Addressing the potential mismatch between the growing needs of persons aging with disability and/or chronic health conditions, and the decreasing availability of paid home care workers to help meet those needs.
The LeadingAge LTSS Center @UMass Boston is serving as a thought leader on a new study addressing ways to meet the future home-based health and personal care needs of a growing and diverse population.
The study, funded by the Gordon and Betty Moore Foundation, is directed by Dr. Lisa I. Iezzoni, a professor of medicine at Harvard Medical School and associate director of the Institute for Health Policy at Massachusetts General Hospital.
Researchers will address the potential mismatch between the growing needs of persons aging with disability and/or chronic health conditions, and the decreasing availability of paid home care workers to help meet those needs. This mismatch is likely to grow into a crisis as more adult Americans pursue their desire to live in their homes and communities even when they are unable to perform basic activities of daily living.
The study will feature 3 distinct projects designed to produce 2 white papers on home care policy and practice, and a compendium of personal narratives exploring the experiences of consumers and workers.
Policy Synthesis of Prior Interventions
LTSS Center Co-Director Dr. Robyn Stone and Senior Research Associate Natasha Bryant are offering guidance to researchers who will produce a white paper summarizing the 40-year history of efforts to improve home care and address the sector’s unique workforce challenges.
“This is about the history of the major drivers, events, activities, and policy and research efforts that have informed the evolution of personal assistance services across the country,” says Stone, who is also senior vice president of research at LeadingAge. “This project relates to a lot of the work that (the LTSS Center) has been doing on workforce. We are contributing our critical thinking about how to frame these issues in terms of next steps.”
The LTSS Center (formerly the LeadingAge Center for Applied Research) has been researching workforce issues for more than 15 years. From 2002-2006, the center managed the Better Jobs Better Care initiative, a 4-year, $15.5 million research and demonstration program designed to address the recruitment and retention of direct care workers. Most recently, the center worked with Global Evaluation & Applied Research Solutions to study current and future trends in home-based care and its impact on the future workforce. The project resulted in recommendations for demonstration and research projects that could strengthen the home care workforce.
“I like the history part of it,” says Stone about the policy synthesis. “We’ve seen many workforce developments over the past 30 years that often are not brought to bear on our future planning. This is an effort to document the key activities that have helped the home and community-based personal care sector move forward, and to identify what has worked and what hasn’t worked. That will help us frame the future so we just don’t keep reinventing the same things over and over again.”
The final synthesis “will offer context and lessons learned, which could really be helpful to LeadingAge members who are either currently home and community-based service providers, or are thinking of adding these services to their continuum,” says Stone.
Home Care Policy and Practices
Researchers from PHI will write a second white paper on the current state of home-based health and personal care in the U.S. The paper will:
- Assess current approaches to PCA recruitment, training, certification, and monitoring;
- Examine new and evolving efforts to involve PCAs in home-based health care teams,
- Identify opportunities for innovation and improvement in home care practice; and
- Make recommendations for addressing the impending crisis in home-based health and personal care services, with an emphasis on standardizing PCA policy across states in ways that enable PCAs to work within their full scope of practice to improve care outcomes.
Perspectives of Consumers and Workers
Researchers will conduct in-depth interviews with 10 direct-care consumers and 10 workers to tell stories that “bring to life” the interpersonal and cultural complexities of receiving and providing assistance with ADLs. Dr. Kathrin Boerner, an associate professor at UMass Boston and an LTSS Center fellow, will serve as a consultant on this project.
Researchers will use their interviews to assess how home-based services affect daily functioning and quality of life, and how formal personal assistance service providers interface with informal caregivers. They will also examine aspects of the job that affect retention, safety, daily work life, career satisfaction, and future employment preferences of direct-care workers.
Convening the Experts
Before the end of the study, 10 experts will gather with the project team to discuss the project findings, including strategies for mitigating the impending crisis in home care. Stone, Bryant, and Majd Alwan, senior vice president of technology at LeadingAge, will participate in the convening.
The experts and project team members will:
- Discuss the major implications of the study findings;
- Specify key steps that should be taken at local, regional, and national levels to avert a home-care crisis caused by unmet need, excessive costs, and an inadequate and poorly compensated workforce; and
- Make recommendations for how study findings could inform policy making and other activities.