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Background: Healthcare aides (HCAs) are the primary caregivers for the vulnerable older population. They have many titles and are largely unregulated, contributing to relative invisibility.
Objective: To provide a broad understanding of the ‘state of the science’ relating to the international HCA workforce.
Methods: We conducted a search of seven o...
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Context 1
... aides (HCAs) go by many titles and are largely unregulated, which contributes to the relative invisibility of this workforce in the eyes of researchers, patients and the general public. Broadly defined, HCAs are those who provide supportive services and personal assistance to dis- abled, elderly and/or ill (acute or chronic) individuals re- quiring either short-term aide or long-term support [1]. See Fig. 1 for a list of alternate HCA titles. HCAs are the primary care providers for frail and vulnerable older per- sons, who reside either in long-term care (LTC) or in their homes with home-based supports. In 2013, 14.1 % [2] of Americans and 14.9 % [3] of Canadians were over the age of 65; this segment of the population is predicted to in- crease by more than 200 % between 2012 and 2060 [4]. By 2050, ten percent of the populations of Organisation for Economic and Co-Operative Development (OECD) coun- tries will be over the age of 79 [5]. In the European Union, near 25 % of the population are predicted to be 65 years or older by 2030; an increase of 8 % in only 25 years. A similar picture is evident across the globe [4]. Between 2010 and 2050, needs for care among older adults are pre- dicted to nearly triple, with the most dramatic increases seen in low and middle-income countries [5]. These demographic trends will increasingly challenge the health- care system as older people require different, and often more, health services than do younger people [6]. Chronic conditions, in particular, are strongly associated with age. Cognitive impairment and dementia, whose prevalence double with every five-year incremental age increase, are the leading global chronic disease contributors to older persons' disability and dependence [5]. number of global trends have contributed to redu- cing the likelihood that older adults will receive care from family members, including declining birth rates [4,5], enhanced workforce mobility and urbanization [5], increased prevalence of single-parent households [4], a more highly educated female population [5], high di- vorce rates [4], and the tendency of adult children to live away from their families [4,5]. As a result, demand for institutional and paid provision of care is high and will continue to grow [4]. For example, the need for LTC in Canada is expected to increase 10-fold by the year 2038 [7]. According to a U.S.-based report, those who reach age 65 have a 40 % chance of eventually entering a nursing home (NH); near 10 % of those who do will stay for five years or more. Notwithstanding, in OECD countries, the proportion of elderly receiving care within their homes is estimated to be as high as 65 % [4]. Societally, we are rely- ing on a rapidly growing HCA workforce to provide qual- ity care to our loved ones [5]. Thus, it is increasingly important that health care systems collect and use HCA data in workforce ...
Citations
Background
Nursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred.
Methods
This study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data.
Results
Most teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams.
Conclusions
Our coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended.
Home health aides (HHAs) increasingly being used by adults with heart failure for long-term assistance and post-hospitalization care. Despite being heavily involved in numerous aspects of heart failure management, most HHAs have not received heart failure training. They also struggle to get in touch with supervising nurses or other members of the care team when they have clinical questions, which may result in unnecessary visits to the emergency room. In addition, despite serving as a backbone in the health system for patients, HHAs, who are mostly women and minorities, are a marginalized and vulnerable group of frontline caregivers, enduring erratic employment, low wages, discrimination, and high levels of burnout. Although digital technologies could help to address many of the challenges HHAs face, little is known about the current impact of technology on HHAs work practices. To this end, we conducted a multi-stakeholder qualitative study with 38 participants in New York City using semi-structured interviews and focus groups. We uncover the ways in which technology is used, the complex socio-technical factors that underpin heart failure care, and stakeholder suggestions for how technology could improve HHAs work. Building on these insights, we synthesize design opportunities for researchers and designers interested in developing tools that support the delivery of home health care for patients suffering from life-threatening diseases like heart failure.
Objectives
To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.
Design
Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models.
Setting
Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.
Participants
Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals.
Main outcome measures
Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction.
Results
Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying.
Conclusions
A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.
