Category Archives: Home Health Workers

The Impact of Work/Family Conflict and Workplace Social Support on Mental Distress in Home Health Workers

Source: Ahyoung Lee, Yuri Jang, Home Health Care Management & Practice, OnlineFirst, First Published April 11, 2017
(subscription required)

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

Federal Policy Priorities: Strengthening the Direct Care Workforce

Source: Robert Espinoza, PHI, 2017

From the abstract:
A federal investment in the direct care workforce would promote better wages and benefits, enhance training, and create advanced roles. It would also regularly collect data on the workforce, expand access to services and supports, and thread the contributions of family caregivers with those of paid caregivers, ultimately creating a vibrant system of care. In response, PHI has released a new federal policy report that details recommendations across these issues. This report speaks to a new presidential administration and a new Congress about the needs of direct care workers—and the millions of older people and people with disabilities they serve.

The Impact of the Affordable Care Act on Health Coverage for Direct Care Worker

Source: Stephen Campbell, PHI, Issue Brief, March 2017

From the summary:
Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care Act (ACA). Between 2010 and 2014, half a million direct care workers gained coverage. At the same time, the uninsured rate across this workforce decreased by 26 percent. As the Trump administration and the new Congress consider the future of the Affordable Care Act (ACA) and Medicaid, it is important to consider the impact of these changes on this critical U.S. workforce.

Competition and Gaming Behavior by Medicare Home Health Agencies in the United States

Source: Hyunjee Kim, Bingxiao Wu, Jeah Jung, OnlineFirst, Home Health Care Management & Practice, First Published December 5, 2016
(subscription required)

From the abstract:
Under the Medicare home health prospective payment system, agencies could make large profits by targeting the 10th therapy visit. The objective of this study is to examine the influence of market competition on home health agencies’ targeting the 10th therapy visit. This article uses changes in competition rates within each market over time to examine whether home health agencies were more likely to target the 10th visit under greater competition. No significant associations were found between competition and agencies’ targeting behavior on average, but competition effects on targeting behavior were significantly greater for freestanding agencies that were likely to be in relatively financially disadvantageous positions. These findings suggest that competition might increase financially unstable agencies’ 10th-visit targeting behavior, potentially leading to unnecessary Medicare spending.

60 Caregiver Issues

Source: PHI, 2017

In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to age in our homes and communities. In turn, families and the agencies that serve them are left with few options.

Recognizing a growing workforce shortage among our nation’s home care aides, nursing aides, and personal care aides, as well as the need to provide quality care to a rapidly growing population of older people and people with disabilities, PHI launched a national campaign: 60 Caregiver Issues.

Over the course of two years, PHI will release a new issue every 2-3 weeks, inspiring policy makers and long-term care leaders to pinpoint what needs to be done to remedy this shortage and create a vibrant, sustainable system of long-term care.

SPOTLIGHT: Aging States

Source: Capitol Ideas, November/December 2016

Articles include:
Facing a wave of aging baby boomers, many states are trying to make it easier for seniors to stay in their homes—as many prefer—instead of moving into more costly nursing homes. With high stakes for state budgets, many states are undertaking long-term planning to pay for long-term care.

What is the best state for retirement? It’s a popular question among baby boomers, who increasingly seek more livable communities that will allow them to age in place. How are states responding? Drawing from an AARP scorecard on state long-term services and supports, here’s a look at top states for retirement and aging.

For many seniors, staying active in their golden years depends on staying mobile. But in many states and communities, transportation systems haven’t been developed with seniors or individuals with disabilities in mind. That’s changing as states are taking steps to improve transportation mobility for older adults.

Elder financial abuse costs older Americans $2.9 billion per year, but the harm to seniors caused by fraud often extends far beyond the checkbook. Oregon Attorney General Ellen Rosenblum shares key steps her state has taken to strengthen elder abuse prevention and response.

When state leaders discuss the fiscal challenges of an aging population, the focus is often on costs for senior services. However, as CSG Senior Fellows Katherine Barrett and Richard Greene point out, declining tax revenues are also a concern.

Client history and violence on direct care workers in the home care setting

Source: Ha Do Byon, Carla Storr, Lori Edwards and Jane Lipscomb, American Journal of Industrial Medicine, Volume 59 Issue 12, December 2016
(subscription required)

From the abstract:
Background: Health care workers providing home care are frequently unaware of their client’s history of violence or mental illness/substance abuse disorder, recognized risk factors for workplace violence. This study estimated the associations between these factors and experiencing client violence among direct care workers in the home settings (DCWHs).

Methods: Acts and threats of violence were estimated using data from an anonymous survey among DCWHs (n = 876) working at two large home care agencies. Logistic regressions were performed to produce odds ratios.

Results: Physical acts and physical or verbal threats of client violence were associated with providing homecare to clients with a violence history (adjusted ORs = 6.60 and 10.78, respectively), whereas threats of client violence (adjusted OR = 5.80) were associated with caring for clients with a mental illness/substance abuse disorder.

Conclusions: Policy and practices that support the communication of appropriate client risk information may reduce the likelihood of workplace violence among DCWHs.

Families Caring for an Aging America

Source: Richard Schulz and Jill Eden, Editors; National Academies of Sciences, Engineering, and Medicine; Committee on Family Caregiving for Older Adults; Board on Health Care Services; Health and Medicine Division, 2016

From the abstract:
At least 17.7 million individuals in the United States are providing care and support to an older parent, spouse, friend, or neighbor who needs help because of a limitation in their physical, mental, or cognitive functioning. The circumstances of individual caregivers are extremely varied. They may live with, nearby, or far away from the person receiving care. The care they provide may be episodic, daily, occasional, or of short or long duration. The caregiver may help with household tasks or self-care activities, such as getting in and out of bed, bathing, dressing, eating, or toileting, or may provide complex medical care tasks, such as managing medications and giving injections. The older adult may have dementia and require a caregiver’s constant supervision. Or, the caregiver may be responsible for all of these activities. With support from 15 sponsors, the National Academies of Sciences, Engineering, and Medicine convened an expert committee to examine what is known about the nation’s family caregivers of older adults and to recommend policies to address their needs and help to minimize the barriers they encounter in acting on behalf of an older adult. The resulting report, Families Caring for an Aging America, provides an overview of the prevalence and nature of family caregiving of older adults as well as its personal impact on caregivers’ health, economic security, and overall well-being. The report also examines the available evidence on the effectiveness of programs and interventions designed to support family caregivers. It concludes with recommendations for developing a national strategy to effectively engage and support them.
Report in Brief (PDF)
Recommendations (PDF)
Press Release (HTML)

Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers

Source: U.S. Government Accountability Office (GAO), GAO-16-718, August 16, 2016

From the summary:
Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data’s usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation’s health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.