Aging services workers in the pandemic: Voiced experience of senior center staff & case workers

The pandemic necessitated immediate shutdown of senior centers, requiring a rapid pivot in the delivery of services to older adults by direct care workers. We provided psychosocial support to older adult service personnel-including Aging and Adult Services case workers and Senior Center Staff, and conducted focus groups with staff at intervals to capture the mid-point of the pandemic (peak of older adult deaths), onset of vaccine availability and the re-entry phase as programs re-opened. We evaluated coping and self-efficacy of workers and discerned sustained high levels of coping and perceived job performance. Using a phenomenological lens, we analyzed transcribed recordings, generated codes, and created categories of experiences. Several themes emerged: personal and professional resilience, passion for serving older adults, motivation to perform their job well, stress of not having face-to-face contact with clients, insufficient resources-especially in rural areas, lack of essential training, feeling disjointed as a team, and work-life balance. Over the course of the pandemic, workers expressed increasing resiliency and skills to navigate the pandemic, oscillations in their fears for their clients’ well-being, and gratitude that they kept their jobs and gained additional State resources. As the vaccine was available and utilized, and as senior centers were reopening, senior center staff were enthusiastic, yet case workers remained apprehensive about long-term consequences of the pandemic. This study affirms the role of direct care workers as essential and valuable. Yet, their expressed need for more education, psychosocial support, and community awareness of their service remains to be addressed.

Challenges Faced by Nursing Home Direct Care Workers During the COVID-19 Pandemic: A Comparison Across Care Settings

The COVID-19 pandemic has generated awareness of the value of the direct care workforce to provide care in settings serving those most at risk from the disease. However, few studies have gauged the impact of COVID-19 on this workforce and their pandemic-related challenges. The purpose of this study was to examine the challenges and stress experienced by direct care workers (N=1,414) and their perceptions of preparation and quality of employer communication during this health crisis. Nursing home (NH) workers reported separation from family members and understaffing as the top external and work-related challenges. They felt adequately prepared and gave their employers high marks for communicating with them during the pandemic. NH direct care workers were more likely to report increased workload and understaffing as a challenge compared to workers in home and community-based settings. They also experienced a significantly higher number of work-related challenges compared to workers in assisted living.

Characteristics, Challenges, and Support of Maryland's Direct Care Workers: Findings From a Statewide Agency Survey

Direct care workers (e.g., personal care aides) are paid health care professionals who provide hands on assistance with daily activities to persons with disabilities in home, community, and institutional settings. Many workers are employed by direct care agencies, but little is known or understood about the organizational attributes of these agencies. We describe results from a mixed mode (postal mail, electronic, and telephone) survey of n=1112 residential care agency administrators in Maryland to assess organizational (e.g., size, supplemental services) and direct care worker (e.g., training) characteristics. Preliminary findings indicate that half of direct care agencies’ revenue comes from Medicaid and roughly 40% of clients are living with dementia. Administrators report challenges managing dementia-related behaviors (70%), communicating with persons living with dementia (63%) and interacting with family caregivers (63%). Findings from this work will inform the development of an organizational level intervention that targets training and support of direct care workers.

LTSS Direct Care Worker Employment During COVID-19

The crisis of COVID-19 in long-term care services and supports (LTSS) has brought attention to challenges in staffing long-term care organizations, as shortages of direct care workers led to a dramatic inability to provide needed care for many residents in nursing homes and other residential care settings. In this study, we examine unemployment among LTSS direct care workers during the crisis and recovery. This study uses monthly data from January 2019 to December 2020 from the Current Population Survey, a monthly household survey collected by the Bureau of Labor Statistics, and we compare an individual’s 2019 monthly employment patterns to their 2020 monthly employment. Long-term care workers had an unemployment rate of 2.8% in April 2020, when unemployment rates in the US reached a peak; however, new unemployment among long-term care workers has not declined as consistently as in other settings. Female health care workers were significantly more likely to be unemployed compared to their male counterparts, a trend that is consistent with the overall economy, and workers who earned the lowest wages were more likely to have transitioned to unemployment. COVID-19 has added significant complexity to the provision of direct care services, making LTSS a hazardous place to work. Concerns remain about unemployment in long-term care where demand for workers remains high; additional measures need to be taken to ensure that direct care workers have the resources they need to remain employed.

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.

Meaningful Engagement of Residents With Dementia in Assisted Living: The Role of Direct Care Workers

Meaningful engagement has important implications for quality of care for persons living with dementia. Yet, little research has focused on direct care workers’ (DCWs) role in facilitating engagement opportunities for residents in assisted living. Using data from our ongoing NIA-funded study, “Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia,” we describe DCW approaches to engaging residents and the factors that influence the use and successful application of these approaches. Focal residents (N=33) were followed at four diverse assisted living communities for one year. Data includes care partner interviews (N=100), including 28 DCWs and 1560 hours of field observation data. DCWs interviewed had between 2 months and 12 years’ experience in their current position and were mostly African American and/or immigrant women of color. Findings suggest that DCW-resident interactions are key opportunities to engage residents in a meaningful way and can facilitate positive, trust-based relationships. This analysis elaborates on our previous work identifying four approaches: knowing the person, connecting with and meeting people where they are, being in the moment, and viewing all encounters as opportunities. We identified factors affecting opportunities for, and experiences with, meaningful engagement between residents and DCWs, including community staffing, consistent assignment, scheduling, DCW training and tenure, and community resources. We conclude with implications for practice emphasizing how elaboration of these approaches can inform the development of DCW training, opportunities for career advancement, and integration of approaches consistently into daily practice in an effort to support meaningful engagement of residents living with dementia.

Applying the New World Kirkpatrick Model to evaluate an online training course introducing a multi-sensory device

Online education offers care providers flexibility and convenience. Applying the New World Kirkpatrick Model of training evaluation, this descriptive study evaluated the design and content of a 30-40 minute online training course that introduces direct-care workers to a multi-sensory device to help manage dementia symptoms in older adults. Following course completion, an online survey obtained ratings of engagement (i.e., aesthetics, ease of use, novelty, and involvement), relevance, and knowledge/skills gained from the training using a 5-point Likert scale. A convenience sample of 72 undergraduate students enrolled in health science and human service programs at a Midwestern university participated. The majority were white (83.3%), non-Hispanic (81.9%) females (88.9%). Most participants agreed or strongly agreed (median=4) with positive statements related to engagement with the course. Statements about relevance to their intended career were rated even higher (median=5). Wilcoxon signed-rank tests for matched pairs revealed statistically significant improvements on self-reported pre-post knowledge/skills scores (p<0.005). The results indicated that participants found the training aesthetically pleasing, easy to use, novel, and that it encouraged user involvement. Participants thought the topics covered were relevant to the professional career they are pursing, and they learned new knowledge/skills. Responses to open-ended questions suggested improvements to the design (e.g., color choice) and content (e.g., expanded topics and resources). Future research will evaluate a revised course with direct-care workers who will use the multi-sensory device in long term care facilities. Subsequently, an intervention study will determine the effectiveness of the device in increasing the well-being of people with dementia.

Effect of Online Palliative Care Training on Knowledge and Self-Efficacy of Direct Care Workers

We evaluated the effectiveness of an online training on palliative care knowledge and self-efficacy among staff working with people with intellectual and developmental disabilities (IDD) using a one-group pretest-posttest design. Staff from four nonprofit residential and day services organizations in a U.S. Midwestern state participated. Among 132 staff who completed a baseline assessment, a 2-hour online training, and a posttest, 98 staff completed a 1-month follow-up survey. Palliative care knowledge was assessed before and after the training, and palliative care self-efficacy, at baseline and 1-month follow-up. We used linear regression to identify the factors that influence the effect of the training on main outcomes. Overall palliative care knowledge and self-efficacy significantly improved while higher education and longer work tenure enhanced training effectiveness.

Grief and Loss During Care Transitions: Experiences of Direct Care Workers

Direct Care Workers (DCW) provide both personal care to patients and emotional support to patients and caregivers in hospice and palliative care. DCWs often develop close ties and are then expected to work with new clients immediately following a care transition, with little or no time to grieve. A qualitative pilot study (n = 24) was conducted to explore the experience of DCWs during care transitions. Data was collected via focus groups and individual interviews. Thematic analysis was used. Results suggest DCWs managed their experiences (n = 19), by anticipating and accepting grief and loss (n = 21), employing personal coping strategies (n = 19), and saying good-bye (n = 15). Relational factors impacted the experience of care transitions (n = 22), including building and maintaining the relationship (n = 14), and the strength of perceived connections (n = 15). Increased organizational support and training to help address grief and loss will better support DCWs and the direct care workforce.