies were cross-sectional and 3 used cohorts. Urban and rural differences were measured primarily using a binary variable. All studies controlled for agency-level characteristics, and two-thirds also controlled for patient characteristics. Rural beneficiaries, compared with urban, had lower home health care utilization (4 of 5 studies) and fewer visits for physical therapy and/or rehabilitation (3 of 5 studies). Rural agencies had lower quality of HHA services (3 of 4 studies). Rural patients, compared with urban, visited the emergency room more often (2 of 2 studies) and were more likely to be hospitalized (2 of 2 studies), whereas urban patients with heart failure were more likely to have 30-day preventable hospitalizations (1 study).Conclusion and ImplicationsThis review highlights similar urban/rural disparities in home health care quality and utilization as identified in previous decades. Variables used to measure the access to and quality of care by HHAs varied, so consensus was limited. Articles that used more granular measures of rurality (rather than binary measures) revealed additional differences. These findings point to the need for consistent and refined measures of rurality in studies examining urban and rural differences in care from HHAs.     

Medicare graduate medical education funding and rural hospitals

To assess the importance of medical residents to rural hospitals, and to predict the possible effect of reductions in Medicare graduate medical education (GME) payments, data from Medicare hospital cost reports and from a telephone survey of rural hospitals with residency programs are analyzed. In prospective payment system year 11, 70 rural hospitals received more than $80 million in Medicare GME payments. The presence of rural training programs enhanced staff physician recruitment and retention and led to increased numbers of physicians settling in communities surrounding the facilities. Many survey respondents felt that elimination of GME funds would results in downsizing or outright elimination of their training programs. The results support the contention that rural training programs are important to hospitals and their surrounding communities and provide an essential component of the physician supply pipeline to rural areas.     

Essential but Excluded: Building Disaster Preparedness Capacity for Home Health Care Workers and Home Care Agencies

COVID-19 has demonstrated the essential role of home care services in supporting community-dwelling older and disabled individuals through a public health emergency. As the pandemic overwhelmed hospitals and nursing homes, home care helped individuals remain in the community and recover from COVID-19 at home. Yet unlike many institutional providers, home care agencies were often disconnected from broader public health disaster planning efforts and struggled to access basic resources, jeopardizing the workers who provide this care and the medically complex and often marginalized patients they support. The exclusion of home care from the broader COVID-19 emergency response underscores how the home care industry operates apart from the traditional health care infrastructure, even as its workers provide essential long-term care services. This special article (1) describes the experiences of home health care workers and their agencies during COVID-19 by summarizing existing empiric research; (2) reflects on how these experiences were shaped and exacerbated by longstanding challenges in the home care industry; and (3) identifies implications for future disaster preparedness policies and practice to better serve this workforce, the home care industry, and those for whom they care.     

Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities

Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women’s pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women’s and professionals’ differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.     

RECRUITMENT AND RETENTION: PERCEPTIONS OF RURAL MENTAL HEALTH WORKERS

ABSTRACT: Recruitment and retention of professionals is a major issue in rural health care. Following a literature review and series of focus groups, a questionnaire to ascertain why professionals applied for, stayed in and would consider leaving rural mental health work was constructed. The questionnaire also included questions regarding possible initiatives that could be undertaken to improve recruitments. The questionnaire was distributed through informal networks to over 900 professionals. Four hundred and seventy eight questionnaires were returned, representing a 52% return rate. According to the response work related issues were generally more important than lifestyle/personal issues particularly as reasons for applying for rural work. Lack of organisational support and professional isolation were important detractors of rural work, with strong support being expressed for initiatives that would address these issues. The findings suggest that recruitment action might highlight the scope, variety, challenge and autonomy aspects of work, with retention focusing on professional support and contact and increased organisational support.     

Rural Illinois Hospital Chief Executive Officers'' Perceptions of Provider Shortages and Issues in Rural Recruitment and Retention

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.     

Health social workers’ assessments as part of a specialized pain rehabilitation: a clinical data-mining study

ABSTRACT

This study examines how health social workers (HSWs) assess the rehabilitation needs of patients with long-term pain. Data were extracted from 66 patient assessments through a retrieval form based on the International Classification of Functioning, Disability, and Health. The assessments included information about relations, work, and recreation. Stress management, problem solving, self-care, participation in community life, and providing personal care were missing in parts of or all assessments. Differences in assessments suggest that information was registered based on traditional gender roles and age. Therefore, HSWs need standardized assessment tools to ensure that assessments are relevant for all patients with long-term pain irrespective of gender or age.