Home Care Aide Safety Concerns and Job Challenges During the COVID-19 Pandemic

Abstract

Home care aides are on the frontlines providing care to vulnerable individuals in their homes during the COVID-19 pandemic yet are often excluded from policies to protect health care workers. The goal of this study was to examine experiences of agency-employed home care aides during the COVID-19 pandemic and to identify ways to mitigate concerns. We used an innovative journaling approach with thirty-seven aides as well as in-depth interviews with fifteen aides and leadership representatives from nine home health agencies in New York and Michigan. Workers described a range of concerns around workplace safety including uncertainty around whether a client had COVID-19, inadequate access to personal protective equipment and safe transportation, as well as fundamental changes to interactions with clients. Agencies also faced challenges acquiring personal protective equipment for their aides. This research points to needed resources to support home care aides and home health agencies both during a public health crisis and in the future.

“It changed everything”: The Safe Home Care qualitative study of the COVID-19 pandemic’s impact on home care aides, clients, and managers

“…When examining the results broadly, surveys of HC aides in New York [ 24 ] and Michigan [ 13 ] as well as surveys of HC agencies nationwide [ 35 , 36 ] have reported similar findings with our study. These include the lack of or difficulty sourcing PPE, concerns over transmitting or contracting COVID-19, grappling with decisions to work with increased exposure risk or face financial hardship, and accessibility issues regarding telehealth.…”

“…A qualitative analysis from a nationwide survey of HC aides ( n = 1204) found that during early weeks of the pandemic, HC aides experienced either decreased service requests from clients or requests to take on additional clients due to staffing shortages [ 11 ]. Another qualitative study using HC aide journaling and interviews identified themes related to the fear of infection and general transmission of COVID-19 [ 13 ].…”

“…The HC industry applied important lessons from earlier influenza outbreaks and a wide range of recommendations by key stakeholders were brought forward to inform pandemic preparedness planning in HHC and HC [9,10]. Yet, these sectors were still overlooked nationwide at the beginning of the COVID-19 pandemic [5,[11][12][13][14] while challenged to function above capacity to provide home service visits [15].…”

“…Since the start of the pandemic, employers have expressed concerns that HC aides will leave their jobs because of fear of infection and that there will not be enough caregivers to replace those who leave [23]. Studies have reported on HC aides' experiences during the pandemic [5,13,23,24] pinpointing workers' concerns about contracting COVID-19 as well as challenges in accessing appropriate personal protective equipment (PPE) and timely information about COVID-19 exposure and safety guidance. Studies have also highlighted the essential contribution of HC aides in working conditions that make them vulnerable to COVID-19 exposure and infection [22,25,26].…”

Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic

“…9,10 In the home care setting, clients canceled in-home visits owing to transmission fears, and clinicians faced barriers to care provision, including a lack of access to personal protective equipment and safe transportation. [11][12][13] The COVID-19 pandemic has been particularly devastating in the nursing home setting, with high mortality rates [14][15][16] prior to vaccine distribution.…”