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Reckrey JM, Watman D, Perez S, Franzosa E, Ornstein KA, Tsui E. Paid Caregiving in Dementia Care Over Time: Paid Caregiver, Family Caregiver, and Geriatrician Perspectives. THE GERONTOLOGIST 2024; 64:gnae055. [PMID: 38794947 PMCID: PMC11217903 DOI: 10.1093/geront/gnae055] [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: 01/03/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As long-term care increasingly moves from facilities to the community, paid caregivers (e.g., home health aides, other home care workers) will play an increasingly important role in the care of people with dementia. This study explores the paid caregiver role in home-based dementia care and how that role changes over time. RESEARCH DESIGN AND METHODS We conducted individual, longitudinal interviews with the paid caregiver, family caregiver, and geriatrician of 9 people with moderate-to-severe dementia in the community; the 29 total participants were interviewed on average 3 times over 6 months, for a total of 75 interviews. Interviews were recorded, transcribed, and analyzed with structured case summaries and framework analysis. RESULTS Paid caregivers took on distinct roles in the care of each client with dementia. Despite changes in care needs over the study period, roles remained consistent. Paid caregivers, family caregivers, and geriatricians described the central role of families in driving the paid caregiver role. Paid and family caregivers collaborated in the day-to-day care of people with dementia; paid caregivers described their emotional relationships with those they cared for. DISCUSSION AND IMPLICATIONS Rather than simply providing functional support, paid caregivers provide nuanced care tailored to the needs and preferences of not only each person with dementia (i.e., person-centered care), but also their family caregivers (i.e., family-centered care). Deliberate cultivation of person-centered and family-centered home care may help maximize the positive impact of paid caregivers on people with dementia and their families.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Watman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sasha Perez
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VAMC, Bronx, New York, USA
| | - Katherine A Ornstein
- Center Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Emma Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Carson DB, Johansson AB, Schaumberg M, Hurtig AK. Addressing the workforce crisis in (rural) social care: A scoping review. Int J Health Plann Manage 2024; 39:806-823. [PMID: 38297468 DOI: 10.1002/hpm.3774] [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: 11/29/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND This scoping review identifies strategies potentially addressing the 'workforce crisis' in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas. METHODS The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies. RESULTS The most common strategies for addressing social care workforce shortages were to improve recruitment and retention ('recruit and retain') processes without materially changing the workforce composition or service models. Further strategies involved 'revitalising' the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved 're-thinking' social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse. CONCLUSION The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.
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Affiliation(s)
- Dean B Carson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Mia Schaumberg
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Cronin CJ, Lieber EMJ. The demand for skills training among Medicaid home-based caregivers. JOURNAL OF HEALTH ECONOMICS 2024; 95:102877. [PMID: 38581749 DOI: 10.1016/j.jhealeco.2024.102877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 12/30/2023] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.
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Affiliation(s)
| | - Ethan M J Lieber
- University of Notre Dame, United States of America; NBER, United States of America
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Burgdorf JG, Ritchie CS, Reckrey JM, Liu B, McDonough C, Ornstein KA. Drivers of Community-Entry Home Health Care Utilization Among Older Adults. J Am Med Dir Assoc 2024; 25:697-703.e2. [PMID: 37931897 PMCID: PMC10990820 DOI: 10.1016/j.jamda.2023.09.031] [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: 07/13/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES A growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral. DESIGN Nationally representative cohort study. SETTING AND PARTICIPANTS Health and Retirement Study (HRS) respondents who were aged ≥65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n = 11,425 unique individuals providing 27,026 two-year observation periods). METHODS HRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14 days of HH admission) within 2 years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics. RESULTS The overall rate of community-entry HH utilization across observation periods was 13.4%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR) = 1.49, P = .001], had fair or poor overall health (aOR = 1.48, P < .001), 3+ activities of daily living limitations (aOR = 1.47, P = .007), and had fallen in the past 2 years (aOR = 1.43, P < .001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if they received family or unpaid help only (aOR = 1.81, P < .001), both family and paid help (aOR = 2.79, P < .001), or paid help only (aOR: 3.46, P < .001). CONCLUSIONS AND IMPLICATIONS Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation.
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Affiliation(s)
- Julia G Burgdorf
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine McDonough
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, MD, USA.
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Lam K, Cenzer I, Levy CR, Matlock DD, Smith AK, Covinsky KE. The Natural History of Disability and Caregiving Before and After Long-Term Care Entry. JAMA Intern Med 2023; 183:1295-1303. [PMID: 37930717 PMCID: PMC10628843 DOI: 10.1001/jamainternmed.2023.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023]
Abstract
Importance Many older persons move into long-term care facilities (LTCFs) due to disability and insufficient home caregiving options. However, the extent of disability and caregiving provided around the time of entry is unknown. Objective To quantitatively describe disability and caregiving before and after LTCF entry, comparing nursing home (NH), assisted living (AL), and independent living (IL) entrants. Design, Setting, and Participants A longitudinal cohort study using prospectively collected annual data from the National Health and Aging Trends Study from 2011 to 2020 including participants in the continental US. Overall, 932 community-dwelling Medicare beneficiaries entering LTCF from 2011 to 2019 were included. Entry into LTCF was set as t = 0, and participant interviews from 4 years before and 2 years after were used. Main Outcomes and Measures Prevalence of severe disability (severe difficulty or dependence in ≥3 activities of daily living), prevalence of caregivers, and median weekly caregiving hours per entrant, using weighted mixed-effects regression against time as linear spline. Results At entry, mean (SD) age was 84 (8.4) years, 609 (64%, all percentages survey weighted) were women, 143 (6%) were Black, 29 (3%) were Hispanic, 30 (4%) were other (other race and ethnicity included American Indian, Asian, Native Hawaiian, and other), and 497 (49%) had dementia. 349 (34%) entered NH, 426 (45%) entered AL, and 157 (21%) entered IL. Overall, NH and AL entry were preceded by months of severe disability and escalating caregiving. Before entry, 49% (95% CI, 29%-68%) of NH entrants and 10% (95% CI, 3%-24%) of AL entrants had severe disability. Most (>97%) had at least a caregiver, but only one-third (NH, 33%; 95% CI, 20%-50%; AL, 33%; 95% CI, 24%-44%) had a paid caregiver. Median care was 27 hours weekly (95% CI, 18-40) in NH entrants and 18 (95% CI, 14-24) in AL entrants. On NH and AL entry, severe disability rose to 89% (95% CI, 82%-94%) and 28% (95% CI, 16%-44%) on NH and AL entry and was 66% (95% CI, 55%-75%) 2 years after entry in AL residents. Few IL entrants (<2%) had severe disability and their median care remained less than 7 hours weekly before and after entry. Conclusions This study found that persons often enter NHs and ALs after months of severe disability and substantial help at home, usually from unpaid caregivers. Assisted living residents move when less disabled, but approach levels of disability similar to NH entrants within 2 years. Data may help clinicians understand when home supports approach a breaking point.
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Affiliation(s)
- Kenneth Lam
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA Health Care System, San Francisco, California
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Cari R Levy
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Dan D. Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatrics Research Education and Clinical Center, Denver, Colorado
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA Health Care System, San Francisco, California
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco VA Health Care System, San Francisco, California
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Dys S, Carder P. Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living. J Appl Gerontol 2023; 42:2198-2206. [PMID: 37268438 DOI: 10.1177/07334648231181517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.
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Affiliation(s)
- Sarah Dys
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Paula Carder
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Gussin GM, Singh RD, Tjoa TT, Saavedra R, Kaplan SH, Huang SS. Evaluating barriers and potential solutions to speaking up about coronavirus disease 2019 (COVID-19) symptoms: A survey among nursing home workers. Infect Control Hosp Epidemiol 2023; 44:1834-1839. [PMID: 37990904 DOI: 10.1017/ice.2023.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Quantify the frequency and drivers of unreported coronavirus disease 2019 (COVID-19) symptoms among nursing home (NH) staff. DESIGN Confidential telephone survey. SETTING The study was conducted in 70 NHs in Orange County, California, December 2020-February 2022. PARTICIPANTS The study included 120 NH staff with COVID-19. METHODS We designed a 40-item telephone survey of NH staff to assess COVID-19 symptom reporting behavior and types of barriers [monetary, logistic, and emotional (fear or stigma)] and facilitators of symptom reporting using 5-point Likert scales. Summary statistics, reliability of survey constructs, and construct and discriminant validity were assessed. RESULTS Overall, 49% of surveys were completed during the 2020-2021 COVID-19 winter wave and 51% were completed during severe acute respiratory coronavirus virus 2 (SARS-CoV-2) δ (delta)/ (omicron) waves, with a relatively even distribution of certified nursing assistants, licensed vocational or registered nurses, and nonfrontline staff. Most COVID-19 cases (71%) were detected during mandated weekly NH surveillance testing and most staff (67%) had ≥1 symptom prior to their test. Only 34% of those with symptoms disclosed their symptom to a supervisor. Responses were consistent across 8 discrete survey constructs with Cronbach α > 0.70. In the first wave of the pandemic, fear and lack of knowledge were drivers of symptom reporting. In later waves, adequate staffing and sick days were drivers of symptom reporting. COVID-19 help lines and encouragement from supervisors facilitated symptom reporting and testing. CONCLUSIONS Mandatory COVID-19 testing for NH staff is key to identifying staff COVID-19 cases due to reluctance to speak up about existing symptoms. Active encouragement from supervisors to report symptoms and stay home when ill was a major driver of symptom reporting and resultant infection prevention and worker safety measures.
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Affiliation(s)
- Gabrielle M Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Raveena D Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Thomas T Tjoa
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Raheeb Saavedra
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Sherrie H Kaplan
- Health Policy Research Institute, University of California Irvine, Irvine, California
| | - Susan S Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
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Reckrey JM, Kleijwegt H, Morrison RS, Nothelle S, Kelley AS, Ornstein KA. Paid Care for People with Functional Impairment and Serious Illness: Results from the Health and Retirement Study. J Gen Intern Med 2023; 38:3355-3361. [PMID: 37349637 PMCID: PMC10681964 DOI: 10.1007/s11606-023-08262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Paid caregivers (e.g., home health aides) care for individuals living at home with functional impairment and serious illnesses (health conditions with high risk of mortality that impact function and quality of life). OBJECTIVE To characterize those who receive paid care and identify factors associated with receipt of paid care in the context of serious illness and socioeconomic status. DESIGN Retrospective cohort study. PARTICIPANTS Community-dwelling participants ≥ 65 years enrolled in the Health and Retirement Study (HRS) between 1998 and 2018 with new-onset functional impairment (e.g., bathing, dressing) and linked fee-for-service Medicare claims (n = 2521). MAIN MEASURES Dementia was identified using HRS responses and non-dementia serious illness (e.g., advanced cancer, end-stage renal disease) was identified using Medicare claims. Paid care support was identified using HRS survey report of paid help with functional tasks. KEY RESULTS While about 27% of the sample received paid care, those with both dementia and non-dementia serious illnesses in addition to functional impairment received the most paid care (41.7% received ≥ 40 h of paid care per week). In multivariable models, those with Medicaid were more likely to receive any paid care (p < 0.001), but those in the highest income quartile received more hours of paid care (p = 0.05) when paid care was present. Those with non-dementia serious illness were more likely to receive any paid care (p < 0.001), but those with dementia received more hours of care (p < 0.001) when paid care was present. CONCLUSIONS Paid caregivers play a significant role in meeting the care needs of those with functional impairment and serious illness and high paid care hours are common among those with dementia in particular. Future work should explore how paid caregivers can collaborate with families and healthcare teams to improve the health and well-being of the seriously ill throughout the income spectrum.
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Affiliation(s)
| | | | | | | | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Feldman PH, Barrón Y, Onorato N, Russell D, Sterling MR, McDonald M. Covid-19: Home Health Aides' Perceived Preparedness and Self-Reported Availability for Work: Six Month Survey Results. New Solut 2023; 33:130-148. [PMID: 37670604 DOI: 10.1177/10482911231199449] [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: 09/07/2023]
Abstract
Throughout the COVID-19 pandemic New York City home health aides continuously provided care, including to patients actively infected or recovering from COVID-19. Analyzing survey data from 1316 aides, we examined factors associated with perceptions of how well their employer prepared them for COVID-19 and their self-reported availability for work (did they "call out" more than usual). Organizational work environment and COVID-19-related supports were predominant predictors of self-reported perceptions of preparedness. Worker characteristics and COVID-19-related stressors were predominant predictors of self-reported availability. Mental distress, satisfaction with employer communications, and satisfaction with supervisor instructions were significantly associated with both outcomes. The study uniquely describes self-reported perceptions of preparedness and availability as two separate worker outcomes potentially modifiable by different interventions. Better public health emergency training and adequate protective equipment may increase aides' perceived preparedness; more household supports could facilitate their availability. More effective employer communications and mental health initiatives could potentially improve both outcomes. Industry collaboration and systemic changes in federal, state, and local policies should enhance intervention impacts.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy and Research, VNS Health, New York, NY, USA
| | - Yolanda Barrón
- Center for Home Care Policy and Research, VNS Health, New York, NY, USA
| | - Nicole Onorato
- Center for Home Care Policy and Research, VNS Health, New York, NY, USA
| | - David Russell
- Center for Home Care Policy and Research, VNS Health, New York, NY, USA
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Madeline R Sterling
- Department of Medicine, Cornell University, New York, NY, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Margaret McDonald
- Center for Home Care Policy and Research, VNS Health, New York, NY, USA
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Dill J, Henning-Smith C, Zhu R, Vomacka E. Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas. J Appl Gerontol 2023; 42:1800-1808. [PMID: 36794536 PMCID: PMC10427731 DOI: 10.1177/07334648231158482] [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: 02/17/2023] Open
Abstract
Using the 2021 Occupational Employment and Wage Statistics (OEWS) dataset, we calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US. We find that there are, on average, 32.9 home health aides per 1000 older adults (age 65+) in rural areas and 50.4 home health aides per 1000 older adults in urban areas. There are, on average, 20.9 nursing assistants per 1000 older adults in rural areas and 25.3 nursing assistants per 1000 older adults in urban areas. There is substantial regional variation. Greater investment needs to be made in improving wages and job quality for direct care workers to attract workers to these critical occupations, especially in rural areas where the need for direct care is greater.
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Affiliation(s)
- Janette Dill
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Rongxuan Zhu
- College of Liberal Arts, University of Minnesota, Minneapolis, MN USA
| | - Elizabeth Vomacka
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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11
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Reckrey JM, Zhao D, Stone RI, Ritchie CS, Leff B, Ornstein KA. Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults. J Am Med Dir Assoc 2023; 24:1002-1006.e2. [PMID: 37084771 PMCID: PMC10330360 DOI: 10.1016/j.jamda.2023.03.016] [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: 01/06/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Describe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Homebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n = 974). METHODS Use of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40 hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS. RESULTS Approximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind. CONCLUSIONS AND IMPLICATIONS Although home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed.
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Affiliation(s)
| | - Duzhi Zhao
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robyn I Stone
- LeadingAge LTSS Center@UMass Boston, Washington, DC, USA
| | | | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kreider AR, Werner RM. The Home Care Workforce Has Not Kept Pace With Growth In Home And Community-Based Services. Health Aff (Millwood) 2023; 42:650-657. [PMID: 37075251 PMCID: PMC10278236 DOI: 10.1377/hlthaff.2022.01351] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Home and community-based services (HCBS) are the predominant approach to delivering long-term services and supports in the US, but there are growing numbers of reports of worker shortages in this industry. Medicaid, the primary payer for long-term services and supports, has expanded HCBS coverage, resulting in a shift in the services' provision out of institutions and into homes. Yet it is unknown whether home care workforce growth has kept up with the increased use of these services. Using data from the American Community Survey and the Henry J. Kaiser Family Foundation, we compared trends in the size of the home care workforce with data on Medicaid HCBS participation between 2008 and 2020. The home care workforce grew from approximately 840,000 to 1.22 million workers between 2008 and 2013. After 2013, growth slowed, ultimately reaching 1.42 million workers in 2019. In contrast, the number of Medicaid HCBS participants grew continuously from 2008 to 2020, with accelerated growth between 2013 and 2020. As a consequence, the number of home care workers per 100 HCBS participants declined by 11.6 percent between 2013 and 2019, with preliminary estimates suggesting that further declines occurred in 2020. Improving access to HCBS will require not just expanded insurance coverage but also new workforce investments.
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Affiliation(s)
- Amanda R Kreider
- Amanda R. Kreider , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel M Werner
- Rachel M. Werner, University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Gleason HP, Miller EA, Boerner K. Focusing on the Positive: Home Health Aides' Desire for Autonomy and Control. J Appl Gerontol 2023; 42:728-736. [PMID: 36523133 DOI: 10.1177/07334648221145177] [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: 12/23/2022] Open
Abstract
Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.
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Affiliation(s)
- Hayley P Gleason
- 50252Colorado Department of Health Care Policy & Financing, Denver, CO, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA.,Department of Health Services, Policy and Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Kathrin Boerner
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
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14
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Reckrey JM, Perez S, Watman D, Ornstein KA, Russell D, Franzosa E. The Need for Stability in Paid Dementia Care: Family Caregiver Perspectives. J Appl Gerontol 2023; 42:607-616. [PMID: 35512123 PMCID: PMC9636070 DOI: 10.1177/07334648221097692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paid caregivers (e.g., home health aides, home care workers) provide essential care to people with dementia living at home; this study explored family caregiver perspectives on the role and impact of paid caregivers in home-based dementia care. We conducted semi-structured interviews with family caregivers (n = 15) of people with advanced dementia who received long-term paid care at home in New York between October 2020 and December 2020. We found that given the vulnerability resulting from advanced dementia, family caregivers prioritized finding the "right" paid caregivers and valued continuity in the individual providing care. The stable paid care that resulted improved outcomes for both the person with advanced dementia (e.g., eating better) and their family (e.g., ability to work). Those advocating for high quality, person-centered dementia care should partner with policymakers and home care agencies to promote the stability of well-matched paid caregivers for people with advanced dementia living at home.
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Affiliation(s)
| | - Sasha Perez
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah Watman
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,20071James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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15
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Wendel CL, LaPierre TA, Sullivan DL, Babitzke J, Swartzendruber L, Barta T, Olds DM. "Anything that Benefits the Workers Should Benefit the Client": Opportunities and Constraints in Self-Directed Care During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:524-535. [PMID: 36471575 PMCID: PMC9729716 DOI: 10.1177/07334648221143604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Self-directed care (SDC) models allow Home and Community Based Services (HCBS) consumers to direct their own care, thus supporting flexible, person-centered care. There are many benefits to the SDC model but access to resources is essential to successful outcomes. Considering the autonomy and flexibility associated with SDC, it is important to understand how SDC responded to the COVID-19 pandemic and the resources available to help manage this situation. We conducted 54 in-depth interviews with HCBS consumers, direct support workers, family caregivers, and providers to examine the impact of COVID-19 on HCBS services in Kansas. Findings illuminate how self-directed consumers carried a lot of employer responsibility, with limited resources and systemic barriers constraining self-determination and contributing to unmet care needs, stress, and burden. Policy flexibilities expanding the hiring of family members were beneficial but insufficient to address under-resourced working conditions and labor shortages that were exacerbated by the pandemic.
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Affiliation(s)
- Carrie L Wendel
- School of Social Welfare, 370371University of Kansas, Lawrence, KS, USA
| | | | - Darcy L Sullivan
- Department of Sociology, University of Kansas, Lawrence, KS, USA
| | | | | | - Tobi Barta
- School of Social Welfare, 370371University of Kansas, Lawrence, KS, USA
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16
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Stawnychy MA, Ringel JB, Riegel B, Sterling MR. Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care. J Appl Gerontol 2023; 42:651-659. [PMID: 35801567 PMCID: PMC9825674 DOI: 10.1177/07334648221113322] [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: 01/11/2023] Open
Abstract
OBJECTIVE Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care. METHODS Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors. RESULTS Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001). CONCLUSION Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.
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Affiliation(s)
- Michael A. Stawnychy
- Robert Wood Johnson Foundation Future of Nursing Scholar
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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17
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Bryant NS, Cimarolli VR, Falzarano F, Stone R. Organizational Factors Associated with Certified Nursing Assistants' Job Satisfaction during COVID-19. J Appl Gerontol 2023:7334648231155017. [PMID: 36748259 PMCID: PMC9908517 DOI: 10.1177/07334648231155017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Given the instability of the nursing home (NH) certified nursing assistant (CNA) workforce and the challenging demands during COVID-19, it is important to understand the organizational factors that are correlated with job satisfaction which is a major predictor of CNA turnover. The purpose of this study was to determine the associations between quality of supervisor relationships, organizational supports, COVID-19 work-related stressors, and job satisfaction among CNAs in NHs. The results indicate that CNAs who reported a more optimal relationship with their supervisors, felt appreciated for the job they do and worked in NHs with lower COVID-19 resident infection rates tended to report higher rates of job satisfaction. The COVID-19 work-related stressors of increased workload demands and understaffing were associated with lower rates of job satisfaction. The study has practical implications for employers regarding how to support CNAs to improve job satisfaction especially during a crisis.
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Affiliation(s)
- Natasha S. Bryant
- LeadingAge, LTSS Center @UMass Boston, Washington, DC, USA,Natasha S. Bryant, LeadingAge LTSS Center @UMass Boston, 2519 Connecticut Avenue NW; Washington, DC 20008, USA.
| | | | - Francesca Falzarano
- Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, NY, USA
| | - Robyn Stone
- LeadingAge, LTSS Center @UMass Boston, Washington, DC, USA
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18
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The burden in palliative care assistance: A comparison of psychosocial risks and burnout between inpatient hospice and home care services workers. Palliat Support Care 2023; 21:49-56. [PMID: 35078551 DOI: 10.1017/s1478951521001887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Literature suggests that home care professionals could be at higher risk of burnout than their colleagues in hospital settings, but research on home-based palliative care is still limited. Our study investigates psychosocial risk factors and burnout among workers involved in palliative care, comparing inpatient hospice, and home care settings. METHOD A cross-sectional study was carried out in a single palliative care organization providing inpatient hospice-based and home care-based assistance in a large urban area of Northern Italy. Participants completed a self-administered questionnaire collecting socio-demographic and occupational data, psychosocial risk factors, and burnout scales (Psychosocial Safety Climate 4; Conflict and Offensive Behavior - COPSOQ II; Work Life Boundaries; Work-home Interaction; Peer Support - HSE; Copenhagen Burnout Inventory). RESULTS The study sample included 106 subjects (95% of the overall eligible working population) who were predominantly female (68%) and nurses (57%), with a mean age of 41 years. Compared to inpatient hospice staff, home care workers reported more frequent communications with colleagues (p = 0.03) and patients/caregivers (p = 0.01), while there were no differences in the perception of work intrusiveness. Inpatient hospice workers showed lower peer support (p = 0.08) and lower psychosocial safety climate (p = 0.001) than home care colleagues. The experience of aggressive behaviors was rare, and it was relatively more frequent among inpatient hospice workers, female workers, and health assistants. Average scores of burnout scales were similar for both groups except for caregiver-related burnout, which was higher among inpatient hospice workers compared to home care colleagues (p = 0.008). The number of subjects at risk for work-related burnout was similar for both groups. SIGNIFICANCE OF RESULTS Our study confirms the presence of psychological and physical fatigue in both home-based and inpatient hospice palliative care. Results suggest that home care assistance may not be characterized by higher psychological burden compared to inpatient hospice setting. Given the general tendency to increase home-based care in our aging population, it is essential to broaden the knowledge of psychosocial risks in this specific context to properly protect workers' health.
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19
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Spetz J, Flatt JD. Alzheimer's Disease Services, Staffing, and Outcomes in Adult Day Health Centers. J Am Med Dir Assoc 2023; 24:645-652. [PMID: 36623809 DOI: 10.1016/j.jamda.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes. DESIGN Cross-sectional analysis of secondary survey data. SETTING AND PARTICIPANTS We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. METHODS Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not. RESULTS ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. CONCLUSIONS AND IMPLICATIONS ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.
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Affiliation(s)
- Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
| | - Jason D Flatt
- School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
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20
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Kamat S, Danias G, Agarwal A, Chennareddy S, Han J, Lee S. Incorporating Paid Caregivers Into Medical Education to Enhance Medical Student Exposure to This Essential Workforce. JMIR MEDICAL EDUCATION 2022; 8:e38329. [PMID: 36485028 PMCID: PMC9789489 DOI: 10.2196/38329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/14/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
The implications of the COVID-19 pandemic underscored the utility of home-based health care due in part to social distancing requirements, curtailment of elective hospital procedures, and patient apprehension of the health care setting. The pandemic particularly accentuated the integral role of paid caregivers (eg, home health aides, personal care attendants, and other home care workers) in caring for patients with chronic health conditions. Given the paradigm shift toward community- and value-based health care models, paid caregivers are likely to play an even greater role as care team members. Despite the increasingly prominent role paid caregivers are assuming in health care, especially for patients who are chronically ill, in our experience as medical students, we have very little exposure to these care team members, with most interactions occurring in brief, chance encounters. Specifically, we advocate for increased medical student exposure to paid caregivers to facilitate their recognition as valuable care team members. We propose to achieve this through (1) classroom-based module learning with live paid caregivers and (2) plain language communication training to enhance reciprocal engagement.
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Affiliation(s)
- Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - George Danias
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Aneesh Agarwal
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sumanth Chennareddy
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Han
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samuel Lee
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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21
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Tyler DA, Squillace MR, Porter KA, Hunter M, Haltermann W. COVID-19 Exacerbated Long-standing Challenges for the Home Care Workforce. J Aging Soc Policy 2022:1-19. [PMID: 36328396 DOI: 10.1080/08959420.2022.2136919] [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: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to understand staffing challenges faced by home care (including home health) agencies due to the COVID-19 pandemic and the policies and practices put into place by the federal government, state governments, and home care agencies themselves to mitigate these challenges. This study included a review of federal and state policy changes enacted in reaction to the pandemic from March through December 2020, a review of home care agency practices described in media reports, peer-reviewed literature, and gray literature focused on responses to workforce challenges encountered during the pandemic, and interviews with a variety of stakeholders. Some of the challenges encountered were entirely new and resulted directly from the pandemic. In other cases, the pandemic worsened long-standing challenges in the industry. States and the federal government addressed some of these issues through changes to policies, regulations, and guidance. Home care agencies also responded with changes to their own policies and practices.
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Affiliation(s)
| | - Marie R Squillace
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Behavioral Health, Disability, and Aging Policy
| | | | | | - William Haltermann
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Behavioral Health, Disability, and Aging Policy
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22
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Chapman SA, Greiman L, Bates T, Wagner LM, Lissau A, Toivanen-Atilla K, Sage R. Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas. Health Aff (Millwood) 2022; 41:1403-1412. [DOI: 10.1377/hlthaff.2022.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Susan A. Chapman
- Susan A. Chapman , University of California San Francisco, San Francisco, California
| | - Lillie Greiman
- Lillie Greiman, University of Montana, Missoula, Montana
| | - Timothy Bates
- Timothy Bates, University of California San Francisco
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23
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Lognon T, Plourde KV, Aubin E, Giguere AMC, Archambault PM, Stacey D, Légaré F. Decision aids for home and community care: a systematic review. BMJ Open 2022; 12:e061215. [PMID: 36129731 PMCID: PMC9362828 DOI: 10.1136/bmjopen-2022-061215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use. DESIGN Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021. ELIGIBILITY CRITERIA DAs designed for home and community care settings or including home care or community services as options. DATA EXTRACTION AND SYNTHESIS Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use. RESULTS After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs). CONCLUSION DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams. PROSPERO REGISTRATION NUMBER CRD42020169450.
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Affiliation(s)
- Tania Lognon
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Karine V Plourde
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Emmanuelle Aubin
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Patient-partner, Quebec, Quebec, Canada
| | - Anik M C Giguere
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Quebec Centre for Excellence on Aging, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Patrick M Archambault
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Patient Decision Aids Research Group, Ottawa, Ontario, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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24
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Houtrow A, Martin AJ, Harris D, Cejas D, Hutson R, Mazloomdoost Y, Agrawal RK. Health Equity for Children and Youth With Special Health Care Needs: A Vision for the Future. Pediatrics 2022; 149:188222. [PMID: 35642875 DOI: 10.1542/peds.2021-056150f] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Health equity is a key pillar in supporting a future in which CYSHCN enjoy a full life and thrive, as envisioned by experts and community partners who gathered in 2019 and 2020 to develop the Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families. However, a variety of contextual factors impact health outcomes across the life course and intergenerationally and must be addressed to achieve this goal. For example, poverty and discrimination, including by some health care professionals and systems, are important, modifiable root causes of poor health outcomes. There are numerous barriers to achieving health equity, including political will, lack of resources, insufficient training, and limited cross-sector collaborations. Political, cultural, societal, and environmental interventions are necessary to eliminate health disparities and achieve health equity. The entities that serve CYSHCN should be equitably designed and implemented to improve health outcomes and address health disparities. Many entities that serve CYSHCN are taking positive steps through workforce development, policy changes, community engagement, and other means. The purpose of this article is to frame health equity for CYSHCN, detail their health disparities, review barriers to health equity, provide examples of strategies to advance health equity for them, and describe a path toward the future in which all CYSHCN have a fair and just opportunity to be as healthy as possible.
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Affiliation(s)
- Amy Houtrow
- Departments of Physical Medicine Rehabilitation.,Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison J Martin
- Oregon Center for Children and Youth with Special Health Needs, School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon
| | - Debbi Harris
- The Arc of the United States, Washington, District of Columbia.,Family Voices of Minnesota, St. Paul, Minnesota
| | - Diana Cejas
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Carrboro, North Carolina
| | - Rachel Hutson
- Title V Maternal and Child Health, Colorado Department of Public Health and Environment
| | | | - Rishi K Agrawal
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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25
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26
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Russell D, Fong MC, Gao O, Lowenstein D, Haas M, Wiggins F, Brickner C, Franzosa E. Formative Evaluation of a Workforce Investment Organization to Provide Scaled Training for Home Health Aides Serving Managed Long-Term Care Plan Clients in New York State. J Appl Gerontol 2022; 41:1710-1721. [PMID: 35420904 DOI: 10.1177/07334648221084182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As part of its Medicaid program restructuring, New York State funded 11 Workforce Investment Organizations (WIO) to support training initiatives for the long-term care workforce. Focusing on one WIO, this formative evaluation examined quality improvement training programs delivered to 11,163 Home Health Aides employed by home care agencies serving clients of Managed Long-Term Care plans. Results are presented from a thematic analysis of qualitative interviews with organizational and program stakeholders examining contextual factors influencing program objectives, implementation, barriers and facilitators, and perceived outcomes. Findings suggested that WIO training programs were implemented during a period of shifting organizational strategies alongside value-based payment reforms and challenges to aide recruitment and retention. Stakeholders appraised WIO training programs positively and valued program flexibility and facilitation of communication and collaboration between agencies and plans. However, delivery and implementation challenges existed, and industry-wide structural fragmentation led stakeholders to question the WIO's larger impact.
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Affiliation(s)
- David Russell
- Department of Sociology, 1801Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Mei-Chia Fong
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Oude Gao
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Dan Lowenstein
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Marian Haas
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Faith Wiggins
- 1199SEIU Home Care Industry Education Fund, New York, NY, USA
| | - Carlin Brickner
- Business Intelligence and Analytics, 44198Visiting Nurse Service of New York, New York, NY, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center (GRECC), 20071James J Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Leykum LK, Penney LS, Dang S, Trivedi RB, Noël PH, Pugh JA, Shepherd-Banigan ME, Pugh MJ, Rupper R, Finley E, Parish-Johnson J, Delgado R, Peacock K, Kalvesmaki A, Van Houtven CH. Recommendations to Improve Health Outcomes Through Recognizing and Supporting Caregivers. J Gen Intern Med 2022; 37:1265-1269. [PMID: 34981348 PMCID: PMC8722428 DOI: 10.1007/s11606-021-07247-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luci K Leykum
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA.
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.
- University of Texas at Austin Dell Medical School, Austin, USA.
- VA Palo Alto Health Care System, Palo Alto, USA.
| | - Lauren S Penney
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Stuti Dang
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Miami VA Healthcare System, Miami, USA
- University of Miami School of Medicine, Miami, USA
| | - Ranak B Trivedi
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Greater Los Angeles Health Care System, Los Angeles, USA
- VA Palo Alto Health Care System, Palo Alto, USA
- Stanford University School of Medicine, Stanford, USA
| | - Polly H Noël
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jacqueline A Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Megan E Shepherd-Banigan
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
| | - Mary Jo Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Rand Rupper
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Erin Finley
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Julie Parish-Johnson
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Roxana Delgado
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Kimberly Peacock
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Andrea Kalvesmaki
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Courtney H Van Houtven
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
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Reckrey JM, Ornstein KA, McKendrick K, Tsui EK, Morrison RS, Aldridge M. Receipt of Hospice Aide Visits Among Medicare Beneficiaries Receiving Home Hospice Care. J Pain Symptom Manage 2022; 63:503-511. [PMID: 34954065 PMCID: PMC8930441 DOI: 10.1016/j.jpainsymman.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Hospice aides provide essential direct care to hospice patients, yet there is minimal research examining hospice aide visits. OBJECTIVES describe the prevalence and frequency of hospice aide visits, and 2) evaluate patient, community, and hospice characteristics associated with these visits. METHODS Longitudinal cohort study of Medicare Current Beneficiary Survey (MCBS) participants who died between 2010-2018 and received routine hospice care in the 6 months prior to death (n = 674). We characterized prevalence and frequency of hospice aide visits over time and used generalized linear modelling to identify factors associated with visits. RESULTS 64% of hospice enrollees received hospice aide visits and average visit frequency (1.3 per week) remained stable throughout enrollment. The only patient characteristic associated with receipt of hospice aide visits was primary hospice diagnosis (respiratory diagnosis vs. dementia: OR 0.372, P = 0.040). Those living in community-based residential housing and those cared for by hospices with aides employed as staff were more likely to receive any hospice aide visits (OR 2.331, P = 0.047 and OR 4.612, P = 0.002, respectively.) CONCLUSION: Hospice aide visits are a common component of hospice care, but visit frequency does not increase as death approaches. Receipt of hospice aide visits was primarily associated with community and hospice agency (rather than patient) characteristics. Future work is needed to ensure that hospice aides are integrated in the hospice interdisciplinary team and that access to hospice aide visits is meaningfully driven by patient and family needs, rather than the practice norms and business models of individual hospice agencies.
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Affiliation(s)
- Jennifer M Reckrey
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York.
| | - Katherine A Ornstein
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York
| | - Karen McKendrick
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York
| | - Emma K Tsui
- CUNY Graduate School of Health and Health Policy (E.K..T.), New York, New York
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York; James J. Peters VA Medical Center (R.S.M., M.A.), Bronx, New York, USA
| | - Melissa Aldridge
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York; James J. Peters VA Medical Center (R.S.M., M.A.), Bronx, New York, USA
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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Falzarano FB, Cimarolli V, Boerner K, Siedlecki KL, Horowitz A. Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers. THE GERONTOLOGIST 2022; 62:252-261. [PMID: 34166493 PMCID: PMC8827323 DOI: 10.1093/geront/gnab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services. RESEARCH DESIGN AND METHODS The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services. RESULTS Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains. DISCUSSION AND IMPLICATIONS Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.
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Affiliation(s)
- Francesca B Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, USA
| | | | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, New York, USA
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Dill J, Duffy M. Structural Racism And Black Women's Employment In The US Health Care Sector. Health Aff (Millwood) 2022; 41:265-272. [PMID: 35130061 PMCID: PMC9281878 DOI: 10.1377/hlthaff.2021.01400] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to describe how structural racism and sexism shape the employment trajectories of Black women in the US health care system. Using data from the American Community Survey, we found that Black women are more overrepresented than any other demographic group in health care and are heavily concentrated in some of its lowest-wage and most hazardous jobs. More than one in five Black women in the labor force (23 percent) are employed in the health care sector, and among this group, Black women have the highest probability of working in the long-term-care sector (37 percent) and in licensed practical nurse or aide occupations (42 percent). Our findings link Black women's position in the labor force to the historical legacies of sexism and racism, dating back to the division of care work in slavery and domestic service. Our policy recommendations include raising wages across the low-wage end of the sector, providing accessible career ladders to allow workers in low-wage health care to advance, and addressing racism in the pipeline of health care professions.
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Affiliation(s)
| | - Mignon Duffy
- University of Massachusetts Lowell, Lowell, Massachusetts
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"I Am the Home Care Agency": The Dementia Family Caregiver Experience Managing Paid Care in the Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031311. [PMID: 35162335 PMCID: PMC8834786 DOI: 10.3390/ijerph19031311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
As the locus of long-term care in the United States shifts from institutions to the community, paid caregivers (i.e., home health aides, personal care attendants) are providing more hands-on care to persons with dementia living at home. Yet, little is known about how family caregivers engage with paid caregivers. We conducted in-depth, semi-structured interviews (n = 15) with family caregivers, of persons living at home with severe dementia, and enriched our findings with data from a second cohort of family caregivers of persons with dementia (n = 9). Whether paid caregivers were hired privately or employed via a Medicaid-funded agency, family caregivers reported that they needed to manage paid caregivers in the home. Core management tasks were day-to-day monitoring and relationship building with family caregivers; training paid caregivers and coordinating care with homecare agencies was also described. In order to support family caregivers of individuals with dementia at home, it is important consider their preferences and skills in order to effectively manage paid caregivers. Support of efforts to build a high-quality paid caregiving workforce has the potential to improve not only care delivered to persons with dementia, but the experiences of their family caregivers.
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Reckrey JM, Li L, Zhan S, Wolff J, Yee C, Ornstein KA. Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia. J Gerontol B Psychol Sci Soc Sci 2022; 77:S11-S20. [PMID: 35034123 PMCID: PMC9122661 DOI: 10.1093/geronb/gbac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories. METHODS We used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n = 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling. RESULTS A 3-group model best fit our data: (a) "low/stable care" (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) "increasing paid care" with increasing, moderate paid and family care, and (c) "high family care" with increasing, high family care and stable, low paid care. While both the "increasing paid care" and "high family care" groups were more functionally impaired than the "low/stable care" group, the "high family care" group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation. DISCUSSION Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.
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Affiliation(s)
- Jennifer M Reckrey
- Address correspondence to: Jennifer M. Reckrey, MD, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1216, New York, NY 10029, USA. E-mail:
| | - Lihua Li
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Serena Zhan
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jennifer Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia Yee
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Scales K. Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports. J Am Med Dir Assoc 2021; 23:207-213. [PMID: 34973168 DOI: 10.1016/j.jamda.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.
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Sterling MR, Li J, Cho J, Ringel JB, Silver SR. Prevalence and Predictors of Home Health Care Workers' General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance System. Am J Public Health 2021; 111:2239-2250. [PMID: 34878879 PMCID: PMC8667821 DOI: 10.2105/ajph.2021.306512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 12/27/2022]
Abstract
Objectives. To determine the prevalence and predictors of US home health care workers' (HHWs') self-reported general, physical, and mental health. Methods. Using the 2014-2018 Behavioral Risk Factor Surveillance System, we analyzed the characteristics and health of 2987 HHWs (weighted n = 659 000) compared with 2 similar low-wage worker groups (health care aides and health care support workers, not working in the home). We conducted multivariable logistic regression to determine which characteristics predicted HHWs' health. Results. Overall, 26.6% of HHWs had fair or poor general health, 14.1% had poor physical health, and 20.9% had poor mental health; the prevalence of each outcome was significantly higher than that of the comparison groups. Among HHWs, certain factors, such as low household income, an inability to see a doctor because of cost, and a history of depression, were associated with all 3 aspects of suboptimal health. Conclusions. HHWs had worse general, physical, and mental health compared with low-wage workers not in home health. Public Health Implications. Increased attention to the health of HHWs by public health experts and policymakers is warranted. In addition, targeted interventions appropriate to their specific health needs may be required. (Am J Public Health. 2021;111(12):2239-2250. https://doi.org/10.2105/AJPH.2021.306512).
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Affiliation(s)
- Madeline R Sterling
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jia Li
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jacklyn Cho
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Joanna Bryan Ringel
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Sharon R Silver
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
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Jumabhoy S, Jung HY, Yu J. Characterizing the direct care health workforce in the United States, 2010-2019. J Am Geriatr Soc 2021; 70:512-521. [PMID: 34687042 DOI: 10.1111/jgs.17519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.
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Affiliation(s)
- Sara Jumabhoy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jiani Yu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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Unger ES, Grabowski DC, Chen JT, Berkman LF. Association Between New-Onset Medicaid Home Care and Family Caregivers' Health. JAMA HEALTH FORUM 2021; 2:e212671. [PMID: 35977187 PMCID: PMC8796991 DOI: 10.1001/jamahealthforum.2021.2671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022] Open
Abstract
Importance More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. Objective To investigate the association between Medicaid home care services and family caregivers' health. Design Setting and Participants This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020. Exposures New onset of regular (≥1 time per month) Medicaid home care in the household. Main Outcomes and Measures Self-rated mental and physical health (planned prior to beginning the study). Results The study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, -0.06 to 0.06; P = .99). Conclusions and Relevance In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.
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Affiliation(s)
- Emily S Unger
- Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jarvis T Chen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lisa F Berkman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Barry J. Real wage growth in the U.S. health workforce and the narrowing of the gender pay gap. HUMAN RESOURCES FOR HEALTH 2021; 19:105. [PMID: 34454538 PMCID: PMC8403397 DOI: 10.1186/s12960-021-00647-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Healthcare has been identified as a job engine during recent recessions in the U.S. Whether the healthcare sector provides better than average pay remains a question. This study investigates if wages grew with the expanding demand for healthcare workers between 2001 and 2017. Wage growth in the (1) physicians and surgeons, (2) nurse, (3) healthcare practitioner and technical, (4) healthcare support, and (5) direct patient care jobs are examined. The gender pay gap in each occupation is investigated. METHODS The American Community Survey (ACS) public use microdata sample (PUMS) for 2001, 2004, 2008, 2013, and 2017 were used to derive hourly wages for full-time, full-year workers aged 18-75. The cumulative percent change in unadjusted, median hourly wages between 2001 and 2017 was calculated for each occupation. Quantile regression estimates predicted a median hourly wage for men and women by year and job after adjusting for differences in demographics, industry, and hours worked. RESULTS Unadjusted median wage growth was 9.92% for nurses, 5.68% for healthcare practitioners, and 37.6% for physicians between 2001 and 2017. These rates are roughly above the estimated national rate of wage growth at the 50th wage percentile. In healthcare support and direct patient care occupations, workers experienced either stagnant or negative wage growth. Women had lower occupational wages than men. CONCLUSION The slow or negative median wage growth in all but the physician occupation between 2004-2008 and 2008-2013 confirms that healthcare wages in the U.S. are not recession-proof, unlike healthcare employment. Generally, women's earnings grew at rates that were higher or less negative than rates for men. This trend contributed to narrowing the gender pay gap in every occupation except for nurse.
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Affiliation(s)
- Janis Barry
- Department of Economics, Fordham University, 113 West 60th Street, New York, NY, 10023, USA.
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Shi M, Zhang F, He X, Huang S, Zhang M, Hu X. Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China. BMC Health Serv Res 2021; 21:641. [PMID: 34217292 PMCID: PMC8254064 DOI: 10.1186/s12913-021-06690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) pandemic has become a challenge for nursing homes in China. Nursing homes are particularly dangerous places in terms of the spread of COVID-19 given that they house vulnerable, high-risk populations. As such, several useful guidelines for coping with COVID-19 in nursing homes have been provided. However, the actual implementation rates of such guidelines are unknown. This study aims to document the adherence of nursing homes to the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes. METHODS A cross-sectional study was conducted among 484 nursing homes in 136 cities of 28 provinces in China. A self-report questionnaire was created based on the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes (first edition). The questionnaire and the Transformational Leadership in the Public Sector Scale were sent to nursing home managers via the Wenjuanxing app online from February 7 to 29, 2020. Ultimately, 461 of 960 nursing homes participated, for a response rate of 48.0%. RESULTS The average overall implementation rate of COVID-19 prevention and control measures was 80.0% (143.97/180). The average implementation rates for hygienic behaviour management and access management were lower, at 75.3 and 78.7%, respectively. Number of medical staff and transformational leadership score of nursing home's manager were associated with total implementation score (p < 0.05). A total of 69.8% (322/461) of the nursing home managers had serious resource problems, and inadequate protective supplies (72.0%) and staff shortages (47.7%) were the two primary problems. The nursing homes that located in urban, with large nursing home size, had hospital-nursing home cooperation and the transformational leadership score of manager> 60, had a lower risk of having serious resource problems. CONCLUSIONS Overall, the implementation of prevention and control measures by nursing homes are insufficient during the epidemic in China. More medical staff, adequate resource, cooperation with hospitals, and higher transformational leadership of manager are required to improve the implementation rate. It is urgent for nursing homes to maintain the safety of residents and staff.
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Affiliation(s)
- Meihong Shi
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, West China Hospital, Sichuan University, PO Box 610041, Chengdu, Sichuan Province, People's Republic of China
- Nursing Department of Southwest Medical University, No. 1 Xianglin Rode, Longmatan District, PO Box 646000, Luzhou, Sichuan, People's Republic of China
| | - Fengying Zhang
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, West China Hospital, Sichuan University, PO Box 610041, Chengdu, Sichuan Province, People's Republic of China
| | - Xinxin He
- Nursing Department of Southwest Medical University, No. 1 Xianglin Rode, Longmatan District, PO Box 646000, Luzhou, Sichuan, People's Republic of China
| | - Siyuan Huang
- Nursing Department of Southwest Medical University, No. 1 Xianglin Rode, Longmatan District, PO Box 646000, Luzhou, Sichuan, People's Republic of China
| | - Mingfeng Zhang
- Nursing Department of Southwest Medical University, No. 1 Xianglin Rode, Longmatan District, PO Box 646000, Luzhou, Sichuan, People's Republic of China
| | - Xiuying Hu
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, West China Hospital, Sichuan University, PO Box 610041, Chengdu, Sichuan Province, People's Republic of China.
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Russell D, Burgdorf JG, Kramer C, Chase JAD. Family Caregivers' Conceptions of Trust in Home Health Care Providers. Res Gerontol Nurs 2021; 14:200-210. [PMID: 34288782 DOI: 10.3928/19404921-20210526-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trust is important to family caregivers of older adults receiving home health care (HHC). Caregivers rely extensively on nurses, home health aides, and other providers to manage complex care tasks. The current study examined how family caregivers conceive of trust in HHC providers. Directed content analysis methods were applied to 40 qualitative interviews conducted with caregivers of HHC patients aged ≥65 years. Results indicated that caregivers invested trust in providers who displayed competencies in caring for patients with chronic conditions and functional difficulties, willingness to foster frequent and open communication with room for questions and feedback, confidence in their ability to be present and alert for patients, and fidelity to a variety of tasks contributing to holistic care. Caregivers' conceptions of trust in providers are affected by interpersonal aspects of their interactions with providers as well as the broader systems of care within which they participate. [Research in Gerontological Nursing, 14(4), 200-210.].
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Scales K. It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care. THE GERONTOLOGIST 2021; 61:497-504. [PMID: 32853357 PMCID: PMC7499598 DOI: 10.1093/geront/gnaa116] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Indexed: 11/15/2022] Open
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.
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Gleason HP, Miller EA. Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job. THE GERONTOLOGIST 2021; 61:517-529. [PMID: 33423049 DOI: 10.1093/geront/gnab003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job. RESEARCH DESIGN AND METHODS Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency. RESULTS The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency. DISCUSSION AND IMPLICATIONS The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.
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Affiliation(s)
- Hayley P Gleason
- Colorado Department of Health Care Policy & Financing, Denver, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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DAWSON WALTERD, BOUCHER NATHANA, STONE ROBYN, VAN HOUTVEN COURTNEYH. COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now. Milbank Q 2021; 99:565-594. [PMID: 33590920 PMCID: PMC8014270 DOI: 10.1111/1468-0009.12500] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Policy Points To address systemic problems amplified by COVID-19, we need to restructure US long-term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near-term and long-term policy solutions. Seven near-term policy recommendations include requiring the uniform public reporting of COVID-19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations. Long-term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age-friendly public health system. CONTEXT The heavy toll of COVID-19 brings the failings of the long-term services and supports (LTSS) system in the United States into sharp focus. Although these are not new problems, the pandemic has exacerbated and amplified their impact to a point that they are impossible to ignore. The primary blame for the high rates of COVID-19 infections and deaths has been assigned to formal LTSS care settings, specifically nursing homes. Yet other systemic problems have been unearthed during this pandemic: the failure to coordinate the US public health system at the federal level and the effects of long-term disinvestment and neglect of state- and local-level public health programs. Together these failures have contributed to an inability to coordinate with the LTSS system and to act early to protect residents and staff in the LTSS care settings that are hotspots for infection, spread, and serious negative health outcomes. METHODS We analyze several impacts of the COVID-19 pandemic on the US LTSS system and policy arrangements. The economic toll on state budgets has been multifaceted, and the pandemic has had a direct impact on Medicaid, the primary funder of LTSS, which in turn has further exacerbated the states' fiscal problems. Both the inequalities across race, ethnicity, and socioeconomic status as well as the increased burden on unpaid caregivers are clear. So too is the need to better integrate LTSS with the health, social care, and public health systems. FINDINGS We propose seven near-term actions that US policymakers could take: implementing a uniform public reporting of COVID-19 cases in LTSS settings; identifying and supporting unpaid caregivers; bolstering support for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing the barriers to telehealth in LTSS; and providing incentives to care for our most vulnerable populations. Our analysis also demonstrates that our nation requires comprehensive reform to build the LTSS system we need through comprehensive workforce development, universal coverage through comprehensive financing reform, and the creation of an age-friendly public health system. CONCLUSIONS COVID-19 has exposed the many deficits of the US LTSS system and made clear the interdependence of LTSS with public health. Policymakers have an opportunity to address these failings through a substantive reform of the LTSS system and increased collaboration with public health agencies and leaders. The opportunity for reform is now.
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Affiliation(s)
- WALTER D. DAWSON
- School of MedicineOregon Health & Science University
- Global Brain Health InstituteUniversity of California, San Francisco and Trinity College Dublin
- Institute on AgingPortland State University
| | - NATHAN A. BOUCHER
- Sanford School of Public PolicyDuke University
- Duke University School of Medicine
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham VA Health System
- Duke‐Margolis Center for Health Policy
| | | | - COURTNEY H. VAN HOUTVEN
- Duke University School of Medicine
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham VA Health System
- Duke‐Margolis Center for Health Policy
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Wagner LM, Van Haitsma K, Kolanowski A, Spetz J. Recommendations to Deliver Person-Centered Long-Term Care for Persons Living With Dementia. J Am Med Dir Assoc 2021; 22:1366-1370. [PMID: 34044010 PMCID: PMC8996758 DOI: 10.1016/j.jamda.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/24/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022]
Abstract
Person-centered care (PCC) is the standard for the delivery of long-term services and supports (LTSS). In this article, we summarize the state of the science on meaningful outcomes and workforce development and discuss what is needed to ensure that person-centered LTSS becomes a universal reality. These 2 themes are intimately related: the dementia care workforce’s capacity cannot be improved until care processes and outcomes that are significant to PCC are explicated. The LTSS workforce needs training in PCC as well as pragmatic measures to assess the quality of the care they provide. We conclude with several recommendations for future policy and practice-oriented workforce research.
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Affiliation(s)
- Laura M Wagner
- Philip R. Lee Institute for Health Policy Studies and the UCSF Health Workforce Research Center on Long-Term Care, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Ann Kolanowski
- College of Nursing, The Pennsylvania State University, State College, PA, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies and the UCSF Health Workforce Research Center on Long-Term Care, University of California, San Francisco, San Francisco, CA, USA
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Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA. Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit? Clin Ther 2021; 43:930-941. [PMID: 33972126 DOI: 10.1016/j.clinthera.2021.03.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. METHODS Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). FINDINGS About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). IMPLICATIONS The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, New York, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Manheim C, Haverhals L, Gilman C, Karuza J, Olsan T, Edwards S, Levy C, Gillespie S. VA Home Based Primary Care Teams: Partnering with and Acting as Caregivers for Veterans. Home Health Care Serv Q 2021; 40:1-15. [PMID: 33411588 DOI: 10.1080/01621424.2020.1869634] [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: 10/22/2022]
Abstract
The U.S. Department of Veterans Affairs' Home-Based Primary Care (HBPC) Interdisciplinary Team (IDT) provides in-home, primary care for medically complex Veterans. This study explores how HBPC and Veterans' caregivers partner to provide care. Interviews, focus groups, and field observations were conducted during eight HBPC site visits. Qualitative thematic analysis was performed. Caregivers/IDT member partnerships are important to care. Effective partnerships include: ease of communication; caregiver-centered support; and when no caregiver is present, IDTs providing more monitoring/services to Veterans and connection to community services. As this model expands, understanding dynamics between IDT members and caregivers will optimize the success of HBPC programs.
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Affiliation(s)
- C Manheim
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care , Aurora, Colorado, USA
| | - L Haverhals
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care , Aurora, Colorado, USA
| | - C Gilman
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care , Aurora, Colorado, USA
| | - J Karuza
- Geriatrics, Extended Care and Rehabilitation, Canandaigua VA Medical Center , Canandaigua, New York, USA.,Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine , Rochester, New York, USA.,Department of Psychology, S.U.N.Y at Buffalo State , Buffalo, New York, USA
| | - T Olsan
- Geriatrics, Extended Care and Rehabilitation, Canandaigua VA Medical Center , Canandaigua, New York, USA.,School of Nursing, University of Rochester , Rochester, New York, USA
| | - S Edwards
- Section of General Internal Medicine, Portland VA Medical Center , Portland, Oregon, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health and Science University , Portland, Oregon, USA
| | - C Levy
- VA Eastern Colorado Health Care System, Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care , Aurora, Colorado, USA.,Department of Medicine, Division of Health Care Policy and Research, Anschutz Medical Campus, School of Medicine, University of Colorado , Aurora, Colorado, USA
| | - S Gillespie
- Geriatrics, Extended Care and Rehabilitation, Canandaigua VA Medical Center , Canandaigua, New York, USA.,Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine , Rochester, New York, USA
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Coe NB, Konetzka RT, Berkowitz M, Blecker E, Van Houtven CH. The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020. Annu Rev Public Health 2021; 42:483-503. [PMID: 33395544 DOI: 10.1146/annurev-publhealth-090419-102354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.
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Affiliation(s)
- Norma B Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - R Tamara Konetzka
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois 60637-1447, USA;
| | - Melissa Berkowitz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Emily Blecker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina 27708, USA; .,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina 27705, USA
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Muench U, Spetz J, Jura M, Harrington C. Racial Disparities in Financial Security, Work and Leisure Activities, and Quality of Life Among the Direct Care Workforce. THE GERONTOLOGIST 2020; 61:838-850. [DOI: 10.1093/geront/gnaa190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
Personal care, home health, and nursing aides provide the majority of care to chronically ill and disabled older adults. This workforce faces challenging working conditions, resulting in high turnover and workforce instability that affect the quality of care for older adults. We examine financial security, work–life balance, and quality of life of Black, Hispanic, and workers of other race/ethnicity compared to White workers.
Research Design and Methods
We hypothesize that Black and Hispanic workers experience greater financial insecurity, spend more time on work-related activities and have less time available for leisure activities, and have a lower quality of life compared to White workers. To test these hypotheses, we analyze the American Time Use Survey using descriptive analyses and multivariable and compositional regression.
Results
Black and Hispanic individuals were 2–3 times more likely to live in poverty than White individuals. The time use analysis indicated that Black and Hispanic workers spent more time on work-related activities and less time on nonwork-related activities, including longer work commutes and less time exercising. In analyses of aggregated paid/unpaid work and leisure, Black workers were the only group that spent significantly more time working and less time on leisure activities compared to White workers. This may explain the lower quality of life that we only observed in Black workers.
Discussion and Implications
Racial/ethnic disparities in well-being among direct care workers may affect the care older adults receive and contribute to widening inequities in this workforce and society. Policymakers should direct efforts toward securing funding for workers, incentivizing employer provisions, and implementing racial equity approaches.
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Affiliation(s)
- Ulrike Muench
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, USA
- Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, USA
| | - Matthew Jura
- Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, USA
| | - Charlene Harrington
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, USA
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Home sweet home? How home health aide compensation, benefits and employment security influence the quality of care delivered by home health organizations. Health Care Manage Rev 2020; 46:E1-E9. [PMID: 32649475 DOI: 10.1097/hmr.0000000000000289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality. PURPOSE We examine how an organization's benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations. METHODOLOGY We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity. RESULTS Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality. CONCLUSION Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization's use of contract home health aides. PRACTICE IMPLICATIONS Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.
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Muench U, Jura M, Spetz J, Mathison R, Herrington C. Financial Vulnerability and Worker Well-Being: A Comparison of Long-Term Services and Supports Workers With Other Health Workers. Med Care Res Rev 2020; 78:607-615. [PMID: 32567500 DOI: 10.1177/1077558720930131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over 1.5 million new jobs need to be filled by 2026 for medical assistants, nursing aides, and home care aides, many of which will work in the long-term services and supports (LTSS) sector. Using 16 years of data from the American Time Use Survey, we examined the financial vulnerability of high-skill and low-skill LTSS workers in comparison with other health care workers, while providing insight into their well-being by measuring time spent on work and nonwork activities. We found that, regardless of skill status, working in LTSS was associated with lower wages and an increased likelihood of experiencing poverty compared with other health care workers. Results from time diary data indicated that the LTSS workforce spent a greater share of their time working and commuting to work. Low-skill LTSS workers were hardest hit, spending more time on paid and unpaid activities, such as household and child care responsibilities.
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Affiliation(s)
| | - Matthew Jura
- University of California, San Francisco, CA, USA
| | - Joanne Spetz
- University of California, San Francisco, CA, USA
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