Safety and Health for Home Care Aides in Healthcare and Social Assistance: The Safe Home Care Intervention Study

Details

• Personal Author:
  Quinn, Margaret M.
• Description:
  Home care (HC) workers provide essential health and personal care services that enable people to live at home rather than receive care in a nursing home or other facility. Major social, economic, and technological trends are driving the need for HC and its largest workforce, HC aides. There is a HC aide shortage and employers face challenges to recruit and retain them, in part due to occupational safety and health (OSH) hazards. HC aides experience numerous physical and psychological safety hazards in clients' homes; many of these also put clients at risk. This proof-of-concept intervention study aimed to evaluate the extent to which HC clients could be coached to make changes in their homes to improve safety for their aides as well as themselves. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. MI is a participatory method based on person-centered counseling skills designed to identify barriers and enhance clients' motivation to make healthy changes. It is used in medical and behavioral sciences to coach individuals to make healthy lifestyle changes; an innovation of this study was the use of MI to coach individuals to make healthy changes to their environments. Control arm NMs performed intake assessments with no changes to usual practices. The intervention's usability and process evaluation elements (fidelity, dose delivered, and dose received) were assessed using mixed methods: 1) surveys completed by NMs during the intervention, 2) audio-recorded and transcribed interviews with NMs and employer representatives, 3) study progress tracking tools. The intervention was implemented with good fidelity. The safety handbook was well received by NMs and clients. The dose delivered efficiency was 85%, measured by distribution of safety handbook copies to clients. Intervention effectiveness was assessed by NMs using questionnaire surveys and by aides using safety checklist surveys. Intervention arm NMs completed a baseline survey at client intake and follow-up survey two weeks into the delivery of HC services by aides. NM surveys assessed clients' receptivity to coaching, barriers to making safety changes, clients' readiness for making changes, and whether specific home safety conditions improved. Aides were blind to the intervention and the intervention of their clients. Aides visited clients when NMs were not present and completed a safety checklist survey approximately weekly for 5 weeks to record hazards in the home. The number of hazards in intervention and control homes were compared. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety. The proof-of-concept intervention methods and materials can be scaled up for wider application. [Description provided by NIOSH]
• Subjects:
  Health Personnel Health Promotion Home Care Services Occupational Exposure Occupational Health Safety
• Keywords:
  Health Care Personnel Health Promotion Home Health Care Intervention Effectiveness Occupational Hazards Personal Services Industry Safety Practices
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Boston Region [OSHA] ; Massachusetts
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-15
• NIOSHTIC Number:
  nn:20070837
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-008229, 2024 Nov; :1-15
• Email:
  Margaret_Quinn@uml.edu
• Federal Fiscal Year:
  2025
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  University of Massachusetts - Lowell
• Peer Reviewed:
  False
• Start Date:
  20040901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20230831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2896b951279c4e708baa43666e9ea044bd3ad3b2b4b2da2b0065f7769e91d11d347793ac30ca980547bdd7c141f13851d17819d8303f8b4818e163c8a41be61c
• Download URL:
  https://stacks.cdc.gov/view/cdc/219288/cdc_219288_DS1.pdf
• File Type:
  [PDF - 552.44 KB ]