Workplace Challenges and Well-being Among Home Health Aides Caring for Older Adults in a Metropolitan Health System:...

Home health aides (HHAs) are the frontline providers for vulnerable community-dwelling older adults. Despite their critical role, HHAs are often a understudied workforce. This study aimed to evaluate HHAs' workplace experiences and perceptions regarding caring for older adults, including data on dementia care needs.

Following preliminary focus groups, an anonymous survey was distributed to HHAs from a large home health care agency in the greater New York metropolitan area. The survey collected demographic data, professional experience, training, perceived job-related challenges, barriers to care, and self-reported burnout and stress levels. Logistic and ordinal logistic regression models, along with Spearman's correlations, identified factors associated with burnout and stress.

Most HHAs (N = 224/600, response rate 37.3%; 93.2% female) were experienced (49.8% ≥ 11 years), aged ≥ 41 (86.4%), and primarily Black (53.9%). While most had cared for at least one person with dementia (82.3%), 70.1% had prior dementia training, and 60.0% desired more. Overall, job-related difficulty significantly increased the odds of high burnout (adjusted odds ratio, aOR 2.13; 95% CI, 1.23-3.77; p = 0.008), and greater difficulty with patient care responsibilities was associated with higher stress (aOR 1.87; 95% CI, 1.32-2.69; p < 0.001). Key stressors included reported racism (24.7%) and workplace violence (25.3%), and viewing families as care barriers (25.0%), all correlating with higher burnout and stress. Less enjoyment of in-service teaching was also associated with higher burnout. Despite challenges, 87.0% were proud of their work; many desired a peer mentorship buddy system (67.5%) or online community (44.2%).

HHAs caring for older adults face significant job-related difficulties, exposure to racism and violence, and family caregiver-related challenges, which are associated with substantial rates of burnout and stress. Targeted interventions, including enhanced, relevant training, robust support systems, and addressing systemic inequities, are crucial to support this vital workforce and ensure quality care for older adults.