Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Abstract

Objectives: Patient care aides, who provide basic care to patients in a variety of healthcare settings, have been observed to have higher prevalences of adverse health metrics than the general US workforce. However, few studies have examined how healthcare access and health behaviors and outcomes among patient care aides differ by work setting (home health, nursing home, and hospital).Methods: Data from the 2013 to 2016 Behavioral Risk Factor Surveillance System were used to assess the prevalences of healthcare access, health-related behaviors, and health outcomes among patient care aides in different work settings, and among nurses (licensed vocational/practical and registered). Adjusted prevalence ratios were used to compare prevalences for healthcare workers to those for nonhealthcare clerical workers.Results: Overall, patient care aides are a low-wage workforce with high prevalences of multiple adverse health metrics and low prevalences of positive health behaviors compared to clerical workers. Results differed by work setting. Home health aides had the lowest income levels and most adverse results for multiple metrics; nursing home aides had better healthcare access and somewhat better health outcomes.Most metrics were best (though still quite poor) for hospital aides, who showed few significant differences from clerical workers. Conclusions:These results show the need to focus resources on the patient care aide workforce, particularly those in home health. While some needs of nursing home aides, such as improving influenza vaccination coverage and reducing the prevalence of arthritis-related conditions, would benefit from standardized workplace interventions, alternate, workplace-specific approaches are needed for home health aides.

Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic

“…18 Consistent with this line of reasoning, another study found that unionized certified nursing assistants working in nursing homes were far more likely than the HHAs in this study to cite their employer as a primary source for COVID-19-related information. 19 The findings on frequent experiences of physical fatigue and emotional exhaustion accord with research documenting high levels of stress and burnout among HHAs, 7,20 and the greater difficulties HHAs reported taking care of their physical and mental health amid the pandemic build on recent work showing increased stress among health care workers during this period. 21,22 For the HHAs in our study, heightened stress may be linked to the concerns participants expressed about exposing themselves, family, and patients to COVID-19.…”

Prevalence of Underlying Medical Conditions Among Selected Essential Critical Infrastructure Workers — Behavioral Risk Factor Surveillance System, 31 States, 2017–2018

“…These include the inability to practice physical distancing at work or to work from home, low wages, lack of paid sick leave, reliance on public or shared transportation, crowded housing, limited access to health care, and the need to hold multiple jobs (3,5,6). Several of these inequities also hinder management of underlying conditions that increase the risk for severe COVID-19 (7). These inequities also pertain to groups of essential workers not assessed in this report because of inadequate sample size (e.g., low levels of health care access among food preparers/servers, agricultural workers, and building/grounds maintenance and support, including housekeepers and janitors in health care) (8).…”

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

“…Clearly, COVID-19 vaccination of HC aides is a high priority. It is concerning therefore that aides have had low rates of vaccination against seasonal flu [ 8 ••]. Along with medical considerations, effective vaccination programs need to address the economic and social determinants of HC aide infection risks, their access to vaccinations, and their concerns about accepting vaccinations [ 8 ••, 87 ].…”

“…The importance of home-based care as an alternative to facility-based care was underscored when the COVID-19 pandemic began: elders were at high risk of severe COVID-19 infection [ 1 ], and nursing homes had high infection rates [ 2 – 5 ]. At the same time, most of the HC workforce is composed of aides, who also are vulnerable to COVID-19 due to their work exposures and to their experience of social and economic inequities (housing where social distancing is not possible, limited health care access) that present infection risks [ 6 , 7 , 8 ••, 9 ]. Many elders were afraid to have aides enter their homes, and many aides were concerned about caring for those with COVID-19 in the home-work environment where infection prevention measures were not well established [ 10 ••].…”