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Franzosa E, Kim PS, Moreines LT, McDonald MV, David D, Boafo J, Schulman-Green D, Brody AA, Aldridge MD. Navigating a "Good Death" During COVID-19: Understanding Real-Time End-of-Life Care Structures, Processes, and Outcomes Through Clinical Notes. THE GERONTOLOGIST 2024; 64:gnae099. [PMID: 39187989 PMCID: PMC11405124 DOI: 10.1093/geront/gnae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic severely disrupted hospice care, yet there is little research regarding how widespread disruptions affected clinician and family decision-making. We aimed to understand how the pandemic affected structures, processes, and outcomes of end-of-life care. RESEARCH DESIGN AND METHODS Retrospective narrative chart review of electronic health records of 61 patients referred and admitted to hospice from 3 New York City geriatrics practices who died between March 1, 2020, and March 31, 2021. We linked longitudinal, unstructured medical, and hospice electronic health record notes to create a real-time, multiperspective trajectory of patients' interactions with providers using directed content analysis. RESULTS Most patients had dementia and were enrolled in hospice for 11 days. Care processes were shaped by structural factors (staffing, supplies, and governmental/institutional policies), and outcomes were prioritized by care teams and families (protecting safety, maintaining high-touch care, honoring patient values, and supporting patients emotionally and spiritually). Processes used to achieve these outcomes were decision-making, care delivery, supporting a "good death," and emotional and spiritual support. DISCUSSION AND IMPLICATIONS Care processes were negotiated throughout the end of life, with clinicians and families making in-the-moment decisions. Some adaptations were effective but also placed extraordinary pressure on paid and family caregivers. Healthcare teams' and families' goals to meet patients' end-of-life priorities can be supported by ongoing assessment of patient goals and process changes needed to support them, stronger structural supports for paid and family caregivers, incentivizing relationships across primary care and hospice teams, and extending social work and spiritual care.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Veterans Health Administration, Bronx, New York, USA
| | - Patricia S Kim
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura T Moreines
- HIGN, New York University Rory Meyers College of Nursing, New York, New York, USA
| | | | - Daniel David
- HIGN, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jonelle Boafo
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dena Schulman-Green
- HIGN, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Abraham A Brody
- HIGN, New York University Rory Meyers College of Nursing, New York, New York, USA
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, New York, USA
| | - Melissa D Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Veterans Health Administration, Bronx, New York, USA
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Yanez Hernandez M, Kuo EFC, Henriquez Taveras Y, Lee A, Ramos A, Ringel J, Andreae S, Tsui E, Safford MM, Avgar AC, Shen MJ, Dell N, Shalev D, Riffin C, Wiggins F, Kozlov E, Moise N, Sterling MR. Mental Health and Well-Being Among Home Health Aides. JAMA Netw Open 2024; 7:e2415234. [PMID: 38842806 PMCID: PMC11157351 DOI: 10.1001/jamanetworkopen.2024.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Home health aides and attendants (HHAs) provide essential care to older adults and those with chronic conditions in the home. However, some HHAs struggle with poor mood and stress, which may have been exacerbated by the COVID-19 pandemic. Objective To elicit HHAs' perspectives toward mental health and well-being, including how their job influences both and how to better support the workforce in the future. Design, Setting, and Participants For this qualitative study, focus groups and interviews with HHAs were facilitated in English and Spanish from August 17, 2022, to February 9, 2023, in partnership with the 1199SEIU Training and Employment Fund, a benefit fund of the 1199SEIU United Healthcare Workers East and the largest health care union in the US. Included were HHAs at risk for poor mental health and well-being, which were defined as having at least mild or more symptoms on either the 8-item Personal Health Questionnaire depression scale, the 4-item Cohen Perceived Stress Scale, or the University of California, Los Angeles Loneliness Scale. Exposure Mental health and well-being of HHAs. Main Outcomes and Measures Focus groups and interviews were audio recorded, professionally transcribed, and translated. A thematic analysis was performed that was informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health model. Results A total of 28 HHAs from 14 different agencies participated (mean [SD] age, 54.3 [10.8] years; 26 female [93%]). Seventeen participants (61%) spoke Spanish at home. Five key themes emerged: (1) HHAs' attitudes toward mental health and well-being were influenced by a variety of personal and cultural factors; (2) HHAs' relationships with their patients impacted their mood in both positive and negative ways; (3) structural and organizational aspects of the job, alongside the COVID-19 pandemic, impacted HHAs' mood and stress levels; (4) HHAs used a variety of strategies to cope with their emotions; and (5) HHAs were eager for interventions that can improve their mood, particularly those that bring them closer to their colleagues. Conclusions and Relevance These findings suggest that HHAs' mental health and well-being may be influenced by both personal and occupational factors. Interventions and policies to better support their emotional well-being on the job are warranted.
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Affiliation(s)
- Melissa Yanez Hernandez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Elizabeth Fong-Chy Kuo
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Yefrenia Henriquez Taveras
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, New York
| | - Aida Ramos
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Susan Andreae
- Kinesiology Department, University of Wisconsin-Madison
| | - Emma Tsui
- School of Public Health, City University of New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ariel C. Avgar
- School of Industrial and Labor Relations, Ithaca, New York
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Daniel Shalev
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, New York
| | - Elissa Kozlov
- School of Public Health, Rutgers University, New Brunswick, New Jersey
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, New York
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Tsui EK, LaMonica M, Boerner K, Baron S. "A Major Issue": The Impact of the COVID-19 Pandemic on How Home Care Leaders Perceive and Promote Aides' Mental Health and Well-Being. J Appl Gerontol 2024:7334648241236245. [PMID: 38414156 DOI: 10.1177/07334648241236245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Home care aides play a critical role in the care of older adults, but they do this under difficult working conditions. The COVID-19 pandemic exacerbated aides' stress and worsened their mental health, raising the question of how agencies can better support aides. We explore how home care industry leaders in New York perceived and addressed home care aides' mental health and well-being prior to and during the pandemic through in-depth interviews conducted in 2019 (n = 8 agencies) and 2022 (n = 14 agencies). We found that these topics became more central in leaders' thinking, reflected in a range of new internally and externally funded agency actions, albeit limited by ongoing financial constraints. Maintaining a skilled and reliable aide workforce is critical to societal health but will remain challenging without continued investment in aide support of the kind described in the Surgeon General's Framework for Workplace Mental Health and Well-Being.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Kathrin Boerner
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY, USA
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Cho J, Toffey B, Silva AF, Shalev A, Safford MM, Phillips E, Lee A, Wiggins F, Kozlov E, Tsui EK, Dell N, Avgar AC, Andreae SJ, Sterling MR. To care for them, we need to take care of ourselves: A qualitative study on the health of home health aides. Health Serv Res 2023; 58:697-704. [PMID: 36815290 PMCID: PMC10154157 DOI: 10.1111/1475-6773.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. DATA SOURCES AND STUDY SETTING Interviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor-management fund of the largest health care union in the US. STUDY DESIGN A qualitative study with English and Spanish-speaking HHAs. Interviews were conducted using a semi-structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. DATA COLLECTION/EXTRACTION METHODS Interviews were recorded, professionally transcribed, and analyzed thematically. PRINCIPAL FINDINGS The 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non-Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient-level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. CONCLUSIONS HHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health.
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Affiliation(s)
- Jacklyn Cho
- Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Brittany Toffey
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel F. Silva
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel Shalev
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Monika M. Safford
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Erica Phillips
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ann Lee
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Faith Wiggins
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Elissa Kozlov
- School of Public HealthRutgers UniversityNew BrunswickNew YorkUSA
| | - Emma K. Tsui
- School of Public HealthCity University of New YorkNew YorkNew YorkUSA
| | | | - Ariel C. Avgar
- School of Industrial Labor RelationsCornell UniversityIthacaNew YorkUSA
| | | | - Madeline R. Sterling
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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Shaw AL, Ringel JB, Avgar AC, Riffin CA, Kallas J, Sterling MR. Addressing the Home Care Shortage: Predictors of Willingness to Provide Paid Home Care in New York. J Am Med Dir Assoc 2022; 23:1621-1626.e1. [PMID: 35970249 DOI: 10.1016/j.jamda.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To determine the prevalence and predictors of willingness to consider becoming a paid home care worker. DESIGN Cross-sectional telephone-based survey study. SETTING AND PARTICIPANTS 800 adult residents of New York State participating in the 2020 Empire State Poll, an annual survey conducted in English and Spanish using random-digit dialing. METHODS Willingness to consider working as a paid home care worker was analyzed as the main outcome. Survey questions also involved demographics and unpaid caregiving experience. We used multinomial logistic regression to examine associations between participant characteristics and willingness to be a paid caregiver. RESULTS Participants had a mean age of 47.7 years (95% CI 45.4-50.0). Demographic information included 51.1% female gender, 65.4% White race, 13.4% Black race, 6.4% Asian or Pacific Islander, 14.8% another race, 19.1% Hispanic/Latino ethnicity, and 43.0% household income below $50,000 per year. A weighted 25.4% of participants would consider becoming a paid home care worker. In an adjusted model, willingness to be a paid home care worker was associated with younger age [odds ratio (OR) 0.98, 95% CI 0.96-1.00, P = .032], female gender (OR 2.46, 95% CI 1.35-4.46, P = .003), Black or other race (OR 2.40, 95% CI 1.11-5.17, P = .026, and OR 3.13, 95% CI 1.30-7.54, P = .011, respectively), Hispanic ethnicity (OR 2.26, 95% CI 1.06-4.81, P = .035), household income below $50,000 per year (OR 2.00, 95% CI 1.03-3.88, P = .040), and having provided unpaid family caregiving (OR 2.08, 95% CI 1.15-3.76, P = .016). CONCLUSIONS AND IMPLICATIONS A quarter of New Yorkers would consider working as a paid home care worker. Willingness to consider this occupation was associated with the demographic characteristics disproportionately represented in the current home care workforce. Improved working conditions and compensation could help attract and retain home care workers, thereby addressing the rising need for home care in the United States.
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Affiliation(s)
- Amy L Shaw
- Division of Geriatrics & Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Joanna B Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ariel C Avgar
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Catherine A Riffin
- Division of Geriatrics & Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - John Kallas
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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