According to the Bureau of Labor Statistics, there were approximately 1.7 million home health aides and personal and home care aides in the United States as of 2008. These home care aides are rapidly ...becoming the backbone of America's system of long-term care, and their numbers continue to grow. Often referred to as frontline care providers or direct care workers, home care aides-disproportionately women of color-bathe, feed, and offer companionship to the elderly and disabled in the context of the home. InThe Caring Self, Clare L. Stacey draws on observations of and interviews with aides working in Ohio and California to explore the physical and emotional labor associated with the care of others.
Aides experience material hardships-most work for minimum wage, and the services they provide are denigrated as unskilled labor-and find themselves negotiating social norms and affective rules associated with both family and work. This has negative implications for workers who struggle to establish clear limits on their emotional labor in the intimate space of the home. Aides often find themselves giving more, staying longer, even paying out of pocket for patient medications or incidentals; in other words, they feel emotional obligations expected more often of family members than of employees. However, there are also positive outcomes: some aides form meaningful ties to elderly and disabled patients. This sense of connection allows them to establish a sense of dignity and social worth in a socially devalued job. The case of home care allows us to see the ways in which emotional labor can simultaneously have deleterious and empowering consequences for workers.
In this revealing look at home care, Cynthia J. Cranford illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful ...relationships even when their different ages, abilities, races, nationalities, and socioeconomic backgrounds generate tension. As Cranford shows, workers can experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security. Cranford analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and she argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics. What comes through from Cranford's analysis is the need for deeply democratic alliances across multiple axes of inequality. To support both flexible care and secure work, she argues for an intimate community unionism that advocates for universal state funding, designs culturally sensitive labor market intermediaries run by workers and recipients to help people find jobs or workers, and addresses everyday tensions in home workplaces.
The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers
Paid home care is one of the fastest growing ...occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities.
Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them.
The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality.
Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.
The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers
Paid home care is one of the fastest growing occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities.
Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them.
The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality.
Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.
In this revealing look at home care, Cynthia J. Cranford illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful ...relationships even when their different ages, abilities, races, nationalities, and socioeconomic backgrounds generate tension. As Cranford shows, workers can experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security. Cranford analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and she argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics. What comes through from Cranford's analysis is the need for deeply democratic alliances across multiple axes of inequality. To support both flexible care and secure work, she argues for an intimate community unionism that advocates for universal state funding, designs culturally sensitive labor market intermediaries run by workers and recipients to help people find jobs or workers, and addresses everyday tensions in home workplaces.
Objective
To examine the growth and evolution of the home health agency (HHA) market and to compare quality performance across HHA ownership categories.
Data Source
Agency characteristics were ...extracted from Medicare cost reports and Provider of Services file. Quality of care and patient characteristics were extracted from Quality of Patient Care Star Ratings and HHA Public Use File.
Study Design
Agency‐ and state‐level analyses were conducted to describe HHA market trends. Patient characteristics and quality measures were compared across ownership categories of interest.
Data Collection/Extraction Methods
All Medicare‐certified HHAs in operation, 2005‐2018.
Principal Findings
Over the study period, the HHA sector grew substantially, increasing from 7899 to 10 818 agencies, and chain‐owned HHAs doubled in number from 903 (11.4% of all agencies) to 1841 (17.0%). In 2018, across agency types, for‐profit nonchain agencies were the largest category both in the number of agencies (67.8%) and the number of Medicare enrollees served (40.7%). Additionally, for‐profit nonchain agencies grew most in total number, from 4293 (54.3%) to 7337 (67.8%), while for‐profit chain agencies grew most in the number of Medicare enrollees served, from 439 998 (12.9%) to 1 082 385 (28.3%). Regarding patient composition, for‐profit nonchain agencies served the highest proportion of dual eligible beneficiaries (42.2%) and African‐Americans (27.9%) among all agency types. Regarding quality performance, a higher star rating is significantly (P < .01) associated with chain agency status. Moreover, chain HHAs performed better on self‐reported process measures, and risk‐adjusted self‐reported outcome measures; however, they performed worse on risk‐adjusted claims‐based outcome measures. These results were similar across for‐profit and nonprofit chain agencies.
Conclusion
Chains play a growing role in the home health sector. Substantial differences in geographic distribution, patient composition, and quality performance were observed between chain‐ and nonchain HHAs. Examining the growth and performance of multi‐agency chains can help inform quality reporting and monitoring, assess payment adequacy, and facilitate greater transparency and accountability within the HHA marketplace.
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Almost home Baranek, Patricia M; Deber, Raisa B; Williams, A. Paul
Almost home,
c2004, 20040930, 2004, 2014, 2004-01-01, 20040101
eBook
Almost Homeis a rich and comprehensive study of the policy questions underlying the shift in medical care from hospitals to homes and communities, a change that is reshaping Canadian health care ...policy and politics. Using document analysis, and interviews with government officials and other key stakeholders in the policy community, the authors analyze the policy content and process of five different attempts to reform home and community care in Ontario between 1985 and 1996, as introduced by governments from three different political parties.
As this study demonstrates, the ongoing shift from the Medicare 'mainstream' of physician and hospital care to the Medicare 'margins,' entails not only a shift in the site of care but an erosion of the post-war state's role in health care. While Medicare continues to resist political and ideological forces aimed at shrinking the state's role, cost constraints, demographic pressures and technological advancements are increasing pressure on home and community care.
The authors have made a significant contribution to research on policy development and change. Their rigorously analytical approach fills a major gap in book-length literature on long-term health care in Canada.
Objective
Patients with heart failure (HF) have high rates of rehospitalization. Home health care (HHC) patients with HF are not well studied in this regard. The objectives of this study were to ...determine patient, HHC agency, and geographic (i.e., area variation) factors related to 30‐day rehospitalization in a national population of HHC patients with HF, and to describe the extent to which rehospitalizations were potentially avoidable.
Data Sources
Chronic Condition Warehouse data from the Centers for Medicare & Medicaid Services.
Study Design
Retrospective cohort design.
Data Extraction
The 2005 national population of HHC patients was matched with hospital and HHC claims, the Provider of Service file, and the Area Resource File.
Principal Findings
The 30‐day rehospitalization rate was 26 percent with 42 percent of patients having cardiac‐related diagnoses for the rehospitalization. Factors with the strongest association with rehospitalization were consistent between the multilevel model and Cox proportional hazard models: number of prior hospital stays, higher HHC visit intensity category, and dyspnea severity at HHC admission. Substantial numbers of rehospitalizations were judged to be potentially avoidable.
Conclusions
The persistently high rates of rehospitalization have been difficult to address. There are health care‐specific actions and policy implications that are worth examining to improve rehospitalization rates.
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Abstract Objectives To determine the relative influence of different factors on place of death in patients with cancer. Data sources Four electronic databases—Medline (1966-2004), PsycINFO ...(1972-2004), CINAHL (1982-2004), and ASSIA (1987-2004); previous contacts with key experts; hand search of six relevant journals. Review methods We generated a conceptual model, against which studies were analysed. Included studies had original data on risk factors for place of death among patients, > 80% of whom had cancer. Strength of evidence was assigned according to the quantity and quality of studies and consistency of findings. Odds ratios for home death were plotted for factors with high strength evidence. Results 58 studies were included, with over 1.5 million patients from 13 countries. There was high strength evidence for the effect of 17 factors on place of death, of which six were strongly associated with home death: patients' low functional status (odds ratios range 2.29-11.1), their preferences (2.19-8.38), home care (1.37-5.1) and its intensity (1.06-8.65), living with relatives (1.78-7.85), and extended family support (2.28-5.47). The risk factors covered all groups of the model: related to illness, the individual, and the environment (healthcare input and social support), the latter found to be the most important. Conclusions The ne of factors that influence where patients with cancer die is complicated. Future policies and clinical practice should focus on ways of empowering families and public education, as well as intensifying home care, risk assessment, and training practitioners in end of life care.
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: media-1vid110.1542/5984244876001PEDS-VA_2017-4211
BACKGROUND AND OBJECTIVES: Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are suggested to be overrepresented in unstable ...housing and foster care. In the current study, we assess whether LGBTQ youth are overrepresented in unstable housing and foster care and examine disparities in school functioning, substance use, and mental health for LGBTQ youth versus heterosexual youth in unstable housing and foster care.
A total of 895 218 students (10-18 years old) completed the cross-sectional California Healthy Kids Survey from 2013 to 2015. Surveys were administered in 2641 middle and high schools throughout California. Primary outcome measures included school functioning (eg, school climate, absenteeism), substance use, and mental health.
More youth living in foster care (30.4%) and unstable housing (25.3%) self-identified as LGBTQ than youth in a nationally representative sample (11.2%). Compared with heterosexual youth and youth in stable housing, LGBTQ youth in unstable housing reported poorer school functioning (
s = -0.10 to 0.40), higher substance use (
s = 0.26-0.28), and poorer mental health (odds ratios = 0.73-0.80). LGBTQ youth in foster care reported more fights in school (
= 0.16), victimization (
= 0.10), and mental health problems (odds ratios = 0.82-0.73) compared with LGBTQ youth in stable housing and heterosexual youth in foster care.
Disparities for LGBTQ youth are exacerbated when they live in foster care or unstable housing. This points to a need for protections for LGBTQ youth in care and care that is affirming of their sexual orientation and gender identity.
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