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

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.

The Benefit of Autonomy and Control: A Positive Characteristic of the Home Health Aide Position

Home Health Aides’ (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit new aides into the field and retain current workers. This study explored HHAs’ experiences with the level of autonomy and control granted to them within their day-to-day work. Findings from six focus groups with 37 HHAs showed that many aides select home care because of the control and independence the positions offer. Interacting one-on-one with clients and being able to self-structure their daily tasks were major benefits that drew HHAs to the field. Additionally, the HHAs highlighted the control they have over their schedule and the flexibility the position offers to enable them to accommodate other responsibilities, like childcare or other jobs. Being able to decline a client because of travel distance, the hours required, or not feeling that it is a “good fit” was also a welcomed aspect of the position. Despite complaints about the job, such as low pay, lack of benefits, and limited support, many of the HHAs admitted staying on in their positions because of the flexibility, autonomy, and control provided. Findings highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for promoting greater recruitment and retention of the home care workforce. Amplifying opportunities for these aspects of the job may thus entice new individuals to pursue a career as an HHA, as well as help to maintain those individuals currently in the position.

Navigating COVID-19: Communication and Coordination Between Home Care Agencies and Aides Caring for Older Veterans

Home health aides are essential members of the home care team, but often report limited communication with agency supervisors. To explore the impact of COVID-19 on these dynamics, we conducted semi-structured interviews with providers (n=9), contracted home health agencies (n=6), and aides caring for veterans (n=8) at an urban Veterans Affairs medical center. Data were analyzed through thematic analysis. Agencies relied on aides to observe and report on patients’ conditions, including COVID-19 symptoms, but aides were not always aware of follow-up and wanted more information about their patients’ health and COVID-19 status. Agencies also reported providing personal protective equipment (PPE) and infection prevention guidance to aides; however, some aides reported purchasing their own PPE and seeking out private COVID-19 testing. Supporting aides by providing needed training and protective resources, and engaging them more collaboratively in medical care, may help improve job satisfaction and quality of care.

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

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.

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

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.

COVID Pandemic Impact on Nevada Adult Protective Services

Empirical data regarding Covid pandemic impact on the Nevada Adult Protective Services (APS) Program clients, casework, and staff was gathered and analyzed as part of a multi-faceted program evaluation. Key findings include: 66% of the staff agreed or strongly agreed that the pandemic made their jobs more challenging. Respondents reported Covid-related challenges faced by clients, the program, and themselves as social workers serving older and vulnerable adults. Adverse client impacts observed included increased social and emotional isolation, loss of housing, exacerbation of symptoms of mental illness, necessary services being cut from clients subsequent to testing Covid positive, and fear and reluctance to allow needed visiting service providers, such as home health aides, into their homes. We will discuss the implications of the findings on APS services and clients, and on related health and human services designed to promote the wellness and independence of older and vulnerable adults.

Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, home health aides (HHAs) provided daily medical and personal care to community-dwelling older adults and those with chronic conditions. Prior qualitative studies have found that providing care during COVID-19 left HHAs susceptible to physical, financial, and emotional risks. However, limited quantitative data exist The objective of this study was to assess the impact of COVID-19 on HHAs and to understand the challenges and opportunities for current and future pandemic planning. A cross-sectional survey of 256 HHAs in the downstate New York region was conducted by telephone in English, French Creole, Chine, Spanish, and Russian between August and November 2020. The survey found that HHAs experienced a variety of physical, financial, and emotional challenges during COVID-19. To better support this work force, action by public health officials and policymakers is warranted, particularly with respect to workplace protections and safety, mental health, compensation, and access to basic resources.

Caregiving and Care Receiving Experiences Among Older Chinese Immigrants and Their Home Health Aide

Introduction: There is limited information about how racial and cultural similarities or differences between patient and caregiver may affect quality care. The purpose of this study was to explore caregiving and receiving experiences among older Chinese immigrants and their home health aides by using in-depth interviews in culturally concordant dyads in a community setting. Methodology: A purposive sample of 10 dyads of older Chinese immigrants and their home health aides were recruited using a snowball sampling method ( N = 20). All interviews were audio recorded, transcribed, and coded for qualitative content analysis. Results: The majority of older adults were female ( n = 8) and their average age was 76.8 years. The following themes emerged: companionship and rapport, reconciling the need for care services with the expectations of family, the value of matched gender, language, and ethnic foodculture, assisting with daily routines, and experiencing caregiving burden due to a dual role. Discussion: This study elucidated the dynamics between care recipients and their caregivers with shared cultural backgrounds.