Focusing on the Positive: Home Health Aides' Desire for Autonomy and Control.

Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.

Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job.

BACKGROUND AND OBJECTIVES: This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job. RESEARCH DESIGN AND METHODS: Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency. RESULTS: The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency. DISCUSSION AND IMPLICATIONS: The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.

Immediate aftermath of a client's death: the experience of home health aides.

This study investigated Home Health Aides' (HHAs) experiences in the immediate aftermath of client death. Semi-structured in-person interviews with 80 HHAs explored how notification of death and reassignment to a new client were handled. Only 42.5% of HHAs were notified of the death; 40% had to notify the agency; 17.5% were not notified at all and had a negative experience. Reassignment preferences varied, but HHAs had a better experience when their preferences were taken into consideration. Study findings suggest that more mindful approaches to transitions following client death would be valued by HHAs and could improve their work experience.

Burnout After Patient Death: Challenges for Direct Care Workers.

CONTEXT: Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention. OBJECTIVES: To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions. METHODS: Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment). RESULTS: Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion. CONCLUSION: Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout.

Supporting home health aides through a client's death: The role of supervisors and coworkers.

This study evaluated home health aides (HHAs) experiences related to the support they received around a client's death. 80 HHAs who had recently experienced a client death participated in semi-structured interviews. They were asked to what extent they felt support was available to them from their supervisor or coworker, whether they sought support, the type of support they sought, and how helpful it was. They were also asked what type of support they would like to receive. Findings showed that just over one third of the HHAs felt they could turn to their supervisors for support and one fifth could turn to their coworkers. Even fewer sought support. However, those who did receive support, found it to be extremely helpful, in particular when the support came from supervisors. Desired types of support were primarily related to having someone to talk to or check in with them, pointing to an important role of nursing supervisors in providing critical support to direct care staff.

Home Health Aides' Experience With Client Death: The Role of Employer Policy.

Home health aides (HHAs) are members of a rapidly growing occupation. They often develop close ties to patients and their family and can experience significant grief when a patient dies. Yet agencies often provide little support or structure to help staff cope during this time. For instance, home care agencies do not always notify their staff of client death and some have policies in place to prevent any follow-up contact with a deceased client's family. Little is known about how these agency factors affect HHAs' work experience. This mixed-method study explored the experiences of 78 HHAs working either at an agency with a restrictive policy regarding contact with a client's family after client death or an agency without such a policy in place. Data were collected through semistructured in-person interviews. Employment outcomes included various aspects of job satisfaction and intention to change jobs. HHAs' responses to client death were assessed with measures of grief and grief processing, and with open-ended questions exploring their experiences in this context. Findings indicated that HHAs from the restrictive agency were significantly more likely to be considering other job options. They also reported significantly lower satisfaction with received supervision, and significantly less grief processing activity. Findings suggest that HHAs from the agency without a contact-restrictive policy had a more positive experience at work and more opportunity to process the client's death.

Mental and behavioral health conditions among older adults: implications for the home care workforce.

OBJECTIVES: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities. METHODS: Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts. RESULTS: Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work. CONCLUSION: This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides.