Perceived Stress and Health among Home Care Aides: Caring for Older Clients in a Medicaid-Funded Home Care Program

Abstract

Home care aides (HCAs) provide housekeeping and personal care services to help older clients remain in the community. However, little is known about the health of HCAs, who themselves constitute an underserved population. The goal of this study was to investigate how HCAs’ work and life contexts manifest themselves in HCAs’ health as perceived by HCAs. Six focus groups were conducted with HCAs (N=45). Analysis revealed how HCAs’ work-and life-related stress accumulated over time and affected HCAs’ health and interaction with their older clients. Home care aides were interested in personal health promotion and client well-being. Home care aides may constitute an underused resource for the care of older adults with disabilities. Information about intricately intertwined work and life contexts should inform policymakers and home care providers in their efforts to improve the quality of publicly funded home care services.

Home health aides’ experiences of their occupational health: a qualitative meta-synthesis

“…The researchers used different qualitative research methods in their studies. The majority of studies (N = 9) used focus group interviews as the only method [26][27][28][29][30][31][32][33][34]. Seven studies used face-to-face interviews [35][36][37][38][39][40][41], while five studies used telephone interviews [42][43][44][45][46].…”

“…One study reported that chronic pain and injuries in the lower back, shoulders, knees and neck resulted in surgery [36]. Strenuous work tasks included assisting clients with activities of daily living, performing housekeeping tasks or cleaning [26,32,35,36,42,47], transferring, assisting, repositioning and turning clients [28,32,35,36,42,47,49] and other heavy lifting [28,30,35,36,45,47,49]. Several informants experienced being in danger through physical violence from clients with mental health issues, dementia or Alzheimer's disease [30,32,33,35,36,40,[43][44][45]].…”

“…Several studies reported that home health aides provide care in an uncontrolled environment and are exposed to environmental hazards such as chemicals and drug residues from administering medication [35,[47][48][49], household infestations [30,35,[47][48][49], poor air quality and secondary tobacco smoke from clients [29,30,35,40,[47][48][49]. Home health aides experienced biological exposure [35,47], which created awareness and concerns of exposure to clients sickness, bloodborne pathogens, potential infections and infestations or bed bugs and worries about transmission to themselves and their family [30,35,45,48]. The studies described patients' pets as unpredictable and dangerous distractions that created an unsafe or unhealthy working space [29,30,40,45,48,49].…”

“…Home health aides experienced biological exposure [35,47], which created awareness and concerns of exposure to clients sickness, bloodborne pathogens, potential infections and infestations or bed bugs and worries about transmission to themselves and their family [30,35,45,48]. The studies described patients' pets as unpredictable and dangerous distractions that created an unsafe or unhealthy working space [29,30,40,45,48,49]. Rugs, cords, loose stairs, medical equipment and furniture, clutter, dark lights, objects on the floor and slippery floors where described as reasons for potential musculoskeletal injuries from slips, trips and falls [31,32,40,45,48,49].…”

“…Home health aides experienced low wages [30,41,43,44,52] and not being reimbursed for mileage [43,44]. Other organisational challenges resulted from tight budgets and restricted hiring of stand-ins [39], lack of training, unclear expectations and inconsistent scheduling [43,46].…”