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Groenewold MR, Billock R, Free H, Burrer SL, Sweeney MH, Wong J, Lavender A, Argueta G, Crawford HL, Erukunuakpor K, Karlsson ND, Armenti K, Thomas H, Gaetz K, Dang G, Harduar-Morano L, Modji K, Luckhaupt SE. Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021. Am J Ind Med 2023. [PMID: 37153939 DOI: 10.1002/ajim.23487] [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] [Received: 11/08/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.
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Affiliation(s)
- Matthew R Groenewold
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Rachael Billock
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Hannah Free
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Sherry L Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Jessie Wong
- California Department of Public Health, Sacramento, California, USA
| | | | | | | | | | - Nicole D Karlsson
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Karla Armenti
- University of New Hampshire, Durham, New Hampshire, USA
| | - Hannah Thomas
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Kim Gaetz
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Gialana Dang
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
- Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado, USA
| | - Laurel Harduar-Morano
- Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komi Modji
- Wisconsin Department of Health Services, Division of Public Health, Madison, Wisconsin, USA
| | - Sara E Luckhaupt
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
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2
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [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: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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3
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Luckhaupt SE, Horter L, Groenewold MR, de Perio MA, Robbins CL, Sweeney MH, Thomas I, Valencia D, Ingram A, Heinzerling A, Nguyen A, Townsend EB, Weber RC, Reichbind D, Dishman H, Kerins JL, Lendacki FR, Austin C, Dixon L, Spillman B, Simonson S, Tonzel J, Krueger A, Duwell M, Bachaus B, Rust B, Barrett C, Morrison B, Owers Bonner KA, Karlsson ND, Angelon-Gaetz K, McClure ES, Kline KE, Dangar D, Reed C, Karpowicz J, Anderson SM, Cantor S, Chaudhary I, Ellis EM, Taylor ML, Sedon A, Kocharian A, Morris C, Samson ME, Mangla AT. COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021. Public Health Rep 2023; 138:333-340. [PMID: 36482712 PMCID: PMC9742731 DOI: 10.1177/00333549221138294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.
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Affiliation(s)
- Sara E. Luckhaupt
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Sara E. Luckhaupt, MD, Centers for Disease
Control and Prevention, COVID-19 Response Team, 1090 Tusculum Ave, MS R-12,
Cincinnati, OH 45226, USA.
| | - Libby Horter
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Goldbelt C6, LLC, Chesapeake, VA,
USA
| | - Matthew R. Groenewold
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie A. de Perio
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl L. Robbins
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie Haring Sweeney
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Isabel Thomas
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- ORISE Fellowship, Oak Ridge Associated
Universities, Oak Ridge, TN, USA
| | - Diana Valencia
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Ingram
- Alabama Department of Public Health,
Montgomery, AL, USA
| | | | - Alyssa Nguyen
- California Department of Public Health,
Sacramento, CA, USA
| | - Emily B. Townsend
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | - Rachel C. Weber
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | | | - Hope Dishman
- Georgia Department of Public Health,
Atlanta, GA, USA
| | | | | | - Connie Austin
- Illinois Department of Public Health,
Springfield, IL, USA
| | - Liana Dixon
- Kentucky Department for Public
Health, Frankfort, KY, USA
| | | | - Sean Simonson
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Julius Tonzel
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Anna Krueger
- Maine Center for Disease Control and
Prevention, Augusta, ME, USA
| | | | | | - Britney Rust
- Mississippi Department of Health,
Jackson, MS, USA
| | | | | | - Katharine A. Owers Bonner
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nicole D. Karlsson
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Kim Angelon-Gaetz
- North Carolina Department of Health
and Human Services, Raleigh, NC, USA
| | | | | | - Dhara Dangar
- Pennsylvania Department of Health,
Harrisburg, PA, USA
| | - Chasey Reed
- Rhode Island Department of Health,
Providence, RI, USA
| | | | | | - Sophia Cantor
- Texas Department of State Health
Services, Austin, TX, USA
| | | | - Esther M. Ellis
- US Virgin Islands Department of
Health, Christiansted, VI, USA
| | | | | | | | | | | | - Anil T. Mangla
- District of Columbia Department of
Health, Washington, DC, USA
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4
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Free H, Luckhaupt SE, Billock RM, Groenewold MR, Burrer S, Sweeney MH, Wong J, Gibb K, Rodriguez A, Vergara X, Cummings K, Lavender A, Argueta G, Crawford HL, Erukunuapor K, Karlsson ND, Armenti K, Thomas H, Gaetz K, Dang G, Harduar-Morano L, Modji K. Reported Exposures Among In-Person Workers With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in 6 States, September 2020-June 2021. Clin Infect Dis 2022; 75:S216-S224. [PMID: 35717638 PMCID: PMC9214180 DOI: 10.1093/cid/ciac486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/03/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Surveillance systems lack detailed occupational exposure information from workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The National Institute for Occupational Safety and Health partnered with 6 states to collect information from adults diagnosed with SARS-CoV-2 infection who worked in person (outside the home) in non-healthcare settings during the 2 weeks prior to illness onset. METHODS The survey captured demographic, medical, and occupational characteristics and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have SARS-CoV-2 infection was categorized by setting as exposure at work, exposure outside of work only, or no known exposure/did not know. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors. RESULTS Of 1111 respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/did not know. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. More than one third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS Exposure to occupational SARS-CoV-2 was common among respondents. Examining differences in exposures among different worker groups can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.
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Affiliation(s)
| | - Sara E Luckhaupt
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Rachael M Billock
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Matthew R Groenewold
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Sherry Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | | | | | | | | | | | | | | | | | | | | | | | - Hannah Thomas
- New Hampshire Department of Health and Human Services
| | - Kim Gaetz
- North Carolina Department of Health and Human Services
| | - Gialana Dang
- North Carolina Department of Health and Human Services,Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Laurel Harduar-Morano
- Pennsylvania Department of Health,Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention
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5
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Sama SR, Quinn MM, Galligan CJ, Karlsson ND, Gore RJ, Kriebel D, Prentice JC, Osei-Poku G, Carter CN, Markkanen PK, Lindberg JE. Impacts of the COVID-19 Pandemic on Home Health and Home Care Agency Managers, Clients, and Aides: A Cross-Sectional Survey, March to June, 2020. Home Health Care Management & Practice 2020. [DOI: 10.1177/1084822320980415] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.
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6
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Karlsson ND, Markkanen PK, Kriebel D, Galligan CJ, Quinn MM. "That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health. Am J Ind Med 2020; 63:368-378. [PMID: 31833084 DOI: 10.1002/ajim.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/03/2019] [Revised: 11/18/2019] [Accepted: 12/03/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. METHODS A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. RESULTS Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. CONCLUSION Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.
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Affiliation(s)
- Nicole D Karlsson
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Pia K Markkanen
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - David Kriebel
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Catherine J Galligan
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Margaret M Quinn
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
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7
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Karlsson ND, Markkanen PK, Kriebel D, Gore RJ, Galligan CJ, Sama SR, Quinn MM. Home care aides' experiences of verbal abuse: a survey of characteristics and risk factors. Occup Environ Med 2019; 76:448-454. [PMID: 31186370 PMCID: PMC6585262 DOI: 10.1136/oemed-2018-105604] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/24/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Violence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors. METHODS We used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses. RESULTS Twenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with too little space for the aide to work (RR 1.52, 95% CI 1.17 to 1.97) and predictable work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal abuse, although not as strongly: having clients with limited mobility (RR 1.35, 95% CI 0.94 to 1.93) and an unclear plan for care delivery (RR 1.27, 95% CI 0.95 to 1.69). Aides reporting verbal abuse were 11 times as likely to also report physical abuse (RR 11.53; 95% CI 6.84 to 19.45). CONCLUSIONS Verbal abuse is common among HC aides. These findings suggest specific changes in work organisation and training that may help reduce verbal abuse.
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Affiliation(s)
- Nicole D Karlsson
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Pia K Markkanen
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - David Kriebel
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Rebecca J Gore
- Department of Biomedical Engineering, University of Massachusetts, Lowell, Massachusetts, USA
| | - Catherine J Galligan
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Susan R Sama
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Margaret M Quinn
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
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