Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

ObjectiveViolence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors.MethodsWe used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.ResultsTwenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with too little space for the aide to work (RR 1.52, 95% CI 1.17 to 1.97) and predictable work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal abuse, although not as strongly: having clients with limited mobility (RR 1.35, 95% CI 0.94 to 1.93) and an unclear plan for care delivery (RR 1.27, 95% CI 0.95 to 1.69). Aides reporting verbal abuse were 11 times as likely to also report physical abuse (RR 11.53; 95% CI 6.84 to 19.45).ConclusionsVerbal abuse is common among HC aides. These findings suggest specific changes in work organisation and training that may help reduce verbal abuse.

Introduction Home care (HC) aide is among the fastest‐growing jobs. Aides often work in long‐term care relationships with elders or people with disabilities in clients’ homes, assisting with daily activities. The purpose of this mixed‐methods paper is to elucidate aides’ experiences around the boundary‐challenging behaviors of clients asking for services beyond aides’ job duties and to identify possible interventions. Methods A cross‐sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post‐survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in‐depth interviews with HC industry and labor representatives. Results Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47‐2.52 for verbal, PR = 1.81; 95%CI: 1.13‐2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11‐2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89‐1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90‐0.98). Qualitative data showed that clients’ requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. Conclusion Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.

Background Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers. Methods The study included 37 phone interviews conducted during April – November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded. Results Fear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship. Conclusions The findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.

Background Surveillance systems lack detailed occupational exposure information from workers with SARS-CoV-2 infection. The National Institute for Occupational Safety and Health partnered with six states to collect information from adults diagnosed with SARS-CoV-2 infection (either COVID-19 or asymptomatic infection) who worked in person (outside the home) in non-healthcare settings during the two weeks prior to illness onset. Methods The survey captured demographic, medical, occupational characteristics, and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have COVID-19 was categorized by setting as: exposure at work, exposure outside of work only, or no known exposure/didn’t know if they had exposures. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors for SARS-CoV-2 infection. Results Of 1,111 qualified respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/didn’t know if they had exposures. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. Over a third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. Conclusions Exposure to SARS-CoV-2 at work was common among respondents. Examining differences in exposures among different groups of workers can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.