By Robyn Stone
It’s time we did a better job of integrating home care aides into home-based care teams.
Behind every successful man is a strong woman.
Most women I know have cringed at that old phrase at least once during their lifetimes. But we can’t ignore the fact that, in its day, the phrase did shine an important spotlight on the valuable, and often overlooked, role that women have always played in their families, social networks, and places of business.
An updated version of that phrase popped into my head recently when I was discussing a similarly undervalued population with colleagues at the Annual Scientific Meeting of the Gerontology Society of America (GSA).
Behind every successful health care professional is a strong home care worker.
I was part of a GSA panel exploring the positive impact that paid caregivers can have on the health of older adults, especially older adults living in community while dealing with health challenges.
Every presenter on the panel agreed that health care professionals would be a lot more successful in caring for older adults if they did a better job of acknowledging the role that home care workers play in that success.
Every presenter is working in her own way to help aides become more integrated members of home-based care teams that typically include only physicians, nurses, social workers, and pharmacists.
I argued during my presentation that home care aides could become the most important members of those home-based teams as we move more primary and hospital-level care into the home.
But there’s a catch. Like that strong woman standing behind her successful man, home care workers are not routinely acknowledged or valued for the important work they do. And that’s bad news for older care recipients, clinicians, and aides.
DISPELLING MYTHS ABOUT HOME CARE AIDES
We need to dispel the myth that home care aides are inexperienced kids who lack skills and have low education levels.
That’s simply not true. Research shows that a third of home care workers are 55 and older and tend to be more stable and more loyal than younger workers in the same sector. Almost half (46%) have some college education.
In spite of the fact that these aides make only about $16,000 a year, they are holding up our entire system of long-term services and supports (LTSS).
They provide 60-80% of all hands-on care, in addition to offering critical social, behavioral, and emotional support to care recipients and their families. Most important, they know the care recipient, and what is going on in the home, better than anyone else. That alone should make them very strong partners with every member of the home-based care team.
So what’s the problem? There are many, so I’ll name just a few: lack of awareness of the role of the home care aide, lack of appreciation for the valuable role aides play, lack of investment in training so aides can hone their skills as caregivers and team members, and lack of consistency in state regulation of the tasks these workers are allowed to complete.
THE ROLE OF RESEARCH
Whenever I’m tempted to view these barriers as insurmountable, I turn to fellow researchers for hope. And that hope was on full display at GSA.
Take Emily Franzosa, DrPh, whose research focuses on the important relationships that home care aides develop with their care recipients—relationships that support care, ensure the care recipient stays emotionally and socially healthy, and yield an intimate knowledge of the older adult that physicians, nurses, and social workers often don’t have.
It’s so great to have such an important resource right in the home day in and day out. The problem, says Emily, is that our payment models, job descriptions, care plans, and quality measures are not set up to recognize the many types of care that home care aides provide.
Emily’s research demonstrates that aides know what they need to be successful. They want more training, especially around dementia. They want to play a larger role in the care team. They want more supportive supervision that focuses on problem solving. They want worker-focused training to help them manage the emotional side of the job, including the isolation they experience every day.
This is great research. And we need more of it.
Madeline Sterling, MD, found that home care workers are performing life-saving work by helping heart failure patients manage critical aspects of care. They weigh patients on a daily basis, take vital signs, help prepare low-salt and low-fat meals, remind patients to take medication, and take them to doctor appointments. In her medical practice, Madeline even asks aides to contribute to the patient’s history and to share their insights about the patient’s health, with the patient’s permission.
In order to carry out these tasks, however, home care aides need training and support from the health care team. They don’t have either—or at least they didn’t until Madeline used her research to develop training courses focusing specifically on heart failure.
This is important work, and we need more of it.
Jennifer M Reckrey, MD, has also contributed to the literature on training by examining whether the New York State training curriculum acknowledges all the tasks home care workers carry out each day. She found gaps that she feels limit the positive impact that aides could have on the health of care recipients.
Jennifer would like to see us expand our view of the home care worker. Why create a new line of professionals to do health coaching, she wonders, when aides could be trained in that role? Why not provide better training on what aides do best: identifying the care recipient’s needs earlier than a physician could?
These are great questions. And we need to ask more of them.
NEXT STEPS
Despite the great work that Jennifer, Madeline, and Emily have done so far, we still have precious little research to rely on as we try to strengthen the home care workforce. My priority is to develop demonstration programs that will help us test the best ways to integrate these workers into home-based care teams. We’re most likely to gain more public investment in the home care workforce if we can demonstrate the positive outcomes of that investment.
I’m convinced that rigorous and continued research is the best way to get clinicians and policy members to value the aides who stand behind them on the home front and who ensure that we will succeed in helping older adults stay healthy, happy, and independent for longer.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.