1. Osakwe, Zainab Toteh PhD, MSN, RN, NP

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The COVID-19 pandemic brought unprecedented challenges to the home health aide (HHA) workforce and highlighted their vital role in the U.S. long-term-care system (Sterling et al., 2020). HHAs provide assistance to homebound older adult with activities of daily living and health-related tasks, enabling them to remain in their own homes. They provide person-centered direct care and can directly influence the patient's quality of life. Yet, concerns persist about HHA receipt of low workplace support and a need for enhanced training and supervision to meet the increasingly complex patient care needs in home healthcare (Osakwe, Osborne, et al., 2021).


Despite the critical nursing workforce challenges in home healthcare, there is an urgent need to focus on support and enhanced supervision of HHAs for two reasons: (a) to improve quality of HHA care delivery, and (b) to improve HHA retention/job satisfaction. Although HHA certification is required and regular in-service is provided by home care agencies, up-to-date educational approaches informed by HHAs are necessary to understand the learning needs of this diverse workforce.


Assessment of each HHA's learning need is key to provide the support HHAs need to provide high-quality patient care. Qualitative studies show that HHAs value one-to-one discussions with the home care nurse, even via telephone, and such interaction are a source of emotional support (Osakwe, Osborne, et al., 2021). High-impact HHA supervision can focus on integrating HHAs within the care team-assessing on-going learning needs, giving HHAs a voice in the development of person-centered care plans, and the provision of emotional support.


The care plan, an understudied mechanism in home healthcare, is one approach that can facilitate high-impact interaction and supervision of the HHA. As a teaching tool, the care plan is critical to reviewing scope of HHA tasks and gain feedback about HHA competency for the assigned task. HHA supervisory visits conducted by home care nurses provide an opportunity to assess HHA level of competence and confidence with assigned task. During supervision, home care nurses can initiate focused discussions centered on HHA's perception of the tasks outlined on the care plan (Osakwe, Madu, et al., 2021). Asking directly about patient-care related challenges HHAs encounter (e.g., management of agitation in patients with cognitive impairment) can help gather information necessary to develop future in-services to meet the learning needs of HHA.


Interdisciplinary (nursing, social work, therapy, and HHA) care plan meetings that engage this workforce are relevant and overdue in home care, which is decentralized and requires a high level of autonomy in the field. Such meetings may increase HHAs' knowledge about their patients' conditions, as well as increase their engagement and contributions to person-centered care plans. Of note, nursing homes now include certified nursing assistants as members of the interdisciplinary team that develops and revise care plans (Centers for Medicare & Medicaid Services, 2016). Similar approach to enhance coordinated team-based care and give the HHAs a voice in the home healthcare team represents a promising approach.




Centers for Medicare & Medicaid Services. (2016). Medicare and Medicaid programs; reform of requirements for long-term care facilities. Final rule. Federal Register, 81(192), 68688-68872. [Context Link]


Osakwe Z. T., Madu E. N., Cespedes A., Atairu M., Osborne J. C., Stefancic A. (2021). Home health aide perceived information needs for dementia-specific care plans. Geriatric Nursing, 43, 1-6. [Context Link]


Osakwe Z. T., Osborne J. C., Samuel T., Bianco G., Cespedes A., Odlum M., Stefancic A. (2021). All alone: A qualitative study of home health aides' experiences during the COVID-19 pandemic in New York. American Journal of Infection Control, 49(11), 1362-1368. [Context Link]


Sterling M. R., Tseng E., Poon A., Cho J., Avgar A. C., Kern L. M., Ankuda C. K., Dell N. (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), 1453-1459. [Context Link]