Home Health Aides' Experience With Client Death

Abstract

Home health aides are members of a rapidly growing occupation and often develop close ties to patients and their family and can experience significant grief when a patient dies. Yet agencies often provide little support or structure to help staff cope during this time. For instance, home care agencies do not always notify their staff of client death and some have policies in place to prevent any follow-up contact with a deceased client’s family. Little is known about how these agency factors affect HHAs’ work experience. This mixed-method study explored the experiences of 78 HHAs working either at an agency with a restrictive policy regarding contact with a client’s family after client death or an agency without such a policy in place. Data was collected through semi-structured in-person interviews. Employment outcomes included various aspects of job satisfaction and intention to change jobs. HHAs’ responses to client death were assessed with measures of grief and grief processing, and with open-ended questions exploring their experiences in this context. Findings indicated that HHAs from the restrictive agency were significantly more likely to be considering other job options. They also reported significantly lower satisfaction with received supervision, and significantly less grief processing activity. Findings suggest that HHAs from the agency without a contact restrictive policy had a more positive experience at work and more opportunity to process the client’s death.

Home Care Workers’ Experiences of Client Death and Disenfranchised Grief

“…In this article, we confirm and build upon the existing research demonstrating that client death can have negative effects on the lives of home care workers (Boerner et al, 2015; Boerner et al, 2017; Delp et al, 2010) and that several types of support are needed to reduce these effects (Boerner et al, 2016; Gleason, Boerner, & Barooah, 2016). In examining aides’ grief strategies, we found some that were similar to those of nurses working with end-of-life clients (e.g., seeking emotional connection and attempting to set boundaries) and others that were largely distinct—specifically, the general lack of employer support in the postloss period and the need to rely primarily on one’s own personal strength to cope with grief.…”

“…Unlike institution-based workers, home care workers may only occasionally have an opportunity to participate in socially endorsed mourning, particularly funeral ceremonies. There are structural reasons for this—like agency policies (Boerner et al, 2016) and the coordinator-led process of facilitating funeral attendance—but also logistical reasons, because home care workers may no longer be in touch with a client’s family members when a funeral is planned or may be invited but unavailable to attend due to new job responsibilities.…”

“…This study surveyed both home care workers ( n = 80) and certified nursing assistants ( n = 140) and found that they experienced grief symptoms similar to those of family caregivers (Boerner, Burack, Jopp, & Mock, 2015). The authors also learned that agency policies rarely allow aides to stay in contact with clients’ families after a death and that few aides felt they could seek support from their supervisors (Boerner, Gleason, & Barooah, 2016; van Riesenbeck, Boerner, Barooah, & Burack, 2015). The grief and lack of support following a client’s death are thus critical problems that likely reduce job satisfaction, increase burnout and turnover, and compromise home care workers’ health and the care they provide (Boerner, Gleason, & Jopp, 2017).…”

Burnout After Patient Death: Challenges for Direct Care Workers

“…This study is part of a larger mixed-method study that looked at bereavement in direct care workers (CNAs and HHAs; 9, 25, 26, 27, 28). For the nursing home sample, we recruited actively employed CNAs from three large nursing homes that were all part of the same care system in Greater New York.…”

The implications of COVID ‐19 on health and social care personnel in long‐term care facilities for older people: An international scoping review

“…Many resident deaths caused by COVID‐19 have occurred within hospital settings and are not necessarily included in care home statistics which suggests the resident death rate as a result of COVID‐19 is even higher (Comas‐Herrera et al, 2020). Whilst death is something to be expected within many long‐term care homes due to the older age and frailty of residents (Dempster, 2012; Greenberg, 2020), the regular experience of death does not make it easier to cope with (Knowles, 2020; Marcella & Kelley, 2015), especially given the relationships HSCPs build with residents (Arons et al, 2020; Boerner et al, 2015; Boerner et al, 2016; Boerner et al, 2017; Bohlken et al, 2020; Rajkumar, 2020).…”