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Gusoff G, Ringel JB, Bensson-Ravunniarath M, Wiggins F, Lee A, Espinosa CG, Avgar AC, Sarkisian C, Sterling MR. Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers. J Am Med Dir Assoc 2024; 25:737-743.e2. [PMID: 38432645 DOI: 10.1016/j.jamda.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions. DESIGN We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument. SETTING AND PARTICIPANTS The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible. METHODS HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. RESULTS The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001). CONCLUSIONS AND IMPLICATIONS Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.
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Affiliation(s)
- Geoffrey Gusoff
- National Clinician Scholars Program, University of California, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | | | | | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Cisco G Espinosa
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Catherine Sarkisian
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA, USA
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Olson R, Hess JA, Turk D, Marino M, Greenspan L, Alley L, Donovan C, Rice SPM. COMMunity of Practice And Safety Support for Navigating Pain (COMPASS-NP): study protocol for a randomized controlled trial with home care workers. Trials 2023; 24:264. [PMID: 37038235 PMCID: PMC10088173 DOI: 10.1186/s13063-023-07149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Chronic pain is a prevalent and costly problem that often has occupational origins. Home care workers (HCWs) are at high risk for work-related injuries, pain, and disability. Current treatments for chronic pain emphasize medications, which are an inadequate stand-alone treatment and can produce significant adverse effects. METHODS In this translational study, we will adapt an established work-based injury prevention and health promotion program (COMmunity of Practice And Safety Support: COMPASS) to address the needs of HCWs experiencing chronic pain. COMPASS employs peer-led, scripted group meetings that include educational content, activities, goal setting, and structured social support. The translated intervention, named COMPASS for Navigating Pain (COMPASS-NP), will be delivered in an online group format. Safety protections will be strengthened through an ergonomic self-assessment and vouchers for purchasing ergonomic tools. Educational content will integrate a self-management approach to chronic pain using proven cognitive-behavioral therapy (CBT) principles. We will use a mixed-methods hybrid type 2 evaluation approach to assess effectiveness and implementation. A cluster-randomized waitlist control design will involve 14 groups of 10 HCWs (n = 140) recruited from Washington, Oregon, and Idaho. Half of the groups will be randomly selected to complete the intervention during the first 10 weeks, while the waitlist groups serve as controls. During weeks 10-20, the waitlist groups will complete the intervention while the original intervention groups complete a follow-up period without further intervention. Our primary hypothesis is that COMPASS-NP will reduce pain interference with work and life. Secondary outcomes include injury and pain prevention behaviors, pain severity, changes in medication use, risk for opioid misuse, well-being, physical activity, and sleep. Qualitative data, including phone interviews with group facilitators and organizational partners, will evaluate the implementation and guide dissemination. DISCUSSION The results will advance the use and knowledge of secondary prevention interventions such as ergonomic tools and cognitive behavior therapy, to reduce injury, pain, and disability and to encourage appropriate uses of analgesic medications among HCWs. TRIAL REGISTRATION ClinicalTrials.gov NCT05492903. Registered on 08 August 2022.
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Affiliation(s)
- Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Department of Psychology, Portland State University, P.O. Box 751, Portland, OR, 97207-0751, USA
| | - Jennifer A Hess
- Labor Education & Research Center, University of Oregon, 1675 Agate Street, Eugene, OR, 97403-1289, USA.
| | - Dennis Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, BB 1425 HSC, Box 356540, 1949 NE Pacific Street, Seattle, WA, 98195-6540, USA
| | - Miguel Marino
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Family Medicine, School of Medicine, Oregon Health & Science University, FM, 3181 SW Sam Jackson Park, Portland, OR, 97239, USA
| | - Leah Greenspan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Lindsey Alley
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Courtney Donovan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Grasmo SG, Liaset IF, Redzovic SE. Home care workers' experiences of work conditions related to their occupational health: a qualitative study. BMC Health Serv Res 2021; 21:962. [PMID: 34521407 PMCID: PMC8438557 DOI: 10.1186/s12913-021-06941-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. Methods A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. Results HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. Conclusions This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.
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Affiliation(s)
- Sunniva Grønoset Grasmo
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway.
| | - Ingeborg Frostad Liaset
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway
| | - Skender Elez Redzovic
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway
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Sterling MR, Dell N, Tseng E, Okeke F, Cho J, Piantella B, Tobin JN. Home care workers caring for adults with heart failure need better access to training and technology: A role for implementation science. J Clin Transl Sci 2020; 4:224-8. [PMID: 32695493 DOI: 10.1017/cts.2020.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Although highly involved in heart failure (HF) patients' care, home care workers (HCWs) lack HF training and are poorly integrated into the healthcare team. For its potential to address these challenges, we examined the role of technology among HCWs caring for HF patients. We conducted 38 interviews with key stakeholders. Overall, four themes emerged. Participants reported that technology is critical for HF care, but existing systems are outdated and ineffective. HCWs also have limited access to electronic resources. Technology, training, and principles of implementation science can be leveraged to improve HCWs' experience in caring for HF patients and home healthcare delivery.
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Ohta R, Ryu Y, Katsube T. Home care workers' judgments about users' acute conditions: A qualitative study on interprofessional collaboration. Home Health Care Serv Q 2020; 39:184-195. [PMID: 32116134 DOI: 10.1080/01621424.2020.1736228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Home care workers' (HCWs) approaches to home care users' acute symptoms are critical for users' safety and quality of life. However, the processes of these approaches are unclear. This study investigates how HCWs assess users' conditions. Focus group discussions and semi-structured interviews with HCWs were conducted in a rural Japanese city. HCWs' decisions were affected by interactions and previous relationships with care managers, home care nurses, physicians, and users' families. Rural HCWs act flexibly, changing the professionals and families they consult with. Understanding HCWs' behaviors and improving relationships among medical/care professionals and families can improve management of users' acute conditions.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital , Unnan, Japan
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Butler SS. Profiles of women who help us to age in place. J Women Aging 2019; 32:122-127. [PMID: 31345127 DOI: 10.1080/08952841.2019.1648177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As our population ages and people overwhelmingly prefer to age in place, the need for home care workers is steadily increasing. Unfortunately, due to the low value society places on caring work, filling these positions and retaining workers is a challenge. Drawing on a pilot study involving in-depth interviews with eight female home care aides, this brief report profiles three categories of worker perceptions of their jobs: "satisfied" (n = 3), "need more support" (n = 3), and "on my way out" (n = 2). Study participants liked their work but believed their jobs needed to be improved. Policy implications based on study findings are explored.
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Butler S. Maine's Bold Initiative: Homecare for All. J Gerontol Soc Work 2019; 62:255-260. [PMID: 30732544 DOI: 10.1080/01634372.2019.1575137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
A 2018 ballot initiative in Maine proposed universal home care and improved work conditions for home care workers.Although ultimately defeated, the innovative proposal received considerable support and laid the groundwork for an upcoming legislative campaign.It offers a framework for increasing access to home care and creating quality jobs for home care aides. This commentary reviews the problems addressed by the Homecare for All initiative, what was proposed, the campaign process and anticipated next steps, and implications for gerontological social workers.
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Affiliation(s)
- Sandra Butler
- a School of Social Work , University of Maine , Orono , Maine , USA
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Olson R, Wipfli B, Wright RR, Garrigues L, Nguyen T, López de Castro B. Reliability and validity of the Home Care STAT (Safety Task Assessment Tool). Appl Ergon 2014; 45:1157-1166. [PMID: 24629346 DOI: 10.1016/j.apergo.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/04/2013] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
Home care workers are a priority population for ergonomic assessment and intervention, but research on caregivers' exposures to hazards is limited. The current project evaluated the reliability and validity of an ergonomic self-assessment tool called Home Care STAT (Safety Task Assessment Tool). Participants (N = 23) completed a background survey followed by 10-14 days of self-monitoring with the STAT. Results showed that the most frequent task was house cleaning, and that participants regularly performed dangerous manual client moving and transferring tasks. Researcher in-home observations of 14 workers (duration ≤ 2 h) demonstrated that workers' self-assessments were moderately reliable. Correlational and multi-level analyses of daily self-assessment data revealed that several task exposures were significantly related to daily fatigue and/or pain. Other associations have implications for Total Worker Health™; for example, daily stress was positively associated with both pain and consumption of high calorie snacks. Findings support the STAT as a reliable and potentially valid tool for measuring home care workers' exposures to physically demanding tasks.
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Affiliation(s)
- Ryan Olson
- Oregon Health & Science University, Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., L606, Portland, OR 97239-3098, USA; Oregon Health & Science University, Department of Public Health and Preventive Medicine, 3181 SW Sam Jackson Park Road, CB 669, Portland, OR 97239-3098, USA; Portland State University, Department of Psychology, P.O. Box 751, Portland, OR 97207-0751, USA.
| | - Brad Wipfli
- Oregon Health & Science University, Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., L606, Portland, OR 97239-3098, USA.
| | - Robert R Wright
- Oregon Health & Science University, Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., L606, Portland, OR 97239-3098, USA; Portland State University, Department of Psychology, P.O. Box 751, Portland, OR 97207-0751, USA.
| | - Layla Garrigues
- Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Rd., Portland, OR 97239-2941, USA.
| | - Thuan Nguyen
- Oregon Health & Science University, Department of Public Health and Preventive Medicine, 3181 SW Sam Jackson Park Road, CB 669, Portland, OR 97239-3098, USA.
| | - Borja López de Castro
- University of Valencia, Department of Social Psychology, Avda. Blasco Ibáñez 21, 46010 Valencia, Spain.
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