Sage Journals: Discover world-class research

Abstract

This study examines the unique challenges facing rural home care workers. Semi-structured interviews were undertaken between July 2021 and February 2022 with 23 participants that have experience in rural home care delivery. The major challenge confronting rural home care workers involved distance and transportation. This challenge emerged due to long distance between clients, unreliable vehicles, inadequate reimbursement, and inclement weather. In turn, this challenge exacerbated three other types of challenges facing rural home care workers: workforce challenges that consisted of a persistent labor shortage and shorter visits that forced workers to rush through tasks, client isolation due to the social and physical seclusion of households, and the poor working conditions of home care work more broadly. Without policy interventions that respond to these particular challenges, the care gap in rural areas can be expected to grow.

Keywords

caregiving home and community based care and services home care rural

Get full access to this article

View all access options for this article.

References

Arcury

T. A.

Preisser

J. S.

Gesler

W. M.

Powers

J. M.

(2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health, 21(1), 31–38.

Bedard

Koivuranta

Stuckey

(2004). Health impact on caregivers of providing informal care to a cognitively impaired older adult: Rural versus urban settings. Canadian Journal of Rural Medicine, 9(1): 15–23.

Bolda

E. J.

Seavey

J. W.

(2001). Rural long-term care integration developing service capacity. Journal of Applied Gerontology, 20(4). https://doi.org/10.1177%2F073346480102000404

Brown

D. K.

Lash

Wright

Tomisek

(2011). Strengthening the direct service workforce in rural areas. Centers for Medicare and Medicaid Services. https://www.paproviders.org/archives/secure/Toolkits/Workforce/3.6.pdf

Butler

Brennan-Ing

Wardamasky

Ashley

(2013). 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). https://doi.org/10.1177%2F0733464813495958

Campbell

Drake

A. D. L.

Espinoza

Scales

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

Coburn

A. F.

Griffin

Thayer

Croll

Z. T.

Ziller

E. C.

(2016). “Are rural adults benefitting from increased state spending on Medicaid home and community-based services?” University of Southern Maine, Maine rural health research center. https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1005&context=longterm_care

Cutchin

(2003). The process of mediated aging-in-place: A theoretically and empirically based model. Social Science & Medicine, 57(6): 1077–1090.

Douthit

Kiv

Dwolatzky

Biswas

(2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6).

10.

Foley

Timonen

(2015). Using grounded theory method to capture and analyze health care experiences. Health Service Resources, 50(4), 1195–1210.

11.

Forbes

D. A.

Janzen

B. L.

(2004). Comparison of rural and urban users and non-users of home care in Canada. Canadian Journal of Rural Medicine, 9(4), 227–235.

12.

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.

13.

Goins

R. T.

Spencer

S. M.

Byrd

J. C.

(2009). Research on rural caregiving: A literature review. Journal of Applied Gerontology, 28(2), 139–170. https://doi.org/10.1177/0733464808326294

14.

Healy

(2019). Nursing homes are closing across rural America, scattering residents. The New York Times. https://www.nytimes.com/2019/03/04/us/rural-nursing-homes-closure.html

15.

Henning-Smith

Lahr

(2018). “Perspectives on rural caregiving: Challenges and interventions.” University of Minnesota Rural Health Research Center. http://rhrc.umn.edu/wp-content/files_mf/1535129278UMNpolicybriefcaregivingchallenges.pdf

16.

Hochschild

A. R.

(1983). The managed heart: Commercialization of human feeling. University of California Press.

17.

Kenney

(1993). Is access to home health care a problem in rural areas? American Journal of Public Health, 83(3): 412–414.

18.

Lahr

Henning-Smith

Rahmn

Hernandez

A. M.

(2021). “Barriers to health care access for rural Medicare beneficiaries: Recommendations from rural health clinics.” University of Minnesota Rural Health Research Center. https://rhrc.umn.edu/wp-content/uploads/2021/01/UMN-RHC-Access-to-Care-PB_1.20.pdf

19.

Devoti

O’Connor

(2022). Rural and urban disparities in quality of home health care: A longitudinal cohort study (2014-2018). The Journal of Rural Health, 2022, 1–8.

20.

Milligan

(2009). There’s No place like home: Place and care in an ageing society. Routledge.

21.

Morris

(2009). Quits and job changes among home care workers in Maine: The role of wages, hours, and benefits. The Gerontologist, 49(5), 635–650.

22.

Ohta

Ryu

Katsube

(2018). Challenges for Japanese rural home care workers in interprofessional collaboration: A qualitative study. Home Health Care Services Quarterly, 37(4), 313–324.

23.

Osterman

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

24.

Pinto

Wagner

K. C.

Weaver

West

(2021). A high road for home care: Program assessment of the healthcare workers rising transportation pilot. The Worker Institute. https://www.ilr.cornell.edu/sites/default/files-d8/2021-09/CORNELL_2021HealthCareWorkersRising_FINALDRAFT.pdf.

25.

Polacsek

Goh

Malta

Hallam

Gahan

Cooper

Low

L-F

Livingston

Panayiotou

Loi

Omori

Savvas

Batchelor

Ames

Doyle

Scherer

Dow

(2019). ‘I know they are not trained in dementia’: Addressing the need for specialist dementia training for home care workers. Health and Social Care in the Community, 28, 475–484.

26.

Roberto

K. A.

Savla

McCann

B. R.

Blieszner

Knight

A. L.

(2022). Dementia family caregiving in rural appalachia: A sociocultural model of care decisions and service use. The Journal of Gerontology, 77(6), 1094–1194.

27.

Siconolfi

Shih

R. A.

Friedman

E. M.

Kotzias

V. I.

Ahluwalia

S. C.

Phillips

J. L.

Saliba

(2019). Rural-urban disparities in access to home- and community-based services and supports: Stakeholder perspectives from 14 States. Journal of the American Medical Directors Association, 20(4).

28.

Sterling

M. R.

Cené

C. W.

Ringel

J. B.

Avgar

A. C.

Kent

E. E.

(2022b). Rural-urban differences in family and paid caregiving utilization in the United States: Findings from the cornell national social survey. The Journal of Rural Health: Official Journal of the American Rural Health.

29.

Sterling

M. R.

Ringel

J. R.

Cho

Riffin

C. A.

Avgar

A. C.

(2022a). Utilization, contributions, and perceptions of paid home care workers among households in New York state. Innovation in Aging.

30.

Sterling

M. R.

Silva

A. F.

Leung

P. B. K.

Shaw

A. L.

Tsui

E. K.

Jones

C. D.

Robbins

Escamilla

Lee

Wiggins

Sadler

Shapiro

M. F.

Charlson

M. E.

Kern

L. M.

Safford

M. M.

(2018). It’s like they forget that the word ‘heath’ is in ‘home health aide’: Understanding the perspectives of home care workers who care for adults with heart failure. Journal of the American Heart Association, 7(23). https://doi.org/10.1161/jaha.118.010134

31.

Thomas

D. R.

(2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27, 237–246. https://doi.org/10.1177%2F1098214005283748

32.

van Dis

(2002). Where we live: Health care in rural vs urban America. The Journal of the American Medical Association, 287(1), Article 108.

33.

Weech-Maldonado

Shea

Elmendorf

(2007). Long-term care providers and their perceptions of the external environment: Rural versus urban differences. Journal of Applied Gerontology, 26(1), 78–94. https://doi.org/10.1177%2F0733464806296145

34.

Zarska

Avgar

A. C.

Sterling

M. R.

(2021). Relationship between working conditions, worker outcomes, and patient care: A theoretical model for frontline health care workers. American Journal of Medical Quality: The Official Journal of the American College of Medical Quality, 36(6), 429–440. https://doi.org/10.1097/01.JMQ.0000735508.08292.73

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.34 MB

Making a Bad Situation Worse: Examining the Challenges Facing Rural Home Care Workers

Abstract

Keywords

Get full access to this article

References

Supplementary Material