Job Design for Home Care Work: Perspectives From Employers and Home Care Aides

Abstract Home-based care is a rapidly growing sector becoming more important to individuals, families, providers, and payers. The ways in which agencies create the work environment for home care aides who are essentially in their clients’ homes is not adequately documented and may be changing rapidly with labor market innovations. This qualitative study describes how different home care business models (e.g., non-profit VNAs, for-profit franchises, uber-style matching, worker-owned coops) address job design and the overall work environment for home care aides. Interviews with employers and focus groups with home care aides examine workplace practices, how work is organized and supported when the workforce is virtual and the workplace is a client’s home, and the perceived attributes of a positive workplace environment across business models. This study fills significant knowledge gaps about home care workplace design and the role of agencies in creating a supportive environment.

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CHALLENGES AND OPPORTUNITIES FOR TRAINING AND SUPPORTING AIDES AS MEMBERS OF HOME-BASED CARE TEAMS

Innovation in Aging ◽

10.1093/geroni/igz038.793 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S216-S216

Author(s):

Robyn Stone ◽

Natasha Bryant

Keyword(s):

Home Care ◽

Scope Of Practice ◽

Ability To Work ◽

Training And Education ◽

Team Members ◽

Home Based ◽

Challenges And Opportunities ◽

Competency Based ◽

Care Aides ◽

Home Based Care

Abstract Despite home heath/home care aides being the informal “eyes and ears” of the health system, team-based home care initiatives have not incorporated this workforce into their programs. This presentation summarizes barriers to their inclusion: a basic lack of understanding on the part of clinical team members of the complex tasks these caregivers perform, inadequate investments in competency-based aide training and education, and variation in state nurse delegation laws that limit aides’ scope of practice and their ability to work effectively in teams. This is followed by a review of several programs that have successfully included aides as key members of home care teams. The presentation concludes with recommendations on how federal and state policymakers, educators and health systems and providers can support inclusion of aides in team-based care through standardization of competency-based training programs, expansion of nurse delegation nationwide, and support for piloting, evaluation, dissemination and replication of promising models.

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Where Policy Meets Practice: Employer Perspectives on Scheduling and Hours for Home Care Aides

Journal of Applied Gerontology ◽

10.1177/0733464817739153 ◽

2017 ◽

Vol 38 (11) ◽

pp. 1615-1634 ◽

Cited By ~ 2

Author(s):

Elizabeth Nisbet ◽

Jennifer Craft Morgan

Keyword(s):

Home Care ◽

State Level ◽

Direct Care ◽

Employment Policy ◽

Policy And Practice ◽

Care Services ◽

Home Based ◽

Fair Labor Standards Act ◽

Care Aides ◽

Home Based Care

In a context of growing demand for home-based direct care services, the need to retain direct care workers (DCWs) is clear. The Patient Protection and Affordable Care Act, changes to the Fair Labor Standards Act, and state-level changes in Medicaid support for home-based care together have affected agencies that hire DCWs, with implications for an issue that affects worker satisfaction: scheduling. Many home-based aides employed by agencies cannot count on consistent or sufficient hours. Hours shortfall and instability have been recognized as important issues for retail and restaurant workers, but focused on less for care aides. This study uses semistructured interviews with agency representatives to examine these issues from an employer perspective, with a focus on how the competing influences of health care, labor, and employment policy shape scheduling and a review of how recommendations for changes in policy and practice in other sectors might apply to home care.

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Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010367 ◽

2021 ◽

Vol 19 (1) ◽

pp. 367

Author(s):

Emma K. Tsui ◽

Marita LaMonica ◽

Maryam Hyder ◽

Paul Landsbergis ◽

Jennifer Zelnick ◽

...

Keyword(s):

New York ◽

Home Care ◽

Work Stress ◽

Home Based ◽

The Social ◽

Feminist Theories ◽

Sources Of Support ◽

Care Aides ◽

Home Care Aides ◽

Depth Interviews

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides’ use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides’ extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides’ efforts to cultivate support stemming from their home-based work environments. Home care aides’ work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.

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Historical Mismatch Between Home-Based Care Policies And Laws Governing Home Care Workers

Health Affairs ◽

10.1377/hlthaff.2018.05494 ◽

2019 ◽

Vol 38 (6) ◽

pp. 973-980 ◽

Cited By ~ 2

Author(s):

Lisa I. Iezzoni ◽

Naomi Gallopyn ◽

Kezia Scales

Keyword(s):

Home Care ◽

Home Based ◽

Care Workers ◽

Care Policies ◽

Home Care Workers ◽

Home Based Care

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Attitudes of In-Home Care Aides toward Elderly Persons: Refinement of the Oberleder Attitude Scale

Perceptual and Motor Skills ◽

10.1177/00315125890693-207 ◽

1989 ◽

Vol 69 (3-2) ◽

pp. 1103-1106

Author(s):

Betty G. Dillard ◽

Betty L. Feather

Keyword(s):

Elderly Patients ◽

Home Care ◽

Attitude Scale ◽

Elderly Persons ◽

Positive Attitudes ◽

Care Aides ◽

Home Care Aides

The Oberleder Attitude Scale was reduced from 25 to 16 items and was factored into three major concepts, potential, limitations, and stereotypes. Responses of 345 in-home care aides indicated that the 345 aides held positive attitudes toward their elderly patients.

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