By Geralyn Magan
A new research study from the LeadingAge LTSS Center @UMass Boston documents how home care agencies across different business models design the jobs and work environments of nonmedical personal care aides.
Home-based care has evolved tremendously since the Medicaid program began paying for home care services in the 1960s. Initially, home-based services were provided primarily through nonprofit home health and home care agencies. As the home care field expanded, however, the range of business models grew while information about how home care work is organized became more limited.
A new study from the LeadingAge LTSS Center @UMass Boston was designed to fill this information gap.
Job Design for Home-Based Care: Perspectives of Employers and Personal Care Aides documents how home care agencies across different business models address job design and the work environment for nonmedical personal care aides (PCA). The research report is based on interviews with leaders and PCAs at 11 home care agencies and surveys of leaders at 10 of the 11 agencies.
The report synthesizes the information researchers collected about:
- Characteristics of the home care workplace.
- Design of home-based care work.
- The role of PCAs.
- Challenges and barriers perceived by employers and PCAs.
- How work is currently designed.
- Attributes of a positive workplace environment, as defined by PCAs.
KEY FINDINGS
Altruistic Motivations: PCAs said they were attracted to their jobs because they wanted to help people and provide older adults with the care and compassion they need to live independently. These motivations should be showcased in PCA recruitment campaigns, says the report.
One-to-One Recruitment: PCAs reported learning about their current jobs through friends or family members who worked at home care agencies. This suggests that current PCAs and other home care staff could play a valuable role in filling vacant caregiving positions, according to researchers.
Onboarding: Home care agency leaders identified quality onboarding as a key factor in the success of PCAs. Some agencies reported implementing job shadowing and peer mentoring programs to support PCAs and help them learn about the PCA role. However, several aides reported having limited access to these supports.
Communication: Communication between home care agencies and PCAs is often one-way. Typically, PCAs alert their agencies about client-related issues and changes in a client’s condition. However, most PCAs said that agency office staff and nurses do not follow up with them or provide feedback.
Supervision: Agencies provide minimal supervision while aides work in client homes. Supervisors primarily use client feedback to assess PCA performance. Most aides said they want supervisors to engage more with them, provide feedback on their work, and show that they respect and acknowledge the contributions of PCAs.
Care Planning: PCAs reported that they are rarely included in the care planning process. They said they want to have their insights and observations about clients acknowledged through a formal process featuring ongoing follow-up and feedback.
Career Advancement: PCAs reported being aware of opportunities for promotion to office jobs at their home care agencies. However, many PCAs reported not knowing how they might move into higher-level clinical or managerial positions.
Recommendations: Recommendations emerging from this study call for:
- Improvements in PCA preparation, compensation, support, evaluation, and career advancement opportunities.
- Better communication between home care agencies and PCAs.
- Enhanced integration of PCAs into care teams.
- Greater acknowledgement of the valuable role that PCAs play in the home care field.
READ THE FULL REPORT
Find out more about the LTSS Center’s research on job design in home-based care by reading Job Design for Home-Based Care: Perspectives of Employers and Personal Care Aides.