Characteristics of home care workers who leave their jobs: a cross-sectional study of job satisfaction and turnover in Washington State.

Attracting and retaining a stable and motivated home care workforce has become a top policy priority. We surveyed 402 former home care workers in Washington State. We compared these "leavers" to current home care workers recently surveyed. Those who left the profession were more highly educated, had higher household income, and were more likely to be White. Those newly employed have better benefits, wages, hours, and career mobility than in their home care jobs. The low status and poor pay of home care workers may result in the inability of the profession to retain those who face better prospects.

Simulating the impact of long-term care policy on family eldercare hours.

OBJECTIVE: To understand the effect of current and future long-term care (LTC) policies on family eldercare hours for older adults (60 years of age and older) in Singapore. DATA SOURCES: The Social Isolation Health and Lifestyles Survey, the Survey on Informal Caregiving, and the Singapore Government's Ministry of Health and Department of Statistics. STUDY DESIGN: An LTC Model was created using system dynamics methodology and parameterized using available reports and data as well as informal consultation with LTC experts. PRINCIPAL FINDINGS: In the absence of policy change, among the elderly living at home with limitations in their activities of daily living (ADLs), the proportion of those with greater ADL limitations will increase. In addition, by 2030, average family eldercare hours per week are projected to increase by 41 percent from 29 to 41 hours. All policy levers considered would moderate or significantly reduce family eldercare hours. CONCLUSION: System dynamics modeling was useful in providing policy makers with an overview of the levers available to them and in demonstrating the interdependence of policies and system components.

La diversificación y consolidación de los servicios sociales para las personas mayores en España y Suecia / Diversification and strengthening of services for older people in Spain and Sweden

La información sobre los servicios públicos para las personas mayores a menudo se limita a la atención residencial y a la ayuda a domicilio. Sin embargo, estos servicios básicos son en muchos países complementados o sustituidos por otros servicios de menor envergadura, como el transporte, comidas a domicilio, teleasistencia y centros de día. Esta diversificación partió de un racionamiento de los servicios para lograr una asignación más racional de los recursos y, si se podía, un menor gasto. En este trabajo se utilizan diversos datos sobre estos servicios en España y Suecia. Cuando se consideran todos los cuidados, la cobertura de atención es mucho mayor que si sólo se contemplan los servicios básicos. Esto indica una mayor consolidación de los mismos. Los datos sugieren mayor focalización en Suecia, y prestaciones fragmentadas en España, donde parece que los usuarios alcanzan lo disponible, con poca diferenciación entre sus necesidades. Cuando las tasas de cobertura son superiores, como en Suecia, hay mayor solapamiento entre el cuidado familiar y los servicios públicos. Con tasas más bajas, como en España, los cuidados familiares y los servicios públicos son sustitutos unos de otros. Se sugiere que una mayor diversidad de servicios, básicos y secundarios, puede adaptarse mejor y de manera más eficiente a las diversas necesidades de las personas mayores que la elección entre ningún servicio, ayuda domiciliaria o atención residencial. Aunque estos servicios secundarios también puedan ser utilizados como un sustituto de bajo coste, e inferior calidad, en la atención(AU)

Information on public services for older people is often limited to institutional care and Home Help/Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services are in many countries supplemented – or substituted – by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems and day care. This diversification is the outcome of a rationing of services to achieve a more rational allocation of resources and attempts to keep down costs. In this presentation we use various data sources to provide information on all these types of support for Spain and Sweden. When all of them are considered, service coverage is much higher than by basic services alone, indicating further consolidation of services. Data suggests a high targeting in Sweden, but fragmented delivery in Spain, where – we suspect - users get what is available, with little differentiation between needs. With higher service rates, as in Sweden, there is greater overlap between family care and public services; with lower coverage rates, as in Spain, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people better – and more efficiently - than the choice between nothing, Home Help or institutional care, but that minor services may also be used as an inexpensive – and sometimes inferior - substitute for full support(AU)

Creating and sustaining an effective coaching culture in home care: one organization's performance improvement related to aides and aide retention.

Relationships between aides and their supervisors are often challenging. Unproductive disciplinary conversations lead to increased dissatisfaction, low morale, high turnover, and stress levels among staff. This cycle can continue to spiral if not effectively addressed and aimed in a positive direction. This article shares the experience of an organization that addressed this concern through a performance improvement initiative.

Fears come true: the experiences of older care recipients and their family members of live-in foreign home care workers.

BACKGROUND: Foreign home care services provided to frail older adults by individuals from the developing world are a global phenomenon. This study evaluated the challenges associated with live-in foreign home care from the perspective of older care recipients and their family members. METHODS: Qualitative interviews were conducted with 23 family members and seven older care recipients. Interviews were analyzed thematically. RESULTS: Three main themes were identified: (i) the intense fears associated with witnessing the decline of the older care recipient and the subsequent employment of a foreign home care worker; (ii) actual negative experiences within this caregiving setting; and (iii) the ways in which family members and older care recipients coped with these challenging experiences. CONCLUSIONS: The key to this caregiving arrangement is the establishment of trust. Yet, many care recipients experienced violations of trust that resulted in abuse and neglect, which served to further intensify fears and concerns about this caregiving arrangement. The same coping methods used to maintain this arrangement, despite fears and concerns, are the ones responsible for maintaining the older care recipient in an abusive situation.

A model for home care clinician and home health aide collaboration: diabetes care by nurse case managers and community health workers.

Researchers at Johns Hopkins University conducted a randomized clinical trial to test the effect of nurse case management and community health worker interventions on diabetes control among inner city African Americans. The results demonstrated that the greatest improvement occurred when nurse case managers and community health workers worked together. This study has implications for how nurse/home health aide collaboration can enhance diabetes management in home care.