Sandra S. Butler

As our population ages and people overwhelmingly prefer to age in place, the need for home care workers is steadily increasing. Unfortunately, due to the low value society places on caring work, filling these positions and retaining workers is a challenge. Drawing on a pilot study involving in-depth interviews with eight female home care aides, this brief report profiles three categories of worker perceptions of their jobs: “satisfied” (n = 3), “need more support” (n = 3), and “on my way out” (n = 2). Study participants liked their work but believed their jobs needed to be improved. Policy implications based on study findings are explored.

A 2018 ballot initiative in Maine proposed universal home care and improved work conditions for home care workers.Although ultimately defeated, the innovative proposal received considerable support and laid the groundwork for an upcoming legislative campaign.It offers a framework for increasing access to home care and creating quality jobs for home care aides. This commentary reviews the problems addressed by the Homecare for All initiative, what was proposed, the campaign process and anticipated next steps, and implications for gerontological social workers.

As the U.S. population ages, the number of people needing personal assistance in the home care setting is increasing dramatically. Personal care aides and home health workers are currently adding more jobs to the economy than any other single occupation. Home health workers face physically and emotionally challenging, and at times unsafe, work conditions, with turnover rates ranging from 44 percent to 65 percent annually. As part of a mixed-method, longitudinal study in Maine examining turnover, interviews with 252 home care aides were analyzed thematically. Responses to interview questions regarding the job’s impact on health and safety, the adequacy of training, and the level of agency responsiveness were examined. Emergent themes, indicating some contradictory perspectives on workplace safety, quality of training, and agency support, were compared across three variables: job termination, occupational injury, and age. Implications for increasing occupational safety and job retention are discussed.

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.

Older lesbians face the triple jeopardy of ageism, sexism, and heterosexism, and their experiences are largely invisible. This qualitative, exploratory study examines the formal and informal caregiving experiences of 20 lesbians, 65 and older, who had utilized home care services due to acute illness or chronic disabilities. Half of those not partnered reported some level of isolation from support networks. Nearly all study participants eventually found home care workers with whom they were satisfied and even quite connected. Practice implications are discussed in context of study participants’ views of how being lesbian affects their aging process and day-to-day lives.

Keywords: Home Care Aides; Home Health Aides

This article presents a case study of policy practice in action. It reviews the place of policy practice and advocacy in the social work profession and education and reports on a state-level example of collaboration between advocacy groups and academics to promote socially just welfare policies. After years of relatively progressive welfare policies in Maine, a conservative governor and legislature passed the State’s first 60-month time limit law in 2011. The author conducted research documenting the impact of the law and used the findings in legislative advocacy, thereby modeling for her students the importance of the policy practice role.

An inadequate supply of direct care workers and a high turnover rate in the workforce has resulted in a “care gap” in our long-term care system. As people are increasingly choosing community-based care, retention of home care workers is particularly important. The mixed-method study described herein explored determinants of longer job tenure for home care aides (n = 261). Study participants were followed for 18 months, completing two mail surveys and one telephone interview each. Predictors of longer job tenure included older age, living rurally, lower physical function, higher wages, a greater sense of autonomy on the job, and less frequent feelings of personal accomplishment. Thematic analysis of telephone interviews revealed long-term stayers to be less concerned about low wages and inconsistent hours than those who left their jobs within a year; both groups of workers reported high levels of job satisfaction. Policy implications of study findings are discussed.