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.     

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.     

Factors Explaining the Job Satisfaction of Home Care Workers Who Left Their Older Care Recipients in Israel

There are high levels of turnover among home care workers. The study goal was to examine factors connected with job satisfaction of home care workers who resigned from their jobs. A survey (self-administered questionnaire) was conducted of 197 home care workers who resigned from their jobs with a home care agency in Jerusalem. Overall job satisfaction of the home care workers was low to moderate. Memory impairment of the care recipient and quality of the relationship between the care worker and the care recipient were significant in explaining overall and intrinsic job satisfaction of the workers. Functional status (activities of daily living) and the impact of the care recipient’s cognitive status on the care worker were significant in explaining job benefit satisfaction. Home care workers who provide care to severely disabled and cognitively impaired older persons experience great work stress. They need ongoing support and training as well as better job benefits.     

Home alone: unmet need for formal support services among home health clients

In order to remain in the home without family or other informal support, home health clients must have access to essential formal services such as nutritional support and homemaking chores to supplement medical and nursing care. In this study, we looked at client-related factors associated with the need for formal support services, and factors associated with whether those needs are adequately met. Data were collected from 2,013 home health clients in Massachusetts. According to the assessment of the skilled nurses treating them, 85 percent of the clients needed one or more support services; some or all needs were not adequately met in nearly half. Significant factors contributing to unmet need included: being non-white, having Medicaid as payer, being in a health maintenance organization, having AIDS, receiving maternal/child health services, and having an acute condition. This research suggests that even clients receiving skilled nursing care may not have many or most of their supportive needs met, and that there are identifiable factors which decrease the likelihood of having adequate care provided.     

Recruitment and Retention of Home Support Workers in Rural Communities

This qualitative study examined recruitment and retention of home support workers (HSWs) providing home support in rural communities. Thirty-two participants were recruited across four island-based communities located in British Columbia, Canada. Thematic analysis of interview data revealed several key themes: (a) how the rural context shapes HSWs’ employment decisions and opportunities; (b) why people become (and stay) HSWs in rural communities; and (c) how rurality influences the nature and scope of HSWs’ work. These findings suggest that health human resource policies and programs aimed at HSW recruitment and retention should be tailored to characteristics, strengths, and challenges of rural communities.     

Employers, home support workers and elderly clients: identifying key issues in delivery and receipt of home support

The Nexus Home Care Project examines the experiences of employers, home support workers and elderly clients and their family members in the delivery and receipt of home support services. The primary purpose of this research is to identify salient issues in the delivery and receipt of home support services to elderly individuals from the perspective of employers, home support workers and clients. The data for this study, funded by the Canadian Institutes of Health Research, are derived from in-depth interviews with home support employers (n=11), home support workers (n=32) and elderly clients (n=14) in British Columbia. Employers emphasized recruitment and retention and the increasing complexity of client needs, and raised questions regarding the appropriateness of home support as a part of the healthcare continuum. Home support workers stressed scheduling and time demands, the tension in providing intimate ongoing care at an emotional distance and the balance between tasks outlined in the care plan and the needs and wants of elderly clients. Elderly clients indicated an ongoing need to prepare for and manage services and expressed a need for companionship. Findings are discussed as they inform and extend our understanding of the key tensions in home support. Strategies for addressing these tensions are also identified.     

Home health care workers' attitudes toward the elderly

This study examined home health care workers' attitudes toward the elderly and their elderly clients. Data were collected from a convenience sample of 106 home health care workers in South Central Florida in October 1994, using the Attitudes Toward the Elderly Questionnaire (ATE). Estimated internal consistency reliability of the scale was .60, using Cronbach's alpha. Findings suggest that home health care workers have positive attitudes toward the elderly, their elderly clients, and provide a reasonable level of service for them. Also, findings suggest that overall the attitudes and perceptions among urban and rural home health care workers are similar.     

Job Stress and Job Satisfaction: Home Care Workers in a Consumer-Directed Model of Care

Objective. To investigate determinants of job satisfaction among home care workers in a consumer‐directed model. Data Sources/Setting. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Data Collection and Analysis. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Principal Findings. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work‐health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Conclusions. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer‐directed models of care and efforts to retain long‐term care workers.     

Working Conditions in Home Care

Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers.     

Home Care Is Where the Heart Is

While the provision of an adequate floor of wages and benefits for paraprofessional workers in the home care component of our long-term care system is desirable, efforts to provide it are curtailed by cost constraints. As a result. other factors which encourage the retention of an adequate home care workforce are all-important. Findings from a study of a representative sample of 487 paraprofessional home care workers in New York City indicate that the ability to develop close interpersonal relationships with home care clients and their families is one of the most attractive and rewarding aspects of the work. It is suggested that agencies focus on their roles in providing an optimum environment for the development of such relationships.     

Intention to Leave the Job Among Live-In Foreign Home Care Workers in Israel

In Israel, almost all around-the-clock home care services are provided by foreign workers. Despite the fact that these workers are considered temporary, the Israeli government has acknowledged the need for consistency in care and now allows workers to stay in the country for as long as their care recipient is alive. Nonetheless, there have been increasing concerns about the tendency of foreign home care workers to view Israel as a temporary station on their way to more attractive destinations, such as Canada or England. Using the job rewards and concerns model, this article evaluates determinants of foreign home care workers' intentions to leave their job. This study was a cross-sectional analysis of 178 Filipino home care workers in Israel. Only 15 workers (8.4%) reported that they would be likely or very likely to leave their job within the next 3 months. The final model suggested that negative experiences within the home/work environment as well as within Israeli society at large contribute to depression and posttraumatic stress symptoms. However, caring for an older adult with dementia was the only predictor of intention to leave the job. The majority of workers do not report an intention to leave their job. Nonetheless, greater supervision of this caregiving arrangement in an attempt to protect the rights of foreign home care workers within the home/work environment is an important step, which has to be followed up by attitudinal changes within society at large. Specific training in dementia care is also warranted.     

Factors Associated with Achievement of Goals for Home Health Care

ABSTRACT

With the introduction of Medicare's Prospective Payment System (PPS) and DRGs, the economic value of home health care services lies in its ability to reduce total patient care costs by the substitution of outpatient home care for inpatient hospital care. Analysis of service delivery patterns utilized by home health agencies in meeting goals for patient care will be an important ingredient in meeting these objectives. The purpose of this study was to determine if important patient characteristics known at the onset of home health care are predictive of utilization of home health services and/or the likelihood of meeting goals for home care established at the time of certification of care. Multivariate models were developed which predicted the odds of terminating with goals met based upon age, intensity of utilization, functional limitations, prognosis, presence of a caregiver, and type of patient condition. Results indicated that variability in likelihood of meeting goals for care is much better predicted by patient characteristics than by utilization of home care services.     

Home care and its relationship to the work environment in health

This paper discusses home care as a service that has expanded in the public and private health system, while arguing for the possibility that such care can leverage a significant impact on the population's quality of life and health. The article presents home care as a strategic possibility for reorganizing the health system, by means of integration between health workers and health institutions, and considers its possible political, economic, and technical impacts on the health system, health workers, and users of the service.     

Home care worker resignations: a study of the major contributing factors

Home care has become a major component in health care delivery. Increasingly demands are being placed on the base of the hierarchical personnel pyramid, the home care worker. These workers have a high turnover rate. This study examines the major reasons that contributed to a home care worker's decision to leave the job, and identifies where she/he went. The hypothesis tested was that factors other than salary influence a home care worker's decision to resign. The findings have implications for practice, education, research, and public policy.     

Integrating Hospice and Home Health Services

Two types of strategic factors promote the development of hospice-home health care alliances. Enabling factors include favorable reimbursement policies, acceptance of innovative and noninstitutional modes of health care delivery, and existing supportive infrastructures. Factors supporting alliances include similar types of patient needs, potential for sharing provider and administrative staff, joint referral networks, and common cost containment methodologies. A study of a multi-institutional arrangement between a hospice and a home health care program provided data on patient demographics, staff utilization, and programmatic costs. An analysis of these data showed surprising similarities between the programs. These findings support the continued efforts for service consolidation and integration.     

Community care for the frail elderly: the case of non-professional home care workers

With the aging of the population there will be a growing demand for non-professional home care workers to augment family caregivers in the care and support of the frail elderly. Despite the present and future importance of these workers, little is known about their job problems and satisfactions and their relationships with clients and their families. This paper presents an overview of what is known about this vital component of home care and suggests policy and research implications.     

Home health care for the elderly.

Home health services must be expanded and must include ongoing social work services. In addition to the provision of direct service, social workers are encouraged to advocate for quality home health services, to develop effective techniques for providing social services to home-care patients, to incorporate these techniques into social work education, and to become involved in the education of their medical colleagues. In this way, the home health field can begin to fulfill its goals by providing patients with quality care in the home setting, thus allowing them to remain independent and at the same time meeting their health and social needs.     

Working in clients' homes: the impact on the mental health and well-being of visiting home care workers

The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.