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Fong MC, Russell D, Gao O, Franzosa E. Contextual Forces Shaping Home-Based Health Care Services Between 2010 and 2020: Insights From the Social-Ecological Model and Organizational Theory. THE GERONTOLOGIST 2023; 63:1117-1128. [PMID: 35921664 PMCID: PMC9384634 DOI: 10.1093/geront/gnac113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around coronavirus disease 2019 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical, and infrastructural contexts are not aligned with the operational needs of home health care organizations, presenting obstacles to home health care equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based health care organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based health care organizations to advance home health care equity. The article represents a synthesis of recent literature and our research and industry experiences.
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Affiliation(s)
- Mei-Chia Fong
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - David Russell
- Center for Home Care Policy & Research, VNS Health, New York, USA
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Oude Gao
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Yan D, Temkin-Greener H, Pavan R, Yu H, Cai S. Did Minimum Wage Policy Changes Impact Home Health Workforce? HOME HEALTH CARE MANAGEMENT AND PRACTICE 2023; 35:206-212. [PMID: 38031569 PMCID: PMC10686279 DOI: 10.1177/10848223221140502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The shortage of home health aides has been exacerbated in recent years partially because of low wages. Minimum wage (MW) policy changes may alleviate this workforce shortage. This study examined the effects of MW policies on wages and employment of home health aides. We performed a county-level longitudinal analysis using 2012 to 2018 national data. The study cohort included 2,496 counties and focused on all workers in the home health industry. Outcome variables included wages and the employment of home health aides. Key variables of interest included the consumer price index adjusted state MW and a set of variables that captured the effect of the Fair Labor Standards Act (FLSA) extension. This study found that home health aides' hourly wages were $1.00 higher (p = .011) in states that increased their MWs from below $8 to above $10. The FLSA extension was associated with $1.15 higher wages in states with higher MWs (i.e., state MW above $10 in 2014). The FLSA extension was associated with higher employment of home health aides in less-competitive markets, rather than high- or average-competitive markets. This study suggests that state MW increases combined with the FLSA extension may help maintain the current home health workforce and improve their wages.
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Affiliation(s)
- Di Yan
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | | | - Hao Yu
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA
| | - Shubing Cai
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Cho J, Toffey B, Silva AF, Shalev A, Safford MM, Phillips E, Lee A, Wiggins F, Kozlov E, Tsui EK, Dell N, Avgar AC, Andreae SJ, Sterling MR. To care for them, we need to take care of ourselves: A qualitative study on the health of home health aides. Health Serv Res 2023; 58:697-704. [PMID: 36815290 PMCID: PMC10154157 DOI: 10.1111/1475-6773.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. DATA SOURCES AND STUDY SETTING Interviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor-management fund of the largest health care union in the US. STUDY DESIGN A qualitative study with English and Spanish-speaking HHAs. Interviews were conducted using a semi-structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. DATA COLLECTION/EXTRACTION METHODS Interviews were recorded, professionally transcribed, and analyzed thematically. PRINCIPAL FINDINGS The 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non-Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient-level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. CONCLUSIONS HHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health.
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Affiliation(s)
- Jacklyn Cho
- Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Brittany Toffey
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel F. Silva
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel Shalev
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Monika M. Safford
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Erica Phillips
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ann Lee
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Faith Wiggins
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Elissa Kozlov
- School of Public HealthRutgers UniversityNew BrunswickNew YorkUSA
| | - Emma K. Tsui
- School of Public HealthCity University of New YorkNew YorkNew YorkUSA
| | | | - Ariel C. Avgar
- School of Industrial Labor RelationsCornell UniversityIthacaNew YorkUSA
| | | | - Madeline R. Sterling
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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Xu EL, Kim PS, Yee C, Zhang M, Reckrey JM, Lubetsky S, Zhao D, Ornstein KA, Franzosa E. "I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:561-570. [PMID: 36283965 PMCID: PMC9597284 DOI: 10.1177/07334648221135584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers' roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.
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Affiliation(s)
- Emily L Xu
- Department of Medical Education, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia S Kim
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Cynthia Yee
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Meng Zhang
- Department of Internal Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer M Reckrey
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Sara Lubetsky
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Duzhi Zhao
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | | | - Emily Franzosa
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
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Russell D, Burgdorf JG, Washington KT, Schmitz J, Bowles KH. "Second set of eyes:" Family caregivers and post-acute home health care during the COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2023; 109:107627. [PMID: 36638714 PMCID: PMC9830895 DOI: 10.1016/j.pec.2023.107627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to explore how the COVID-19 pandemic shaped the experiences of family caregivers of older adults who were hospitalized with COVID-19 and discharged to post-acute, skilled home health care (HHC) services. METHODS Thirty semi-structured interviews with family caregivers of older adults who received services from a large, not-for-profit HHC agency following hospitalization with COVID-19 infection were conducted between March-July 2021 and analyzed using thematic analysis. RESULTS During the pandemic, family caregivers encountered societal and institutional barriers to assisting older adults across post-acute care transitions. These barriers included hospital visitation restrictions as well as difficulties accessing community-based resources and medical equipment. Despite limitations and delays in HHC services, many family caregivers identified post-acute HHC, delivered in-person or via telehealth, as important to addressing care gaps for older adults, as well as their own needs for training and support during the pandemic. CONCLUSIONS Policies intended to reduce the spread of COVID-19 introduced new challenges for caregivers during HHC. However, HHC agencies and their staff adapted within this context to provide a needed bridge of support.
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Affiliation(s)
- David Russell
- Appalachian State University Department of Sociology, Boone, NC, USA; Center for Home Care Policy & Research at VNS Health, New York, NY, USA.
| | - Julia G Burgdorf
- Center for Home Care Policy & Research at VNS Health, New York, NY, USA
| | - Karla T Washington
- Division of Palliative Medicine at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer Schmitz
- Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research at VNS Health, New York, NY, USA; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Wong J, Pedersen J, Tennety N, DuBois L, Chiu R, Shah D, Malecki G, Wafford QE, Heinemann AW. Service-Delivery Competencies in Home and Community-Based Services Needed to Achieve Person-Centered Planning and Practices: A Systematic Review. J Appl Gerontol 2023; 42:493-504. [PMID: 36384346 DOI: 10.1177/07334648221139476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Home and community-based services (HCBS) assist people with disabilities and older adults to remain in their homes. Direct support professionals and care managers who facilitate the development of support plans need to employ person-centered approaches to ensure services are tailored to peoples' needs and preferences. The aims were to identify the key competencies needed for delivery of person-centered supports and examine the relationship between HCBS and its' outcomes in the United States. We used the competencies developed by the National Center on advancing Person-Centered Practices and Systems as a framework. We conducted a systematic review to identify the skills necessary to deliver person-centered HCBS. We coded 43 articles and identified seven competencies. Most frequently mentioned competencies related to culturally informed practice, cultivating connections, and promoting rights, choice, and control. Policy makers should create training standards for person-centered practices to ensure that people receiving HCBS live the lives they want.
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Affiliation(s)
- Jasin Wong
- 34881National Tsing-Hua University, Hsinchu City, Taiwan
| | - Jessica Pedersen
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Niveda Tennety
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Lindsay DuBois
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | - Dhrumil Shah
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Glenn Malecki
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Q Eileen Wafford
- 491146Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allen W Heinemann
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA.,12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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