“It Hits Me Right Here at my Heart”: Promoting Emotional Health of Home Care Workers

Abstract

Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs’ emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: “right state of mind,” practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.

Keywords

emotional health home care workers home and community-based services long-term services and supports retention

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References

Abbott

Van Haitsma

Heid

A. R.

Hepner

(2022). Miami university professional education: Emotion-focused communication training. Miami University Professional Education. https://www.preferencebasedliving.com/emotion-focused-communication-training/

Akerjordet

Severinsson

(2004). Emotional intelligence in mental health nurses talking about practice. International Journal of Mental Health Nursing, 13(3), 164–170. https://doi.org/10.1111/j.1440-0979.2004.0328.x

Alkema

Linton

J. M.

Davies

(2008). A study of the relationship between self-care, compassion satisfaction, compassion fatigue, and burnout among hospice professionals. Journal of Social Work in End-Of-Life & Palliative Care, 4(2), 101–119. https://doi.org/10.1080/15524250802353934

Baron

S. L.

Tsui

E. K.

Quinn

M. M.

(2022). Work as a root cause of home health workers’ poor health. American Journal of Public Health, 112(1), 9–11. https://doi.org/10.2105/AJPH.2021.306582

Bedworth

D. A.

Bedworth

A. E.

(2010). Emotional health. In The dictionary of health education. Oxford University Press.

Blanco-Donoso

L. M.

Moreno-Jiménez

Amutio

Gallego-Alberto

Moreno-Jiménez

Garrosa

(2021). Stressors, job resources, fear of contagion, and secondary traumatic stress among nursing home workers in face of the COVID-19: The case of Spain. Journal of Applied Gerontology, 40(3), 244–256. https://doi.org/10.1177/0733464820964153

Bowers

B. J.

Esmond

Jacobson

(2003). Turnover reinterpreted: CNAs talk about why they leave. Journal of Gerontological Nursing, 29(3), 36–43. https://doi.org/10.3928/0098-9134-20030301-09

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Butler

S. S.

Brennan-Ing

Wardamasky

Ashley

(2014). Determinants of longer job tenure among home care aides: What makes some stay on the job while others leave? Journal of Applied Gerontology, 33(2), 164–188. https://doi.org/10.1177/0733464813495958

10.

Campbell

Del Rio Drake

Espinoza

Scales

(2021). Caring for the future: The power and potential of America’s direct care workforce (p. 126). PHI. http://phinational.org/caringforthefuture/

11.

Curnow

Rush

Maciver

Górska

Forsyth

(2021). Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: A systematic review and meta-analysis. Aging & Mental Health, 25(3), 397–407. https://doi.org/10.1080/13607863.2019.1695741

12.

Donlan

(2021, January 3). ‘Once they’re gone, they’re gone’: Family & nursing care rebuilds workforce after COVID-19 losses. Home Health Care News. https://homehealthcarenews.com/2021/01/once-theyre-gone-theyre-gone-family-nursing-care-rebuilds-workforce-after-covid-19-losses/

13.

Espinoza

(2019). Workforce matters: The direct care workforce and state-based LTSS social insurance programs [Research report]. https://phinational.org/resource/workforce-matters/workforce-matters-phi-and-cag-2019/

14.

Famakinwa

(2021, March 31). ‘A monumental advance’: Newly unveiled American jobs plan would invest $400B into home-based care. Home Health Care News. https://homehealthcarenews.com/2021/03/a-monumental-advance-newly-unveiled-american-jobs-plan-would-invest-400b-into-home-based-care/

15.

Franzosa

Tsui

E. K.

Baron

(2019). “Who’s caring for us?”: Understanding and addressing the effects of emotional labor on home health aides’ well-being. The Gerontologist, 59(6), 1055–1064. https://doi.org/10.1093/geront/gny099

16.

Frogner

Spetz

(2015). Entry and exit of workers in long-term care [Research report]. UCSF Health Workforce Research Center on Long-Term Care. https://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/files/Report-Entry_and_Exit_of_Workers_in_Long-Term_Care.pdf

17.

Heffernan

Quinn

Griffin, M. T.

McNulty

S. R.

Fitzpatrick

J. J.

(2010). Selfcompassion and emotional intelligence in nurses: Self-compassion and emotional intelligence in nurses. International Journal of Nursing Practice, 16, 366–373. https://doi.org/10.1111/j.1440-172X.2010.01853.x

18.

Karlsson

N. D.

Markkanen

P. K.

Kriebel

Gore

R. J.

Galligan

C. J.

Sama

S. R.

Quinn

M. M.

(2019). Home care aides’ experiences of verbal abuse: A survey of characteristics and risk factors. Occupational and Environmental Medicine, 76(7), 448–454. https://doi.org/10.1136/oemed-2018-105604

19.

Kemper

Heier

Barry

Brannon

Angelelli

Vasey

Anderson-Knott

(2008). What do direct care workers say would improve their jobs? Differences across settings. The Gerontologist, 48(suppl 1), 17–25. https://doi.org/10.1093/geront/48.Supplement_1.17

20.

Kim

I.-H.

Noh

Muntaner

(2012). Emotional demands and the risks of depression among homecare workers in the USA. International Archives of Occupational and Environmental Health, 86(6), 635–644. https://doi.org/10.1007/s00420-012-0789-x

21.

Kusmaul

Butler

Hageman

(2020). The role of empowerment in home care work. Journal of Gerontological Social Work, 63(4), 316–334. https://doi.org/10.1080/01634372.2020.1750524

22.

Marquand

(2013). Personal care aide training requirements: Summary of state findings [Research report]. https://phinational.org/wp-content/uploads/legacy/research-report/pca-training-reqs-state-findings.pdf

23.

Maslach

Schaufeli

W. B.

Leiter

M. P.

(2001). Job burnout. Annual Review of Psychology, 52(1), 397–422. https://doi.org/10.1146/annurev.psych.52.1.397

24.

Maxwell

J. A.

(2013). Qualitative research design: An interactive approach (3rd ed.). SAGE Publications, Inc.

25.

McQueen

A. C. H.

(2004). Emotional intelligence in nursing work. Journal of Advanced Nursing, 47(1), 101–108. https://doi.org/10.1111/j.1365-2648.2004.03069.x

26.

Mills

Wand

Fraser

J. A.

(2017). Self-care in Palliative care nursing and medical professionals: A cross-sectional survey. Journal of Palliative Medicine, 20(6), 625–630. https://doi.org/10.1089/jpm.2016.0470

27.

Mittal

Rosen

Leana

(2009). A dual-driver model of retention and turnover in the direct care workforce. The Gerontologist, 49(5), 623–634. https://doi.org/10.1093/geront/gnp054

28.

Montes-Berges

Augusto

J.-M.

(2007). Exploring the relationship between perceived emotional intelligence, coping, social support and mental health in nursing students. Journal of Psychiatric and Mental Health Nursing, 14(2), 163–171. https://doi.org/10.1111/j.1365-2850.2007.01059.x

29.

NIOSH . (2014). Caring for yourself while caring for others (No. 2015–103; p. 82). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/docs/2015-103/pdf/2015-103.pdf

30.

Nisbet

Morgan

J. C.

(2019). Where policy meets practice: Employer perspectives on scheduling and hours for home care aides. Journal of Applied Gerontology, 38(11), 1615–1634. https://doi.org/10.1177/0733464817739153

31.

Osterman

(2017). Who will care for us? Long-term care and the long-term care workforce. Russel Sage Foundation.

32.

Pfefferle

S. G.

Weinberg

D. B.

(2008). CNAs making meaning of direct care. Qualitative Health Research, 18(7), 952–961. https://doi.org/10.1177/1049732308318031

33.

PHI . (2018). U.S. home care workers: Key facts. https://phinational.org/resource/u-s-home-care-workers-key-facts-2018/

34.

PHI & Institute for the Future of Aging Services . (2003). Workforce strategies - state wage pass-through legislation: An analysis [Research report]. https://phinational.org/wp-content/uploads/legacy/clearinghouse/WorkforceStrategies1.pdf

35.

Rochester

Kilstoff

Scott

(2005). Learning from success: Improving undergraduate education through understanding the capabilities of successful nurse graduates. Nurse Education Today, 25(3), 181–188. https://doi.org/10.1016/j.nedt.2004.12.002

36.

Rosen

Stiehl

E. M.

Mittal

Leana

C. R.

(2011). Stayers, leavers, and switchers among certified nursing assistants in nursing homes: A longitudinal investigation of turnover intent, staff retention, and turnover. The Gerontologist, 51(5), 597–609. https://doi.org/10.1093/geront/gnr025

37.

Salovey

Mayer

J. D.

(1990). Emotional intelligence. Imagination, Cognition and Personality, 9(3), 185–211. https://doi.org/10.2190/DUGG-P24E-52WK-6CDG

38.

Scales

Lepore

(2020). Always essential: Valuing direct care workers in long-term care. Public Policy & Aging Report, 30(4), 173–177. https://doi.org/10.1093/ppar/praa022

39.

Şenyuva

Kaya

Işik

Bodur

(2014). Relationship between self-compassion and emotional intelligence in nursing students: Self-compassion and emotional intelligence. International Journal of Nursing Practice, 20(6), 588–596. https://doi.org/10.1111/ijn.12204

40.

Stacey

C. L.

(2005). Finding dignity in dirty work: The constraints and rewards of low-wage home care labour. Sociology of Health & Illness, 27(6), 831–854. https://doi.org/10.1111/j.1467-9566.2005.00476.x

41.

Sterling

M. R.

Cho

Ringel

J. B.

Silver

S. R.

(2021). Prevalence and Predictors of home health care workers’ general, physical, and mental health: Findings from the 2014‒2018 behavioral risk factor surveillance system. American Journal of Public Health, 111(12), 2239–2250. https://doi.org/10.2105/AJPH.2021.306512

42.

Sterling

M. R.

Tseng

Poon

Cho

Avgar

A. C.

Kern

L. M.

Ankuda

C. K.

Dell

(2020). Experiences of home health care workers in New York city during the coronavirus disease 2019 pandemic: A qualitative analysis. JAMA Internal Medicine, 180(11), 1453. https://doi.org/10.1001/jamainternmed.2020.3930

43.

Stone

(2004). The direct care worker: The third rail of home care policy. Annual Review of Public Health, 25, 521–537. https://doi.org/10.1146/annurev.publhealth.25.102802.124343

44.

Stone

R. I.

Dawson

S. L.

(2008). The origins of better jobs better care. The Gerontologist, 48(suppl 1), 5–13. https://doi.org/10.1093/geront/48.Supplement_1.5

45.

Tsui

E. K.

Franzosa

Reckrey

J. M.

LaMonica

Cimarolli

V. R.

Boerner

(2021). Interventions to reduce the impact of client death on home care aides: Employers’ perspectives. Journal of Applied Gerontology, 41(2), 332-340. https://doi.org/10.1177/0733464821989859

46.

Wellin

(2018). Paid caregiving for older adults with serious or chronic illness: Ethnographic perspectives, evidence, and implications for training. In Critical gerontology comes of age: Advances in research and theory for a new century (pp. 112–133). Routledge.

47.

Zeidner

Matthews

Roberts

R. D.

(2012). The emotional intelligence, health, and well-being Nexus: What have we learned and what have we missed?: The emotional intelligence, health, and well-being Nexus. Applied Psychology: Health and Well-Being, 4(1), 1–30. https://doi.org/10.1111/j.1758-0854.2011.01062.x

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