1. Tsui, Emma K. PhD, MPH
  2. Cimarolli, Verena R. PhD

Article Content

Home health aides and personal care aides help clients carry out activities of daily living and provide healthcare support to older adults and individuals with disabilities. Because home care aides usually work with individuals who are older and ill, the death of clients is likely a regular feature of the work of many aides, and often a significant stressor. Research suggests that client death can lead to temporary job loss and emotional strain for aides, issues that can exacerbate each other (Boerner et al., 2015, Delp et al., 2010; Tsui et al., 2019). Further, grief experiences related to client death are associated with burnout and, therefore, may have implications for both client care and aide retention (Boerner et al., 2017).


We also know from studies that agencies currently take few steps to acknowledge the significance of client death in the lives of aides (Gleason et al., 2016; Tsui et al., 2019). As a result, home care aides often report feeling unprepared to manage client death (Tsui et al.). Aides and researchers have recommended several interventions that agencies could implement to address these concerns, including additional training around end-of-life issues, enhanced emotional support, and paid time off (Barooah et al., 2019; Gleason et al.; Tsui et al.). These strategies hold great promise. High-quality certification training and on-the-job training are associated with increased job satisfaction and retention (Ejaz et al., 2008; Feldman et al., 2019). Research also demonstrates that emotional support from agency staff can improve well-being and satisfaction. Aides have noted the importance of paid time off after a client's death for their economic and emotional well-being (Gleason et al.; Tsui et al.).


Researchers have some insights into the issues associated with client death from the perspective of aides. The relative lack of knowledge about home care agencies' policies and practices relevant to client death prompted us to interview home care agency leaders in New York City in 2019. Our study explored how agencies viewed their roles in supporting home care aides as those aides cope with client death (Tsui et al., 2021).


We found that agency leaders typically demonstrated awareness of, and empathy for, the impact that a client's death had on aides. Yet, we also discovered that client death receives little attention in the systems that agencies create to structure home care employment. We asked agency leaders about several actions that aides and researchers recommended they undertake to address the impact of client death on aides. We found relatively little targeted or formal activity in the recommended areas.


Specifically, agency leaders reported that their agencies:


* Lacked policies offering paid time off after client death.


* Relied heavily on coordinators to navigate aides' needs regarding time off, responsive case reassignment, and emotional support, and had taken few formal actions to address these needs.


* Offered limited end-of-life training, and almost no training addressing aides' emotional experiences related to client death.



Agency leaders generally acknowledged a need for greater support of aides following a client death. However, they pointed to a lack of sustainable home care financing and policy resources to help agencies provide this support.


Given our study's findings, we recommend policy and funding changes that would allow agencies to provide supportive services to home care aides who have experienced a client death. Agencies could then give paid time off to aides following client death and create improved emotional support systems, such as coordinator training and counseling paid for by the agency, if needed.


At 2.3 million strong (PHI, 2019), home care aides are a critical part of this nation's long-term services and supports workforce. This home-based workforce will need to expand dramatically in the future to meet a growing demand from individuals who, due to the COVID-19 pandemic, now prefer to receive services and supports in their own homes (Holly, 2020).


Given the critical role that home care aides will play well into the future, it behooves us to take deliberate steps now to strengthen both the well-being and retention of these important members of the long-term services and supports workforce.


Video Coaching Program May Improve Parenting Skills and Children's School Readiness

NIH: A video and coaching intervention program for at-risk mothers and infants increases parent-child interactions and helps to improve children's social, emotional and language development, suggests a study funded by the National Institutes of Health. The program, the Video Interaction Project (VIP), consists of videotaping three-minute mother and child interactions, followed by feedback to the mother from a coach with expertise in early childhood development. Scheduled during well baby checkups, the authors say this program is an efficient, cost-effective approach to reducing disparities in school readiness.


The study enrolled 403 at-risk families in New York City and Pittsburgh. Roughly half were randomized to the control group, which consisted of usual pediatric care, and half to receive Smart Beginnings, an intervention that includes VIP, and a home-visiting program at age six months for families at higher risk. From birth to six months, parents and infants were scheduled for either four pediatric well-care visits alone or in combination with a VIP session. After six months, parents responded to a questionnaire on their interactions with their children. Those in the VIP group were more likely to report interactions such as reading aloud, play and talking to their infants. Similarly, in a videotaped interaction with their children, parents in the VIP group scored higher in behaviors known to promote cognitive, language, social and emotional development.




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Tsui E. K., Franzosa E., Reckrey J. M., LaMonica M., Cimarolli V. R., Boerner K. (2021). Interventions to reduce the impact of client death on home care aides: Employers' perspectives. Journal of Applied Gerontology, 733464821989859. [Context Link]