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Liu Y, Qiu H, Tang F, Huang Z, Gao Y, Wang Y, Wang S, Zhang Y. Association of adverse childhood experiences with poor health condition among middle-aged and elderly adults in the United States: A nationally retrospective cohort study. Psychiatry Res 2024; 338:115977. [PMID: 38823165 DOI: 10.1016/j.psychres.2024.115977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/27/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The specific effects of adverse childhood experiences (ACEs) in adulthood and senectitude were less known. We aim to examine the relationship between early ACEs and overall health condition as well as specific dimensions in the middle-aged and elderly population. METHODS In the 2019-2021 Behavioral Risk Factor Surveillance System Study, robust Poisson regression models were used to estimate the relationship between ACE exposure and current health status among adults aged 45 ≥ years. RESULTS Of the 195,472 participants, 53.8 % were female and the mean age was 65.0 years. Compared to populations without ACE, ACE exposures were more significantly associated with depression (PR: 2.03, 95 %CI: 1.94-2.21), frequent mental health (PR: 1.85, 95 %CI: 1.74-1.97) and subject cognitive decline (PR: 1.99, 95 %CI:1.85-2.14) than with physical health (PR: 1.37, 95 %CI: 1.32-1.44), with dose-response patterns. The association with mental disorder was especially significant among the elderly population. CONCLUSION Early ACEs are associated with adverse health outcomes that persist into later life, particularly mental disorders and cognitive decline. Poor mental health may indirectly influence associations with ACEs and cognitive decline as well as physical health. Our findings emphasize the importance of lifelong psychological screening and support for the ACE-exposed middle-aged and elderly population.
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Affiliation(s)
- Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Hongbin Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Fan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Zemin Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Yi Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Ye Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education; State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China
| | - Shanjie Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education; State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China
| | - Yiying Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China.
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McCall S, Scales K, Wagner LM. Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States. J Am Med Dir Assoc 2024; 25:105039. [PMID: 38796167 DOI: 10.1016/j.jamda.2024.105039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Direct care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. DESIGN An observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. SETTING AND PARTICIPANTS The sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. METHODS We used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. RESULTS The sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. CONCLUSIONS AND IMPLICATIONS Given the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.
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Affiliation(s)
- Stephen McCall
- Long-Term Services and Supports Division, Altarum, Ann Arbor, MI, USA
| | - Kezia Scales
- Research and Evaluation Department, PHI, New York, NY, USA.
| | - Laura M Wagner
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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3
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Gadbois EA, Brazier JF, Turner J, Hawes C, Florence LC, Belazis L. "It Made Me Feel Like a Person Again": Benefits of Meals on Wheels-Based Social Connection Programs. J Appl Gerontol 2024:7334648241257798. [PMID: 39023859 DOI: 10.1177/07334648241257798] [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: 07/20/2024] Open
Abstract
Social isolation and loneliness are associated with negative health outcomes, and these outcomes are exacerbated among older adults who are homebound. To address this issue, Meals on Wheels programs increasingly provide social connection services to clients in addition to home-delivered meals. This descriptive qualitative study examines the impact of three types of social connection programs on the well-being of homebound older adult clients, as well as on the volunteers and staff members who deliver the programs. Thematic analysis of semi-structured interviews conducted with 117 clients, volunteers, and staff in six Meals on Wheels social connection programs across the United States indicated that program participation was associated with substantial benefits. Benefits included the development of supportive friendships, reduced feelings of loneliness, and an improved overall sense of well-being. Insights from this study may inform the development, expansion, and sustainability of social connection programs provided by community-based organizations.
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Affiliation(s)
- Emily A Gadbois
- Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Joan F Brazier
- Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Jeffrey Turner
- Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Courtney Hawes
- Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Laura Belazis
- Strategy & Impact, Meals on Wheels America, Arlington, VA, USA
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Yanez Hernandez M, Kuo EFC, Henriquez Taveras Y, Lee A, Ramos A, Ringel J, Andreae S, Tsui E, Safford MM, Avgar AC, Shen MJ, Dell N, Shalev D, Riffin C, Wiggins F, Kozlov E, Moise N, Sterling MR. Mental Health and Well-Being Among Home Health Aides. JAMA Netw Open 2024; 7:e2415234. [PMID: 38842806 PMCID: PMC11157351 DOI: 10.1001/jamanetworkopen.2024.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Home health aides and attendants (HHAs) provide essential care to older adults and those with chronic conditions in the home. However, some HHAs struggle with poor mood and stress, which may have been exacerbated by the COVID-19 pandemic. Objective To elicit HHAs' perspectives toward mental health and well-being, including how their job influences both and how to better support the workforce in the future. Design, Setting, and Participants For this qualitative study, focus groups and interviews with HHAs were facilitated in English and Spanish from August 17, 2022, to February 9, 2023, in partnership with the 1199SEIU Training and Employment Fund, a benefit fund of the 1199SEIU United Healthcare Workers East and the largest health care union in the US. Included were HHAs at risk for poor mental health and well-being, which were defined as having at least mild or more symptoms on either the 8-item Personal Health Questionnaire depression scale, the 4-item Cohen Perceived Stress Scale, or the University of California, Los Angeles Loneliness Scale. Exposure Mental health and well-being of HHAs. Main Outcomes and Measures Focus groups and interviews were audio recorded, professionally transcribed, and translated. A thematic analysis was performed that was informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health model. Results A total of 28 HHAs from 14 different agencies participated (mean [SD] age, 54.3 [10.8] years; 26 female [93%]). Seventeen participants (61%) spoke Spanish at home. Five key themes emerged: (1) HHAs' attitudes toward mental health and well-being were influenced by a variety of personal and cultural factors; (2) HHAs' relationships with their patients impacted their mood in both positive and negative ways; (3) structural and organizational aspects of the job, alongside the COVID-19 pandemic, impacted HHAs' mood and stress levels; (4) HHAs used a variety of strategies to cope with their emotions; and (5) HHAs were eager for interventions that can improve their mood, particularly those that bring them closer to their colleagues. Conclusions and Relevance These findings suggest that HHAs' mental health and well-being may be influenced by both personal and occupational factors. Interventions and policies to better support their emotional well-being on the job are warranted.
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Affiliation(s)
- Melissa Yanez Hernandez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Elizabeth Fong-Chy Kuo
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Yefrenia Henriquez Taveras
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, New York
| | - Aida Ramos
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Susan Andreae
- Kinesiology Department, University of Wisconsin-Madison
| | - Emma Tsui
- School of Public Health, City University of New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ariel C. Avgar
- School of Industrial and Labor Relations, Ithaca, New York
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Daniel Shalev
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, New York
| | - Elissa Kozlov
- School of Public Health, Rutgers University, New Brunswick, New Jersey
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, New York
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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5
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Tsui EK, LaMonica M, Boerner K, Baron S. "A Major Issue": The Impact of the COVID-19 Pandemic on How Home Care Leaders Perceive and Promote Aides' Mental Health and Well-Being. J Appl Gerontol 2024:7334648241236245. [PMID: 38414156 DOI: 10.1177/07334648241236245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Home care aides play a critical role in the care of older adults, but they do this under difficult working conditions. The COVID-19 pandemic exacerbated aides' stress and worsened their mental health, raising the question of how agencies can better support aides. We explore how home care industry leaders in New York perceived and addressed home care aides' mental health and well-being prior to and during the pandemic through in-depth interviews conducted in 2019 (n = 8 agencies) and 2022 (n = 14 agencies). We found that these topics became more central in leaders' thinking, reflected in a range of new internally and externally funded agency actions, albeit limited by ongoing financial constraints. Maintaining a skilled and reliable aide workforce is critical to societal health but will remain challenging without continued investment in aide support of the kind described in the Surgeon General's Framework for Workplace Mental Health and Well-Being.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Kathrin Boerner
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY, USA
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Silver SR, Sweeney MH, Sanderson WT, Pana-Cryan R, Steege AL, Quay B, Carreón T, Flynn MA. Assessing the role of social determinants of health in health disparities: The need for data on work. Am J Ind Med 2024; 67:129-142. [PMID: 38103002 PMCID: PMC10842318 DOI: 10.1002/ajim.23557] [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: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.
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Affiliation(s)
- Sharon R Silver
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Marie H Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Wayne T Sanderson
- Department of Biosystems and Agricultural Engineering, Southeast Center for Agricultural Health and Injury Prevention, Central Appalachian Regional Education Research Center, College of Agriculture Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Regina Pana-Cryan
- National Institute for Occupational Safety and Health, Economic Research and Support Office, Washington, District of Columbia, USA
| | - Andrea L Steege
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Brian Quay
- National Institutes of Health (work performed at NIOSH), Bethesda, MD, USA
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Michael A Flynn
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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7
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Finnanger Garshol B, Knardahl S, Emberland JS, Skare Ø, Johannessen HA. Effects of the Labor Inspection Authority's regulatory tools on physician-certified sick leave and employee health in Norwegian home-care services - a cluster randomized controlled trial. Scand J Work Environ Health 2024; 50:28-38. [PMID: 37903341 PMCID: PMC10924761 DOI: 10.5271/sjweh.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study aimed to determine the effects of the Labor Inspection Authority's regulatory tools on physician-certified sick leave and self-reported health outcomes among employees in municipal home-care services in Norway. METHODS We conducted a cluster-randomized controlled trial in the home-care service sector, and 96 eligible municipalities were randomly assigned to one of three groups: (i) labor inspection visits, based on the Labor Inspection Authority's standard inspections; (ii) guidance-through-workshops, where participants from home-care services met with labor inspectors to receive information and discuss relevant topics; and (iii) the control group. Data on employee self-reported health (N=1669) were collected at baseline and 6 and 12 months after the interventions. Additionally, registry data (N=1202) on diagnosis specific physician-certified sick leave were collected for 18 months after the interventions. RESULTS We found no statistically significant effects of either intervention on self-reported health outcomes. There was, for both interventions, a pattern of decrease in days and periods of physician-certified sick leave due to musculoskeletal diagnoses and increase in days and periods of physician-certified sick leave due to psychological diagnoses, but these were not statistically significant. CONCLUSION Labor inspections and guidance-through-workshops had no statistically significant effect on self-reported health and physician-certified sick leave. The results should be interpreted with caution given the low response rate and subsequent attrition, and in the context of the COVID-19 pandemic. Future studies, in various industries, should further elucidate whether regulatory tools influence employee health and sick leave due to musculoskeletal and mental disorders.
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Affiliation(s)
- Bjørnar Finnanger Garshol
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.
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8
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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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Tsui EK, Wyka K, Beato L, Verkuilen J, Baron S. How client death impacts home care aides' workforce outcomes: an exploratory analysis of return to work and job retention. Home Health Care Serv Q 2023; 42:230-242. [PMID: 36739614 DOI: 10.1080/01621424.2023.2175758] [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: 02/06/2023]
Abstract
Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p < .001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = -0.002, p = .002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n 216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Latifa Beato
- Cooperative Home Care Associates, Bronx, NY, USA
| | | | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, Queens, NY, USA
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Cho J, Toffey B, Silva AF, Shalev A, Safford MM, Phillips E, Lee A, Wiggins F, Kozlov E, Tsui EK, Dell N, Avgar AC, Andreae SJ, Sterling MR. To care for them, we need to take care of ourselves: A qualitative study on the health of home health aides. Health Serv Res 2023; 58:697-704. [PMID: 36815290 PMCID: PMC10154157 DOI: 10.1111/1475-6773.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. DATA SOURCES AND STUDY SETTING Interviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor-management fund of the largest health care union in the US. STUDY DESIGN A qualitative study with English and Spanish-speaking HHAs. Interviews were conducted using a semi-structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. DATA COLLECTION/EXTRACTION METHODS Interviews were recorded, professionally transcribed, and analyzed thematically. PRINCIPAL FINDINGS The 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non-Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient-level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. CONCLUSIONS HHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health.
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Affiliation(s)
- Jacklyn Cho
- Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Brittany Toffey
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel F. Silva
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel Shalev
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Monika M. Safford
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Erica Phillips
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ann Lee
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Faith Wiggins
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Elissa Kozlov
- School of Public HealthRutgers UniversityNew BrunswickNew YorkUSA
| | - Emma K. Tsui
- School of Public HealthCity University of New YorkNew YorkNew YorkUSA
| | | | - Ariel C. Avgar
- School of Industrial Labor RelationsCornell UniversityIthacaNew YorkUSA
| | | | - Madeline R. Sterling
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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Cannings-John R, Schoenbuchner S, Jones H, Lugg-Widger FV, Akbari A, Brookes-Howell L, Hood K, John A, Thomas DR, Prout H, Robling M. Impact of the COVID-19 pandemic on domiciliary care workers in Wales, UK: a data linkage cohort study using the SAIL Databank. BMJ Open 2023; 13:e070637. [PMID: 37263685 DOI: 10.1136/bmjopen-2022-070637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To quantify population health risks for domiciliary care workers (DCWs) in Wales, UK, working during the COVID-19 pandemic. DESIGN A population-level retrospective study linking occupational registration data to anonymised electronic health records maintained by the Secure Anonymised Information Linkage Databank in a privacy-protecting trusted research environment. SETTING Registered DCW population in Wales. PARTICIPANTS Records for all linked DCWs from 1 March 2020 to 30 November 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was confirmed COVID-19 infection; secondary outcomes included contacts for suspected COVID-19, mental health including self-harm, fit notes, respiratory infections not necessarily recorded as COVID-19, deaths involving COVID-19 and all-cause mortality. RESULTS Confirmed and suspected COVID-19 infection rates increased over the study period to 24% by 30 November 2021. Confirmed COVID-19 varied by sex (males: 19% vs females: 24%) and age (>55 years: 19% vs <35 years: 26%) and were higher for care workers employed by local authority social services departments compared with the private sector (27% and 23%, respectively). 34% of DCWs required support for a mental health condition, with mental health-related prescribing increasing in frequency when compared with the prepandemic period. Events for self-harm increased from 0.2% to 0.4% over the study period as did the issuing of fit notes. There was no evidence to suggest a miscoding of COVID-19 infection with non-COVID-19 respiratory conditions. COVID-19-related and all-cause mortality were no greater than for the general population aged 15-64 years in Wales (0.1% and 0.034%, respectively). A comparable DCW workforce in Scotland and England would result in a comparable rate of COVID-19 infection, while the younger workforce in Northern Ireland may result in a greater infection rate. CONCLUSIONS While initial concerns about excess mortality are alleviated, the substantial pre-existing and increased mental health burden for DCWs will require investment to provide long-term support to the sector's workforce.
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Affiliation(s)
| | | | - Hywel Jones
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Ashley Akbari
- Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ann John
- Health Data Research UK | Administrative Data Research Wales, Swansea University, Swansea, UK
- DECIPHer-Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Daniel Rh Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
- Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Prout
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Janssen LM, Abbott KM. "It Hits Me Right Here at my Heart": Promoting Emotional Health of Home Care Workers. J Appl Gerontol 2023; 42:680-688. [PMID: 36305376 DOI: 10.1177/07334648221127690] [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: 11/16/2022] Open
Abstract
Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.
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Affiliation(s)
- Leah M Janssen
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology & Gerontology, 6403Miami University, Oxford, OH, USA
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [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: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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14
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Zagrodney KAP, Deber R, Saks M, Laporte A. Personal Support Worker Socio-Demographic Differences Across Care Sectors in Canada. J Appl Gerontol 2023; 42:670-679. [PMID: 36464973 PMCID: PMC9996787 DOI: 10.1177/07334648221142301] [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] [Indexed: 12/12/2022] Open
Abstract
With the growing reliance on Personal Support Workers (PSWs) in health care delivery for older adults across hospital, nursing and long-term care home, and home and community (HC) sectors, understanding the PSW labor market is critical for healthcare human resource capacity to care for an aging population. This study utilizes a longitudinal, cross-provincial, individual-level dataset of PSWs in Canada from 1996-2010 to provide socio-demographic characteristics of PSWs by sector. Means, proportions, and multivariate tests of significance showed that PSWs differed significantly by care sector across many factors-including sex, health, family, and education characteristics. That HC PSWs were more likely to be older with lower health and higher disability status is important to consider when examining labor policies. Evidence of sector heterogeneity can lead to important differential effects on PSW labor supply behaviors and this research highlights the importance of tailoring initiatives aimed at recruitment and retention by sector.
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Affiliation(s)
- Katherine A P Zagrodney
- IHPME, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, Canada.,612784VHA Home HealthCare, Toronto, ON, Canada; Canadian Health Workforce Network (CHWN); 6363University of Ottawa, Ottawa, ON, Canada
| | - Raisa Deber
- IHPME, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, Canada
| | - Mike Saks
- IHPME, 7938University of Toronto, Toronto, ON, Canada.,102099University of Suffolk, Ipswich, Suffolk, UK; 4547University of Lincoln, Lincoln, Lincolnshire, UK; 4921University of Westminster, London, UK
| | - Audrey Laporte
- IHPME, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, Canada
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Gebhard D, Herz M. How to Address the Health of Home Care Workers: A Systematic Review of the Last Two Decades. J Appl Gerontol 2023; 42:689-703. [PMID: 36440715 PMCID: PMC9996797 DOI: 10.1177/07334648221141084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Making home care a healthy workplace is a societal concern but research on specific interventions is still scarce. The aim of this systematic review was to provide an initial overview of interventions addressing home care workers' health. All (quasi-) experimental studies, presenting any intervention among home care employees, and reporting any outcome related to occupational health, safety, or well-being were included. PsycArticles, Medline, PubMed, and Web of Science were searched from January 2000 to February 2022. From 16,345 publications, 18 studies with 2432 participants were included and assessed with the Joanna Briggs Institute Critical Appraisal Tools. Organizational and training/educational approaches were found in five studies each, a behavioral approach in one, and seven studies presented a combined approach. Due to methodological limitations and the heterogeneity of interventions, the existing studies are insufficient to inform new programs, but emphasize the need for tailored approaches, integrated concepts, and participatory intervention development.
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Affiliation(s)
- Doris Gebhard
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
| | - Michael Herz
- Department of Sport and Health Sciences, 9184Technical University of Munich, Germany
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Finnanger Garshol B, Knardahl S, Emberland JS, Skare Ø, Johannessen HA. Effects of the Labour Inspectorate Authority's regulatory tools on psychosocial and biomechanical work factors in Norwegian home care services: a cluster randomised controlled trial. Occup Environ Med 2022; 79:807-815. [PMID: 36167785 DOI: 10.1136/oemed-2022-108470] [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: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to determine the effects of the Labour Inspectorate Authority's (LIA's) regulatory tools on psychosocial and biomechanical work factors in the Norwegian municipal home care services. METHODS A cluster-randomised controlled trial conducted in the home care services with employee questionnaire data on work factors at baseline, and 6 and 12 months after the interventions. In total, 96 eligible municipalities were randomly assigned to either the control group or one of two interventions: (1) labour inspection visits, based on the LIA's standard inspections; and (2) guidance-through-workshops, where the participating services highlighted issues and trained labour inspectors provided guidance based on existing labour laws and regulations. RESULTS No favourable intervention effect was observed for the inspection intervention. No effects were observed for most of the variables in the guidance intervention, although an effect was observed for the following psychosocial factors: decision control, control over work intensity and empowering leadership. However, after adjusting for multiple testing, none of the observed effects were statistically significant. CONCLUSION Labour inspections did not affect psychosocial and biomechanical work factors in the home care services. A favourable effect of the guidance intervention on psychosocial work factors was observed. However, this was not evident after adjusting for multiple testing. Further research is needed to elaborate on how labour inspections and other regulatory tools can impact psychosocial and biomechanical work factors. TRIAL REGISTRATION NUMBER NCT03855163.
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Affiliation(s)
- Bjørnar Finnanger Garshol
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Stein Knardahl
- Research Director, National Institute of Occupational Health, Oslo, Norway
| | - Jan Shahid Emberland
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Øivind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Håkon A Johannessen
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
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Yearby R. The Social Determinants of Health, Health Disparities, and Health Justice. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:641-649. [PMID: 36883406 PMCID: PMC10009371 DOI: 10.1017/jme.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Although the federal government and several state governments have recognized that structural discrimination limits less privileged groups' ability to be healthy, the measures adopted to eliminate health disparities do not address structural discrimination. Historical and modern-day structural discrimination in employment has limited racial and ethnic minority individuals' economic conditions by segregating them to low wage jobs that lack benefits, which has been associated with health disparities. Health justice provides a community-driven approach to transform the government's efforts to eliminate health disparities, by acknowledging the problem of structural discrimination; empowering less privileged groups to create and implement structural change; and providing support to redress harm.
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Tsui EK, LaMonica M, Hyder M, Landsbergis P, Zelnick J, Baron S. Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:367. [PMID: 35010626 PMCID: PMC8744702 DOI: 10.3390/ijerph19010367] [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] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides' use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides' extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides' efforts to cultivate support stemming from their home-based work environments. Home care aides' work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.
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Affiliation(s)
- Emma K. Tsui
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY 10027, USA;
| | - Marita LaMonica
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY 10027, USA;
| | - Maryam Hyder
- Barnard College, Columbia University, New York, NY 10027, USA;
| | - Paul Landsbergis
- Department of Environmental and Occupational Health Sciences, School of Public Health, State University of New York (SUNY)-Downstate Health Sciences University, New York, NY 11203, USA;
| | - Jennifer Zelnick
- Graduate School of Social Work, Touro College, New York, NY 10001, USA;
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York (CUNY), New York, NY 11365, USA;
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