9. Challenges and Experiences in Training Multilingual, International Direct Care Workers in Dementia Care in the United States

Author(s):  
Boyd Davis ◽  
Margaret Maclagan
Author(s):  
Alana Lee Glaser

There are approximately 4.4 million direct-care workers in the United States. Comprising the labor of nurses, home health aides, certified nursing assistants, personal attendants, and companions to the elderly, direct-care work constitutes one of the fastest-growing labor niches in the United States. Within the commodified caregiving sector, cost-cutting imperatives to subdivide care labor introduce insalubrious complications for patients by cleaving – or attempting to do so – their physical needs from their emotional and relational needs, a process that I label ‘rationalized aging’. In this essay, I reflect on my experiences as a paid elder companion in New York City to argue that this process of subdivision combines earlier nineteenth-century rationalization strategies with neoliberal regimes of flexible accumulation and to highlight the consequences of subdivision in this sector both for care workers and for the patients in their care.


Author(s):  
Kezia Scales

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.


AAOHN Journal ◽  
2009 ◽  
Vol 57 (8) ◽  
pp. 338-347 ◽  
Author(s):  
Tracy L. Zontek ◽  
Jody C. Isernhagen ◽  
Burton R. Ogle ◽  
Patricia B. Strasser

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (χ2 = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.


Dementia ◽  
2016 ◽  
Vol 17 (4) ◽  
pp. 423-438
Author(s):  
Sang E Lee ◽  
Banghwa Lee Casado ◽  
Michin Hong

This focus group study explored experience of Korean American personal care aides caring for older Korean Americans with dementia symptoms. Personal care aides described dementia caregiving as challenging, demanding and stressful, yet they cared for their clients with love and affection, particularly with jeong (i.e., a Korean cultural concept of love, affection, sympathy, and bondage). They learned about dementia mostly through their caregiving experience and expressed their need and strong desire to learn more about dementia. They felt for family struggle and observed family conflict and filial obligation. They advocated the value of personal care aides’ involvement in dementia care. This study revealed a pressing need for dementia training for personal care aides and called for an outreach effort to recruit and train direct care workers with potential of providing culturally competent care for traditionally underserved ethnic minorities.


2014 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Ana Barbosa ◽  
Mike Nolan ◽  
Liliana Sousa ◽  
Daniela Figueiredo

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 86-86
Author(s):  
Zhenzhen Zhang ◽  
Shuangshuang Wang ◽  
Nengliang (Aaron) Yao ◽  
Zhang Zhenzhen

Abstract High retention rates among direct care workers (DCWs) affect the quality of aged care. However, limited research has explored factors associated with retention in the Chinese aged care industry. This study compared turnover intention and job satisfaction among DCWs in Chinese hospitals and nursing homes. A total 370 DCWs from 7 hospitals (297 contractual, 73 non-contractual) and 311 DCWs from 7 nursing homes (27 contractual, 284 non-contractual) located in Fujian, China were recruited to fill out a questionnaire. Overall, DCWs from hospitals reported lower turnover intention (20.5 % vs 37.0%) and higher levels of job satisfaction (31.1% vs 16.4%) than DCWs from nursing homes. Specifically, contractual DCWs from hospitals indicated lower turnover intention (14.8%) than non-contractual DCWs from hospitals (43.8%) and both types of DCWs from nursing homes (36.3% and 44.4%). Higher job satisfaction was associated with lower turnover intention, but did not mediate the association between DCW types and turnover intention. Findings suggested that the government and institutions should help DCWs complete the identity transformation from non-contractual DCWs to contractual DCWs to enhance job security and benefits. For nursing home DCWs, licensing and registration requirements shall meet the standards for hospital DCWs. Attention is also to be paid to working conditions and staff welfare of DCWs, including social insurance, pensions, and trainings, to improve job satisfaction and reduce turnover intention.


2017 ◽  
Vol 25 (2) ◽  
pp. 257-274 ◽  
Author(s):  
Ha Do Byon ◽  
Donna Harrington ◽  
Carla L. Storr ◽  
Jane Lipscomb

Background and Purpose: Workplace violence research in health care settings using the Job Demands-Resources (JD-R) framework is hindered by the lack of comprehensive examination of the factor structure of the JD-R measure when it includes patient violence. Is patient violence a component of job demands or its own factor as an occupational outcome? Method: Exploratory factor analysis and confirmatory factor analysis were conducted using a sample of direct care workers in the home setting (n = 961). Results: The overall 2-construct JD-R structure persisted. Patient violence was not identified as a separate factor from job demands; rather, two demand factors emerged: violence/emotional and workload/physical demands. Conclusions: Although the three-factor model fits the data, the two-factor model with patient violence being a component of job demands is a parsimonious and effective measurement framework.


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