Category Archives: Home Health Workers

The Changing Policy Landscape of the Direct Care Workforce

Source: Robert Espinoza, Public Policy & Aging Report, Volume 27 Issue 3, August 2017

As the largest growing occupation in the country, the direct care workforce represents a critical segment of the long-term services and supports field and the U.S. economy. Direct care workers are the paid frontline of long-term care, supporting millions of older people and people with disabilities in residential settings and in their homes and communities. The need for direct care will surge over the next few decades, as millions of people reach retirement age, and as people live longer with higher rates of chronic illness and functional limitations (Administration for Community Living, 2014).

Unfortunately, jobs in this sector are characterized by low wages and high turnover, which impairs both the livelihood of workers and the quality of care they provide. In the face of growing demand for long-term care, policymakers have increasingly begun strengthening this workforce, largely by increasing wages and benefits, promoting better training and advanced roles, collecting reliable data on the workforce, expanding access to long-term care, and supporting the relationship between paid and unpaid caregivers. States around the country are also steadily adopting laws that increase wages for workers and government funding for paid caregiving, create advanced roles and training opportunities for workers, establish working groups to study this workforce, and explore universal long-term care insurance options. Heightened attention on this sector, paired with a health framework that elevates the role of the worker in care delivery, can improve both the quality of jobs for workers and the quality of care for families nationwide…..

Surveying the Home Care Workforce: Their Challenges & The Positive Impact of Unionization

Source: Anastasia Christman, Caitlin Connolly, National Employment Law Project (NELP), Data Brief, September 22, 2017

From the summary:
In the closing months of 2016, we asked home care workers (i.e., caregivers who provide non-medical in-home assistance with daily living tasks such as mobility, eating, dressing, toileting, and bathing) to participate in an online survey about their jobs and their lives. More than 3,000 workers located in 47 states and the District of Columbia responded to a short survey; 2,600 of them went on to complete a second, more detailed section. These responses reveal an experienced and committed workforce that puts in long hours caring for consumers but receives unsustainably low pay and few benefits. A sizeable percentage of respondents are treated as independent contractors and may be misclassified. These workers are overwhelmingly women of color, many of whom are in their prime earning years. Despite the importance of the work they do, they frequently have to supplement their home care work with other jobs to make ends meet.

In addition to examining the experience of the workforce as a whole, we also compared the responses of unionized versus non-unionized home care workers. In doing so, we found several trends that speak to the difference that unionization makes—not only for home care workers but for the consumers they care for as well. To gain additional insight into the impact of home care unionization, we conducted phone interviews with four unionized home care workers whose stories are included in this report…..

Safety of union home care aides in Washington State

Source: Ashley L. Schoenfisch, Hester Lipscomb and Leslie E. Phillips, American Journal of Industrial Medicine, Vol. 60 Issue 9, September 2017
(subscription required)

From the abstract:
Introduction:
A rate-based understanding of home care aides’ adverse occupational outcomes related to their work location and care tasks is lacking.

Methods:
Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides’ demographic and work characteristics. Injury narratives and focus groups provided contextual detail.

Results:
Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern. Conclusions: Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides’ improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce.c

Capping Medicaid: How Per Capita Caps Would Affect Long-Term Services & Supports and Home Care Jobs

Source: LeadingAge and Community Catalyst – Center for Consumer Engagement in Health Innovation, June 2017

The American Health Care Act (AHCA) – passed by House Republicans in May, and currently under consideration in the Senate – would dramatically change Medicaid’s financing structure. Currently, Medicaid operates as a federal-state partnership where each pays a percentage of Medicaid’s costs and federal financial support increases with need. Under the per capita cap system proposed in the AHCA, the federal government would provide states with an aggregate amount of funding based on the number and category of eligible beneficiaries in the state, with nominal differences in the amount per beneficiary category. The proposed per capita cap system would adjust for overall population growth, but would not account for other relevant factors affecting Medicaid expenditures, such as changes in health care needs or costs. The Congressional Budget Office estimates that this change in the financing structure along with other changes proposed in the AHCA would cut $834 billion from the Medicaid program. States would likely have to account for the decreased funding by cutting benefits, cutting payments to providers, changing eligibility requirements, and/or adding to program waiting lists.

A per capita cap system would have serious implications for people receiving long-term services and supports (LTSS) – including millions of older adults with functional and cognitive impairments. LTSS include a range of typically non-medical services designed to help individuals perform activities of daily living such as bathing, dressing and eating. Medicaid is the primary payer for LTSS so reductions in Medicaid funds would have serious consequences for people receiving LTSS.

States provide LTSS both in the community and in institutional settings. Per capita caps would cause a shift away from home and community based services (HCBS) toward institutional care such as nursing homes. This is because providing LTSS services through HCBS is optional under Medicaid rules while institutional care is mandatory. HCBS varies by state but generally includes home health services and other services such as adult day care.

This brief provides information on some of the factors that would affect states’ abilities to provide LTSS in a per capita cap system. Additionally, we look at a portion of the labor force that provides LTSS – home health aides and personal care aides specifically – and predict that across the United States, between 305,000 and 713,000 home health aides and personal care aides would lose their jobs if the proposed per capita cap system in the AHCA were to be implemented.

Computer-based training (CBT) intervention reduces workplace violence and harassment for homecare workers

Source: Nancy Glass, Ginger C. Hanson, W. Kent Anger, Naima Laharnar, Jacquelyn C. Campbell, Marc Weinstein and Nancy Perrin, American Journal of Industrial Medicine, Vol 60 Issue 7, July 2017
(subscription required)

From the abstract:
Background: The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care.

Methods: Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline.

Results: Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups.

Conclusion: CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care.

Elder Care Is a Looming Crisis. Hawaii Is Facing It Head-On

Source: Christina Cauterucci, Slate, Better Life Lab blog, June 5, 2017

…. If Gov. David Ige signs this legislation, people who work at least 30 hours a week outside the home and serve their kupuna as primary caregivers will be eligible for up to $70 a day in help from trained home aides. The Kupuna Caregiver Assistance Program would help a family caregiver continue to work outside the home, get some necessary breaks in caregiving work, and give her the money to pay a fair wage to the care workers she hires. It’s an important step toward meeting the needs of a fast-aging population and the family members who are expected—but too often financially unequipped—to shoulder the burden…..
Related:
Hawaii Long-Term Health-Care Bill Serves as National Model
Source: Rachel M. Cohen, American Prospect, January 12, 2016

Hawaii legislators are tackling the nation’s elder care crisis head-on with a bill that would offer universal long term care to the state’s senior citizens.

Implementation of a resident handling programme and low back pain in elder care workers

Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016
(subscription required)

From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP

Home and community-based service and other senior service use: Prevalence and characteristics in a national sample

Source: Amanda Sonnega, Kristen Robinson, Home Health Care Services Quarterly, Latest Articles, Published online: 07 Dec 2016
(subscription required)

From the abstract:
We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a “gateway” to HCBS that can help keep older adults living in the community.

State of Care: Minnesota’s Home Care Landscape

Source: PHI, 2017

From the press release:
PHI released a research report this week on the home care landscape in Minnesota, examining the state’s home care workforce and highlighting trends in the broader sector.

The report—State of Care: Minnesota’s Home Care Landscape—was released at a May 2 “workforce solutions” conference hosted by LeadingAge Minnesota, which gathered nearly 300 workforce and aging professionals statewide. PHI partnered with LeadingAge Minnesota to host a May 1 panel presentation where leaders throughout the state spoke about home care and the new report.
Related:
Summary
Slideshow

Frequency and Risk of Occupational Health and Safety Hazards for Home Healthcare Workers

Source: Rassull Suarez, Noma Agbonifo, Beverly Hittle, Kermit Davis, Andrew Freeman, Home Health Care Management & Practice, First Published April 17, 2017
(subscription required)

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