As the U.S. population ages, the number of people needing personal assistance in the home care setting is increasing dramatically. Personal care aides and home health workers are currently adding more jobs to the economy than any other single occupation. Home health workers face physically and emotionally challenging, and at times unsafe, work conditions, with turnover rates ranging from 44 percent to 65 percent annually. As part of a mixed-method, longitudinal study in Maine examining turnover, interviews with 252 home care aides were analyzed thematically. Responses to interview questions regarding the job’s impact on health and safety, the adequacy of training, and the level of agency responsiveness were examined. Emergent themes, indicating some contradictory perspectives on workplace safety, quality of training, and agency support, were compared across three variables: job termination, occupational injury, and age. Implications for increasing occupational safety and job retention are discussed.
MarquandAYorkA. Squaring to the challenge: who will be tomorrow’s caregivers?Generations2016; 40: 10–17.
2.
AgbonifoNHittleBSuarezRet al.Occupational exposures of home healthcare workers. Home Healthc Nurse2017; 35: 150–159.
3.
SpetzJTrupinLBatesTet al.Future demand for long-term care workers will be influenced by demographic and utilization changes. Health Aff (Millwood)2015; 34: 936–945.
4.
JohnsonRWWienerJM. A profile of frail older Americans and their caregivers, Washington, DC: The Urban Institute, 2006.
5.
SeaveyDMarquandA. Caring in America: a comprehensive analysis of the nation’s fastest-growing jobs: home health and personal care aides, New York City: PHI, 2011.
6.
Paraprofessional Healthcare Institute (PHI). U.S. home care workers: key facts, New York City: Author, 2016.
7.
BorisEKleinJ“We are the invisible workforce.” Unionizing home care. In: CobbleDS (ed). The sex of class, Ithaca, NY: Cornell University Press, 2007, pp. 8.
8.
DawsonSLSurpinR. Direct-care health workers: the unnecessary crisis in long-term care, Washington, DC: The Aspen Institute, 2001, pp. 7.
9.
AshleyAButlerSSFishwickN. Home care aides’ voices from the field: job experiences of personal support specialists—the Maine Home Care Worker Retention Study. Home Healthc Nurse2010; 28: 399–405.
10.
ButlerSSWardamaskySBrennan-IngM. Older women taking care of older women: the rewards and challenges of the home care aide job. J Women Aging2012; 24: 1–22.
11.
ButlerSSBrennan-IngMWardamaskySet al.Determinants of longer job tenure among home care aides: what makes some stay on the job while others leave. J Appl Gerontol2014; 33: 164–188.
12.
FaulACSchapmireTJD’AmbrosioJet al.Promoting sustainability in frontline home care aides: understanding factors affecting job retention in the homecare workforce. Home Health Care Manag Pract2010; 22: 408–416.
13.
StaceyCL. The caring self: the work experience of home care aides, Ithaca, NY: Cornell University Press, 2011, pp. 50.
14.
National Institute for Occupational Safety and Health (NIOSH). NIOSH hazard review: occupational hazards in home healthcare, Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014, pp. iii.
15.
ParsonsKSGalinskyTLWatersT. Preventing musculoskeletal disorders in home healthcare workers. Home Healthc Nurse2006; 24: 158–163.
16.
Bureau of Labor Statistics (BLS). Nonfatal occupational injuries and illnesses requiring days away from work, 2015, Washington, DC: U.S. Department of Labor, 2016. , Table 3.
17.
MeyerJDMuntanerC. Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database. Am J Ind Med1999; 35: 295–301.
18.
WipfliBOlsonRWrightRRet al.Characterizing hazards and injuries among home care workers. Home Healthc Nurse2012; 30: 387–393.
19.
GersonRRMPogorzelskaMQureshiKAet al.Home health care patients and safety hazards in the home: preliminary findings. In: HenriksenKet al.(eds). Advances in patient safety: new directions and alternative approaches (Vol 1: Assessment), Rockland, MD: Agency for Healthcare Research and Quality, 2008. . https://www.ncbi.nlm.nih.gov/books/NBK43619/ (accessed 16 October 2017).
20.
LeeAAJangY. What makes home health workers think about leaving their job? The role of physical injury and organizational support. Home Health Care Serv Q2016; 35: 1–10.
21.
McCaugheyDet al.Workforce implications of injury among home health workers: evidence from the National Home Health Aide Survey. Gerontologist2012; 52: 493–505.
22.
Institute of Medicine (IOM). Retooling for an aging America: building the healthcare workforce, Washington, DC: The National Academies Press, 2008.
23.
PHI. Federal policy priorities: strengthening the direct care workforce, Bronx, NY: Author, 2017.
24.
Institute for the Future of Aging Services (IFAS). Direct care worker retention: strategies for success, Washington, DC: Author, 2010.
25.
MorrisL. Quits and job changes among home care workers in Maine: the role of wages, hours, and benefits. Gerontologist2009; 49: 635–650.
26.
RhoadesLEisenbergerRArmeliS. Affective commitment to the organization: the contribution of perceived organizational support. J Appl Psychol2001; 86: 825–836.
27.
RhoadesLEisenbergerR. Perceived organizational support: a review of the literature. J Appl Psycho2002; 87: 698–714.
28.
Wickenheiser M. Census: Maine most rural state in 2010 as urban centers grow nationwide. Bangor Daily News, 26 March 2012, http://bangordailynews.com.
29.
Office of Aging and Disability Services. Maine’s state plan on aging 2016-2020, Augusta, ME: Maine Department of Health and Human Services, 2016.
30.
HouserAFox-GrageWUjvariK. Across the states: profiles of long-term services and supports, Washington, DC: AARP Public Policy Institute, 2012.
31.
Maurer J. Testimony in support of L.D. 1466, an act to address severe and ongoing shortfalls in the funding of direct care workers in long-term care settings and to establish the commission to study long-term care workforce issues. Maine State Legislature public hearing (1 May 2017), http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=1466&PID=1456&snum=128&sec3# (accessed 16 October 2017).
32.
Erb R. Testimony in support of L.D. 1466, an act to address severe and ongoing shortfalls in the funding of direct care workers in long-term care settings and to establish the commission to study long-term care workforce issues. Maine State Legislature public hearing (1 May 2017), http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=1466&PID=1456&snum=128&sec3# (accessed 16 October 2017).
33.
Zeh-Higgins G. Testimony in support of L.D. 1466, an act to address severe and ongoing shortfalls in the funding of direct care workers in long-term care settings and to establish the commission to study long-term care workforce issues. Maine State Legislature public hearing (1 May 2017), http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=1466&PID=1456&snum=128&sec3# (accessed 16 October 2017).
34.
PholmannL. Without care: Maine’s direct care worker shortage, Augusta, ME: Maine Center for Economic Policy, 2003.
