Direct Care Workers Employed as Medical Aides: Home Health Aides, Nursing Assistants, and Orderlies

Abstract Purpose This study describes the differences among direct workers (DCWs) employed as medical aides in three occupations: home health aides, nursing assistants, and orderlies. Design and Methods Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed as medical aides in three occupations: home health aides, nursing assistants and orderlies. Results Compared to orderlies and psychiatric aides, home health aides are more likely to be foreign born, more likely to be female, less likely to work in institutional settings, less likely to be under age 25, less likely to work year-round full-time, less likely to have more education, and less likely to receive insurance from their employers. Implications: Since 2018, the PUMS of the ACS separates nursing, psychiatric, and home health aides (previously one occupational category) into three: home health aides, nursing assistants, and orderlies. This affords researchers a more precise understanding of this part of the direct care workforce. Home health aides represented more than 2/3 of DCWs employed as medical aides in 2019. Further, these workers are distinct among medical aides. More than nursing assistants and orderlies, home health aides are older, female, underinsured, foreign-born, and with limited education. This reflects both the barriers home health aides face to other occupations and also the preferences of their employers (which include private households). These findings have implications for the recruitment and retention of medical aides across all three occupations.

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Direct Care Workforce: Where the Boys Really Are

Innovation in Aging ◽

10.1093/geroni/igaa057.584 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 180-181

Author(s):

Christopher Kelly ◽

Jerome Deichert ◽

Lyn Holley

Keyword(s):

Home Health ◽

Nursing Assistants ◽

Direct Care ◽

Direct Care Workers ◽

Physical Strength ◽

Home Health Aides ◽

Direct Care Workforce ◽

Occupation Category ◽

The One ◽

Design And Methods

Abstract Purpose: This study describes the continued growth of male direct care workers (DCWs) and identifies the occupations with the greatest concentrations of male DCWs by utilizing the expanded information available in the 2018 American Community Survey (ACS). Design and Methods: Data were taken from the 1% Public Use Microdata Sample (PUMS) from the 2018 ACS. Beginning in 2018, the ACS separated the single occupation category nursing, psychiatric, and home health aides into three categories: home health aides, nursing assistants, and orderlies and psychiatric aides. Results: Between 2000 and 2018, the total number of male DCWs in the U.S. increased 118% to 474,925, with more than half (52.6%) in 2018 employed as nursing, psychiatric, and home health aides. Among these 250,139 aides, 62% (154,557) were employed as nursing assistants, 23% (57,126) worked as home health aides, and 15% (38,456) were employed as orderlies and psychiatric aides. However, 60% of all orderlies and psychiatric aides were male; this was the only occupation in the direct care workforce in which men were in the majority. Implications: The majority of male DCWs work as nursing, psychiatric, and home health aides and the new occupation classifications in the ACS reveal that while most work as nursing assistants and home health aides, the one occupation with a majority male workforce was orderlies and psychiatric aides. These findings suggest that the greatest need for male DCWs may be as orderlies and psychiatric aides, occupations in which size and physical strength are important factors.

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It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care

The Gerontologist ◽

10.1093/geront/gnaa116 ◽

2020 ◽

Cited By ~ 1

Author(s):

Kezia Scales

Keyword(s):

Long Term Care ◽

The United States ◽

Direct Care ◽

Direct Care Workers ◽

Term Care ◽

Home Health Aides ◽

Emerging Trends ◽

Care Workers ◽

Direct Care Workforce

Abstract Nearly 4.6 million direct care workers—including personal care aides, home health aides, and nursing assistants—provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers’ contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.

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DIRECT CARE WORKERS EMPLOYED BY PRIVATE HOUSEHOLDS: A DISTINCT LABOR FORCE

Innovation in Aging ◽

10.1093/geroni/igz038.2582 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S702-S702

Author(s):

Christopher M Kelly ◽

Jerome Deichert ◽

Lyn Holley

Keyword(s):

Health Insurance ◽

Labor Force ◽

Home Health Care ◽

Direct Care ◽

Direct Care Workers ◽

Full Time ◽

Term Care ◽

Private Households ◽

Care Workers ◽

The U.S

Abstract Purpose: This study tracks the growing number of direct care workers (DCWs) employed by private households and describes the differences between this often ignored labor force and DCWs employed by agencies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2000 and 2017 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed by private households and DCWs employed by agencies, which include outpatient care centers, home health care services, and individual and family services. Results: Between 2000 and 2017, the number of DCWs employed by private households in the U.S. increased 32% and the majority of this growth was since 2007. Compared to DCWs employed by agencies, DCWs employed by private households were more likely to be over age 65, white, unmarried, have higher educational attainment, be more likely to be in poverty, receive health insurance from Medicare or direct-pay. DCWs employed by private households were less likely to be under age 25, nonwhite, Hispanic, speak a language other than English, work year-round and full-time, receive health insurance from an employer or through Medicaid, and have a disability. Implications: DCWs employed by private households represent a small, but growing proportion of the long-term care (LTC) workforce in the U.S. Further, these workers are distinct within the LTC workforce. This has important implications both for DCWs and for families, particularly those with limited LTC options due to location, financial resources, family support, or other factors.

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Challenges for Children 65+ Caring for Parents 90+ With Dementia During COVID-19

Innovation in Aging ◽

10.1093/geroni/igab046.536 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 140-140

Author(s):

Elizabeth Gallagher ◽

Kathrin Boerner ◽

Yijung Kim ◽

Kyungmin Kim ◽

Daniela Jopp

Keyword(s):

Oldest Old ◽

Home Health ◽

The Novel ◽

Dementia Caregivers ◽

Home Health Aides ◽

Institutional Settings ◽

Additional Burden ◽

Alternative Means ◽

Novel Coronavirus ◽

Depth Interviews

Abstract With the rise of the novel coronavirus, family caregivers of persons with dementia have been tasked with adapting to an entirely new caregiving landscape. Adult children caring for parents in the ‘oldest old’ age group bear an additional burden. Namely, children that are older adults themselves are navigating the joint vulnerability of both their own and their parents’ aging-related issues (e.g., health problems). The aim of this study was to explore the experiences of dementia caregivers during COVID-19 from the unique perspective of children aged 65 and older caring for parents aged 90 and older. Participants were 30 caregivers from the Boston Aging Together Study with whom we conducted in-depth interviews between March 2020 and February 2021. Thematic analysis revealed key challenges related to COVID-19. Children were worried about the prospect of their parent contracting the virus and took steps to minimize their parent’s exposure, such as discontinuing use of formal supports (e.g., home health aides) or assistance from other family and friends. Forgoing these supports often created greater responsibilities for caregivers as well as contributed to greater social isolation for both child and parent. In situations where parents resided in institutional settings, children were often unable to provide necessary help and support to parents due to restrictions. Caregivers also faced difficulties due to their parent not understanding or practicing COVID-19 regulations and in utilizing alternative means of communication with their parent (e.g., video conferencing). Supports and services should be designed in light of the unique challenges of this group.

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The Homecare Aide Workforce Initiative: Implementation and Outcomes

Journal of Applied Gerontology ◽

10.1177/0733464817707298 ◽

2017 ◽

Vol 38 (2) ◽

pp. 253-276 ◽

Cited By ~ 5

Author(s):

Penny H. Feldman ◽

Miriam Ryvicker ◽

Lauren M. Evans ◽

Yolanda Barrón

Keyword(s):

New York ◽

Logistic Regression ◽

Home Health ◽

Direct Care ◽

Direct Care Workers ◽

Entry Level ◽

Home Health Aides ◽

Care Workers ◽

Training And Support ◽

New Hires

Improved training and support are thought to improve retention among direct care workers. However, few studies have examined actual retention. This study examined satisfaction and retention among home health aides enrolled in the “Homecare Aide Workforce Initiative” (HAWI) at three New York agencies. Data included surveys of HAWI trainees and new hires and payroll data for HAWI graduates and others. Three months after hire, 91% of HAWI hires reported they were “very satisfied” or “satisfied” with the job; 57% reported they were “not at all likely” to leave their job in the coming year. At 365 days, 60% were still working. In logistic regression, the odds of being retained at 3, 6, and 12 months were significantly higher among HAWI graduates than non-HAWI new hires. Although not a randomized trial, the study demonstrates an association between participation in an innovative entry-level workforce program and superior 3-, 6-, and 12-month retention.

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Influences of Prejudice and Stereotyping in the Direct Care Workforce

Innovation in Aging ◽

10.1093/geroni/igab046.3495 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 980-980

Author(s):

Jennifer May

Keyword(s):

Older Adults ◽

Residential Care ◽

Home Health ◽

Direct Care ◽

Future Research ◽

Residential Care Facilities ◽

Home Health Services ◽

Care Facilities ◽

Direct Care Workforce ◽

And Gender

Abstract Direct Care Workers (DCW; nursing assistants, personal care aides, home health aides) have the most one on one care with sexual and gender minority (SGM) older adults who reside in residential care facilities or use home health services. DCWs make up a vast majority of the healthcare workforce, holding almost five million jobs in 2019, with approximately 70% of the positions held being in residential care facilities. In a qualitative design study, 11 DCWs were interviewed using an open-ended, semi-structured format to describe their perceptions of care provided to SGM older adults in residential care facilities and the home health setting. These results were part of a larger qualitative study which found there were cues of stereotyping and prejudice in DCW narratives toward SGM older adults. The category DCWs’ care and social system referred to characteristics of the DCWs’ work environment and the perspectives, attitudes, and reported care toward SGM older adults and diverse populations. It was determined that there are synergies among SGM older adults’ care and DCW along with DCW workforce issues (short staffed, low wages, lack of health benefits) that may prevent the DCW from being accepting of implicit bias training or culture change within these facilities/agencies. Implications for practice, policy, and future research are discussed.

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Support From a Distance: How Home Care Agencies Influence Paid Caregiving in the Home

Innovation in Aging ◽

10.1093/geroni/igab046.833 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 217-218

Author(s):

Emily Franzosa ◽

Robyn Stone

Keyword(s):

Home Care ◽

Home Health ◽

Direct Care ◽

Direct Care Workers ◽

Home Health Aides ◽

Care Workers ◽

Functionally Impaired ◽

Workforce Turnover ◽

The Impact ◽

Paid Caregivers

Abstract Paid caregivers (e.g., home health aides, personal care attendants, and other direct care workers) who care for functionally impaired older adults in the home frequently report that while rewarding, their work is logistically, physically, and emotionally demanding. Unlike direct care workers in institutional settings, paid caregivers work with care recipients one-on-one in private settings and often have limited contact with or support from their employers. These factors contribute to high workforce turnover and may impact the quality of patient care. In this symposium, we explore ways that home care agency policies and practices influence the experience of giving and receiving care in the home. First, Bryant et al. describe the range of agency-based models and the impact of workplace design in creating supportive working environments. Next, Fabius et al. explore characteristics of direct care agencies across Maryland, with implications for worker training and support. Reckrey et al. describe the differing perceptions of aides, caregivers and providers around the role agencies play in defining paid caregivers’ roles, and how this may lead to conflict within the caregiving team. Finally, in the context of COVID-19, Franzosa et al. examine communication and coordination between Veterans Affairs-paid agencies and home health aides during the pandemic, while Tsui et al. present a case study of an agency’s efforts to support paid caregivers through group support calls. Together, these studies highlight challenges in the structure, organization and perceptions of home care agencies, and identify potential avenues for agencies to support paid caregivers and their clients.

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