Mental and behavioral health conditions among older adults: implications for the home care workforce

Abstract

Objectives: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities.

Methods: Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts.

Results: Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work.

Conclusion: This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides.

Keywords:

• home health aides
• long-term care
• mental health
• behavioral health
• direct care workforce

Acknowledgements

The authors thank Lisa Gurgone, Executive Director of the Home Care Aide Council, for her support in our data collection efforts. We also want to thank Elizabeth H. Bradley, Professor in the Department of Health Policy & Management in the Yale School of Public Health, for her thoughtful review of a previous draft of this manuscript. Finally, we want to give our sincere thanks to the home care agencies and home health aides that participated in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Health Care Workforce Transformation Fund grant through the Commonwealth of Massachusetts, Executive Office of Labor and Workforce Development. The grant program was administered by Commonwealth Corporation [grant number 4129].