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This July/August issue of Home Healthcare Nurse brings together two of my favorite topics. Home health, home care aides, and hospice aides can have more than a few titles/names-some dependent on state licensure and some on history and custom. I believe as the number of uninsured and underinsured swell the ranks of covered care though healthcare reform (whether federal or state-based) and nurses are needed more than ever in caring for the additional 32 million to be insured under the Patient Protection and Affordable Care Act (Henry J. Kaiser Family Foundation, 2012). Aides may have new and expanded roles. I think that some aides are ready for expanded, specialized roles in the bigger picture of what they might accomplish in the revised, improved healthcare big-picture view. There are innovative programs going on that involve aides and we hope to bring you some of those exemplars in upcoming issues of Home Healthcare Nurse. Think of aides (who may know the patient and their care histories and needs the best-especially if family caregivers live out of town) accompanying their patients to the emergency room or coming to the hospital to provide inpatient team member with what "Mrs. Jones likes and dislikes" and what her daily routine has "looked like" for the last 5-plus years. All these kinds of ideas can help with transitions of care and maybe with some of the untoward effects of hospitalization-particularly those that effect older adults, such as "sun downing," disorientation, anxiety, delirium, depression, and other distressing symptoms.


In a thoughtful and groundbreaking book, The Caring Self: The Work Experiences of Home Care Aides, the author, Clare L. Stacey (2011), a medical sociologist, brings fundamental insights into the world of the aide and caring for people at home. This book, which I highly recommend, explains why the link between one's identity at work and emotional labor must be investigated if we are ever to fully understand turnover and burnout among aides. This book gives voice to aides as the author goes on poignant home visits and interviews and describes thoughtful and caring aides. Such data are needed as policy must become aligned with patient needs and wishes, cost, and quality. Senator Robert Casey (D-PA) has an innovative bill proposed titled the Improving Care for Vulnerable Older Citizens through Workforce Advancement Act that could impact models of care and grant funds with aides and direct care workers. (Readers can read the full bill at .) I heard Senator Casey present information about the bill while at a meeting in Washington, D.C., a few months ago. I was impressed with his knowledge of aides and their roles and the importance of aides helping clients remain at home.


We must support policies that allow people to remain at home with caring, dedicated, and competent aides. We will need aides more than ever given the projections from the Bureau of Labor Statistics (2012), which has estimated that there will be as many as 1.7 million home health aides by 2020, experiencing a growth rate of 69% between 2010 and 2020. There have been many writings about the projections of a shortfall of aides. We can have a positive role in this area if we advocate, retain, and encourage our aide team members. Three articles in this issue pertain directly to aides as team members. The first one, a research article titled "Characterizing Hazards and Injuries Among Home Care Workers" by Brad Wipfi and colleagues, addresses findings that many home care and hospice managers will empathize with, especially the list of the most common injuries are presented in this thoughtful work. (And perhaps how best to avoid and prevent these injuries.) The second one is this month's Hospice and Palliative Care article entitled "Creative Forces for Retention of Home Health Aides in Hospice and Palliative Care." In this article, Lauren Brown identifies what worked in their hospice organization to recruit and retain aides. Finally, the Commentary, "Hurricane-No Power-No Water-A Tree on the Roof! A Day in the Life of One Creative Hospice Aide," also by Lauren Brown (a special online-only offering), shows the days of one committed hospice aide after a storm and the community she lives and works in-this is the community of care we all seek in the revised world of healthcare improvement! (Visit


Using the evidence to apply to practice will only continue to be more important as we seek to improve healthcare and health. "Best Practices for Heart Failure: A Focused Review" by Paula Suter and colleagues is a CE as well as an online Published Ahead of Print (PAP) article on the HHN Web site ( HHN wants readers to have some articles before they can get into the print issue and this is how we accomplish this task. The second evidence-based article, an in-depth article authored by Kathleen Scanlon and colleagues entitled "Reducing Catheter Associated Urinary Tract Infections in Home Care: A Performance Improvement Project," is also a CE and a PAP that can be accessed at the journal's Web site. This month's VNAA's Voice column is authored by the VNAA's President and Chief Executive Officer, Andy Carter, who submitted a thoughtful column, "Unleashing Home Health's Potential: Looking Beyond Today's Medicare Benefit," lists some innovative models being considered, tested, or piloted. It is a great way to think about home care in a different light and what it might look like in the revised healthcare world.


As always, I love to hear from subscribers and readers. We also have the new editorial themes for 2013 and the first quarter of 2014 in Box 1. (These dates make those aide numbers we need by 2020 sound awfully close!) If you wish to submit a manuscript for review, e-mail me with your idea or query me at, and we can go from there.



Box 1 - Click to enlarge in new windowBox 1.
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Tina Marrelli Editor




Bureau of Labor Statistics. (2012). Home Health and Personal Care Aides. Retrieved from[Context Link]


Henry J. Kaiser Family Foundation. (2012). How People Get Coverage Under the Affordable Care Act. Retrieved from[Context Link]


Stacey, C. L. (2011). The Caring Self: The Work Experiences of Home Care Aides. Ithaca, NY: ILR Press. [Context Link]