Home Health Aides' Perceptions of Quality Care: Goals, Challenges, and Implications for a Rapidly Changing Industry

Abstract

Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide-client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker-client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.

“That's not my job”: A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health

“…Written care plans that clearly specify care tasks are desired by aides and may reflect professionalization that supports aides' safety and job satisfaction. However, the job is much more than the formal tasks captured in a list, care plan, or job description; and the small things that aides do that are not technically part of the job description may make the job more satisfying and safer for aide and client . As aides explained, the “little in‐between things ” that happen in the job outside of what is written explicitly on the care plan are “[l]ittle things that aren't little things, because they are what make the relationship work.”(FG4)…”

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]].…”

“…The informants relayed that time pressure during hectic workdays was one of the most strenuous factor in home care work [26,27,33,37,39,52,53] and created negative emotions such as frustration, stress, fatigue or fear of making mistakes [27,37,52,53].…”

“…The informants described increased indirect work tasks-for instance paperwork-as endeavours that did not directly involve patient care but increased the time pressure and workload, were difficult to complete during paid work hours and were a source of overtime hours [34,47,51,53]. Home health aides indicated that excessive sick leave from others created strain and pressure [39] and required them to take on extra responsibilities, perform extra tasks beyond the work schedule and work unpaid hours to fill care gaps and to meet the client's needs [26,27,32]. The informants reported that they kept working despite health problems because they could not afford to be absent, even if working could lead to long-term health consequences as psychological stress and burnout [30,31].…”